Bunions: What Causes Them and What You Can Actually Do

A bunion (hallux valgus) is a bony bump on the inside of the foot at the base of the big toe, with the toe itself drifting toward the second toe. They're more common in women but men get them too — and the single biggest risk factor isn't shoes, it's family history.

What actually causes bunions

• Genetics — if your mother or grandmother had bunions, your risk is high
• Foot mechanics — flat feet and excessive rolling-in load the big toe joint sideways
• Hypermobility — looser ligaments allow the joint to drift more easily
• Footwear — tight, pointed or high-heeled shoes accelerate an existing tendency (but rarely cause bunions alone)
• Inflammatory arthritis — rheumatoid arthritis can produce bunion-like deformities

When bunions hurt — and when they don't

A bunion can be large and look dramatic but be painless. Pain typically comes from three sources: friction against shoes (the bump rubbing), joint pain inside the toe (early big-toe arthritis), and pain elsewhere as the foot compensates (under the ball of the foot, the second toe, or the arch).

Conservative treatment that genuinely helps

Footwear changes

The single highest-impact change. Wide-toe-box shoes (you should be able to wiggle all toes freely), low heel, soft uppers, and adequate length. We can recommend specific brands that work well for bunion-prone feet.

Custom orthoses

If your foot is rolling in and overloading the big toe joint, an orthotic that corrects this slows progression and reduces pain. It will not 'push the bunion back' — nothing non-surgical does — but it changes the forces driving it.

Toe spacers and exercises

Silicone toe spacers worn at home reduce friction between the big toe and second toe. Big-toe strengthening exercises (toe-yoga, short-foot exercise) help maintain joint control.

When to consider surgery

Surgery is appropriate when pain is significant, daily activities are limited, and conservative care has been properly tried for 6–12 months. Modern minimally invasive bunion surgery has good outcomes and faster recovery than older procedures. A podiatrist can give you an honest read on whether you're at that stage and refer if needed.