What Causes Bunions? Shoes, Foot Type, or Conditions? (2024)

Bunions (hallux valgus) occur when something puts extra pressure on the big toe, pushing it out of its natural alignment and toward the other toes. A bump forms on the outside of the base of the big toe. Bunions are often painful and can limit toe movement. Bunions form gradually, but a flare of bunion pain may occur suddenly.

The exact causes of bunions are unknown, but possible theories include:

• Foot stress or a foot injury
• Inflammatory condition
• Inherited foot type or a congenital (present at birth) anatomical difference

Bunion Formation: How New Symptoms Start

Bunions develop on the inside edge of the metatarsophalangeal (MTP) joint, the point where the base of the big toe meets the foot. A bunion in your MTP joint will develop slowly. You may not notice it until you have a sudden flare of pain from it. Without treatment, the bunion will get worse over time and cause you pain and discomfort.

When you get a bunion, the bones around your big toe shift while the metatarsal bone pushes up against the skin. Over time, the bump will also become more pronounced and painful.

Signs and symptoms of a bunion include:

• A bulging bump at the outside of the base of the big toe
• Corns and calluses (thickened skin areas) due to friction or pressure
• Difficulty wearing closed-toe shoes because of pain or problems with fitting
  
• Numbness of the big toe
  
• Persistent pain or pain that goes and comes
• Stiffness and limited movement of the big toe
• Swelling, soreness, and redness around the affected big toe joint
  
• Trouble with walking due to pain
  

Causes of Ongoing Bunions and Severe Pain

Bunions are common foot problems. The global prevalence of hallux valgus is around 19%. The condition is more prevalent in people assigned female than male at birth, those aged 60 and older, and people of certain ethnic backgrounds, such as those from Oceania countries, including Australia and New Zealand.

In the United States, bunions affect one-third of the population.

Additional risk factors for bunions are:

• Age: Bunions are more common in older adults, and the possibility of developing a bunion increases with age. Children rarely get bunions, but they can occur in children with inflammatory diseases or foot structure problems.
• Female at birth: The factors that lead to more females than males developing bunions include foot anatomy, genetic influences, and footwear designs that include high heels, narrow toe boxes, and tight-fitting shoes that force their toes into a cramped position.
• Flat feet: Flat feet do not cause a normal arch when standing. Flat feet pronate (turn in so that most of the weight is on the inside of the foot) and their arch collapses. Walking this way can, over time, cause the big toe to be pushed out of alignment, leading to a bunion.
• Foot injury or loose joints or tendons: If you have underlying foot problems and wear cramped or uncomfortable shoes, you could develop a bunion.
• Genetics: Seventy percent of people with bunions have a family history of bunions, with a higher risk if a first-degree relative, such as a sibling or parent, has a bunion. Bunions are also linked to genetic conditions that affect bone development, such as fibrodysplasia ossificans progressiva.
• Inflammatory diseases: Having an inflammatory disease like rheumatoid arthritis (an autoimmune disease mainly affecting the synovial membrane surrounding in joints) increases your risk for bunions.
  
• Pregnancy: The hormones released during pregnancy can loosen ligaments in the feet and cause feet to become flatter and with increase pronation. This can raise the risk of developing bunions during pregnancy or afterward.
  

Causes Compared: What Is Worse for Bunions?

Many people experience bunions from wearing tight-fitting shoes or shoes that are narrow, pointy, or compress the toes together. These shoe types place more pressure on your toes.

Tight-fitting shoes can lead to inflammation of the big toe if you already have a bunion. You may also experience pain while walking.

Wearing supportive and wider shoes can also help reduce bunions and bunion pain from other causes. For example, many people develop bunions because of the foot structure they were born with or because they have an inflammatory condition like rheumatoid arthritis. Comfortable and supportive shoes can help prevent bunions or bunion pain linked to these risk factors.

How to Minimize Bunion Flares

Bunions do not always cause pain. Plenty of people have small bunions that do not produce symptoms. But as the bunion gets more pronounced or if it becomes irritated or inflamed, you experience pain, swelling, or a burning sensation.

You may experience a sudden bunion flare from:

• Foot compression if you are wearing pointy or tight shoes
• Walking for long periods, especially if there are inclines
• Running or doing intense foot exercises

You can relieve bunion pain and swelling by:

• Taking OTC nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin (ibuprofen) to reduce swelling in the big toe
• Using ice on the affected toe when you are not wearing shoes to reduce pain and swelling
• Walking barefoot
• Wearing a splint overnight that straightens out the toe or taping the toe to avoid pressure
• Wearing custom-made orthotics and foot insoles to improve your shoe fit
  
• Wearing open-toed shoes or shoes that best fit your foot's shape
• Wearing over-the-counter (OTC) gel-filled foot pads that cover the bunion to relieve pressure of the bunion
  

You can prevent a bunion from flaring or getting worse by:

• Doing foot exercises to increase the toe's mobility
• Maintaining a healthy weight
• Protecting an existing bunion with gel-filled pads
  
• Stretching the calf muscles to reduce stress on the forefoot (front pat of the foot)
• Treating arthritis and other foot problems
• Using shoe inserts to manage flat feet and other foot structure problems
• Wearing well-fitting shoes that are wide in the toe box
  

If you find that at-home treatments are not helping to manage bunion pain, consider scheduling an appointment with a podiatrist. A podiatrist is a doctor of podiatric medicine (DPM) who diagnoses and treats problems of the foot, ankle, and lower legs. A podiatrist may recommend additional therapies to help you manage bunion pain and symptoms.

Dry Needling

Podiatrists sometimes recommend dry needling to treat bunions. When used for this purpose, dry needling has been found to eliminate bunions, restore the toe joint's mobility, and reduce pain intensity.

Dry needling involves using a microfine needle to release trigger points. It may also stimulate the body to release pain-killing endorphins and cortisol to reduce inflammation and speed healing.

Surgery

If your bunions are extremely painful, the bunion causes problems with walking, or nonsurgical treatment has not helped, a podiatrist may recommend surgery. Surgery may restore the big toe's natural angle, correct the bunion deformity, and reduce pain and discomfort.

Different surgical procedures may help correct bunions. The type of surgery used will depend on the size of the bunion. Surgery recommendations will be based on the X-rays and physical exam findings.

Most bunion surgeries are same-day procedures that do not require a hospital stay. There will be a short period where you will need to stay off the affected foot.

Summary

Bunions are bony bumps that form near the base of the big toe. They can become red and swollen and cause much pain. In severe cases, they can cause significant swelling, making it hard to find comfortable-fitting shoes and pain with walking.

Bunions develop slowly, so you may not realize you have one until you experience pain or discomfort. Causes include family history, foot structure problems, pregnancy, inflammatory arthritis, ill-fitting shoes, and injury to the foot or toe.

Wearing comfortable, wide-toe shoes can reduce your risk for bunions. This is especially important if you have a family history of bunions or if you have inflammatory arthritis or foot structure problems, like flat feet.

You can manage a bunion flare with ice, NSAIDs, wearing comfortable shoes, custom orthotics, or toe splints (taping the affected toe at night), and using OTC gel pads. A podiatrist can recommend additional treatment options like dry needling and, if needed, surgery.