How do bunions form?
Bunions form when the joint at the base of your big toe (called the first metatarsophalangeal joint, or MTP joint) drifts outwards, and the big toe itself begins to point inwards towards the other toes. 1
This leaves a visible bump on the edge of your big toe joint, which can make fitting into your shoes a challenge. The area may also be painful.
This bump is primarily caused by the MTP bone protruding, but also by the soft tissue surrounding the joint thickening and swelling. Fluid also builds up around the area, increasing its size. 2
Sometimes, a bunion can develop on the other side of the foot at the joint where the little toe meets the foot. This is known as a bunionette.
Severe untreated bunions can cause crowding or overlapping of the other toes, known as hammer toes.
We take a look at some of the main causes of bunions – and share our tips on bunion prevention.
You might have noticed an older family member with the tell-tale prominent toe joint and wondered, ‘are bunions hereditary?’
Unfortunately, the leading cause of bunions is your genes. This is because the shape of your foot is passed down in your DNA. If that particular foot type is prone to bunion formation– for instance flat feet – you’ll be at risk of developing them too if you don’t take care of your feet. 3
Bad news for fans of elegant footwear, wearing the wrong shoes for your feet is probably the leading bunions cause beyond genetics.
Bunions are more common in women, which is thought to be because of the more restrictive nature of some women’s footwear. High heels force the foot forward and down into the toe of the shoe, squeezing the toes together unnaturally into a triangle shape.
Even if you’ve never worn high heels in your life, other shoe types can also lead to bunion formation over time. Pointy shoes, narrow pumps or even rigid men’s dress shoes push the big toe over towards the little toes and create the right environment for a bunion to form.
If you continue to wear such footwear, the bunion will get worse. The bump will rub on tight shoes, causing swelling and thickening of the skin over the MTP joint and increasing the size of the bunion.
In some cases, the fluid-filled sacs (the bursae) which cushion the MTP joint can become inflamed and red. This is known as bursitis and is a complication of untreated bunions.
3. Rheumatoid arthritis or osteoarthritis
Rheumatoid arthritis is a condition where your joints can become inflamed, stiff painful. Osteoarthritis is when the cartilage between joints wears down over time, becoming swollen and stiff.
Both types of arthritis can affect the big toe and make those who experience it more susceptible to developing bunions.
This is because inflammation and swelling can cause the joints to move. Changes to the joint caused by either hard or soft tissue damage can cause the MTP joint to drift outwards, forming a bunion. 5
Do only older people get bunions?
Bunions usually form in adulthood. Wearing tight, high or pointy shoes can hasten the onset of a bunion and they have been seen in adults from their late 20’s onwards. Usually, though, they develop later.
Some women report developing bunions after pregnancy.
More rarely, children develop bunions, usually as a result of hereditary ‘over-pronated’ feet. 6
Is there a bunion cure?
Yes and no. Bunions can be managed through various practical methods, including surgery if less invasive methods have not improved your bunions.
1.Wear good shoes
Wear shoes that fit and aren’t too narrow. Canvas shoes or soft leather shoes are preferable over stiff leather or plastic patent materials.
Make sure there’s enough room in the toe area for your toes to all make good contact with the sole of the shoe.
High heels or pointy-toe shoes are known to increase the likelihood of bunions, so avoid these if you can.
Use toe sleeves or a gel toe spacer to realign the toe and keep it in place. Be sure to get shoes that fit this apparatus as splints are most effective when worn frequently. 7
You can buy soft pads to protect the bunion from the inside of your shoes. They help pad around the bump to prevent the skin from thickening and making the bunion larger. 8
Options include cutting and realigning the MTP joint, removing soft tissue, tightening the tissues and ligaments supporting the bone or bone fusion. 9
What causes bunions to require surgery?
It’s usually recommended to start with less invasive measures to manage your bunions.
However, in cases where bunions are very painful, or having bunions causes problems performing daily activities or where you have trouble fitting into any shoes, surgery can be a good option.
As with all surgeries, bunion surgery isn’t without its risks. Always discuss your concerns with a podiatrist and your GP.
Last Updated: 20th November 2020
Author: Bhupesh Panchal, Regulatory Affairs
Bhupesh started his career as a clinical toxicologist for Public Health England, advising healthcare professionals all around the country on how to manage clinical cases of adverse exposure to supplements, pharmaceuticals, cosmetics, industrial chemicals and agricultural products. After 7 years in this role and a further year working as a drug safety officer in the pharmaceutical industry, Bhupesh joined Holland & Barrett as a Senior Regulatory Affairs Associate in 2019.
In his spare time, Bhupesh likes to cycle and has been learning to speak Korean for several years.