What causes bunions?

Dear Alice,

What is the cause of bunions? A stubbed toe? Nutritional? Can the growth be stopped before a shoe doesn't fit? Why the occasional burning sensation when there is no pressure on the "bone?"

Dear Reader,

To understand the why this little piggy (toe) went inward and not to the market, it’s helpful to know what a bunion is in the first place. Originating from the Greek word for turnip, a bunion, or hallux vagus, is the term for a bony bump that can form around the joint of the foot’s big toe. They can also occur on the little toe’s joint on the other side of the foot, they’re referred to as bunionettes — cute, huh? Symptoms include bulging toe joints, swelling and inflammation of the affected area, the development of corns or calluses, pain that may persist or come and go over time (as you’ve described in your question), and limited range of motion of the affected toe joint. As for the cause — experts aren’t exactly sure why bunions develop; injuries are a possibility, but nutritional factors aren’t among the current causal theories. Ready to tread deeper into this topic? Keep on reading!

Who gets bunions and why? It’s a common condition that affects quite a few folks. It’s estimated that nearly a quarter of adults between the ages of 18 to 65 have bunions and the prevalence increases to 36 percent for those older than 65 years of age. It appears to be more common among women and those who wear shoes as compared to those who stroll around sans footwear. As mentioned, the exact cause hasn’t been established yet, but injuries to the feet, congenital (present at birth) deformities, and having inherited a foot type that is more prone to bunions have all been posited as possibilities. Regardless of the cause, there are some noted factors that put folks at an increased risk for developing these bumps, including:

  • Shoe choice: It appears that wearing high-heeled shoes and those that are a bit too tight or narrow can increase the likelihood of developing bunions.
  • A diagnosis of rheumatoid arthritis: Living with this inflammatory condition also comes with an elevated risk for bunions.
  • Being predisposed for the condition: Some folks are just more likely to develop these bony bumps than others, due to the structure of their feet.

List adapted from Mayo Clinic.

Potential causes aside, the mechanics of how a bunion is formed are better understood. The issue occurs at the metatarsophalangeal joint (MTP), which is the joint where the toe bones meet the foot bones. The bony bump forms when the bones that make up the joint become misaligned. The lower foot bone starts to move towards the inside of the foot away from the other foot bones. At the same time, the toe bone starts to angle toward the other toes. The result is a swollen and inflamed MTP joint that protrudes from the side of the foot. Bunions often develop over time, starting out small, growing bigger, and may change the way the foot looks as the affected joints change the angle of the associated toe. Folks with this condition may also develop calluses and corns around the areas as a result of the toes being pushed together.  

Medical professionals can typically diagnose the issue by simply taking note of symptoms and through a physical exam. An x-ray may be taken of the affected joint to determine whether there is any damage to the toe. And while beating bunions may not be in the cards, there are ways to treat them, with the majority of methods being non-surgical. Swapping out pinchy footwear may be in order for shoes that allow more wiggle room for the toes. Using pads to cushion the bunions may be an option, which can typically be purchased at the pharmacy. Similarly, some relief may be found by using either over-the-counter or custom shoe inserts or orthotics. Icing the affected area or using nonsteroidal anti-inflammatory medications (NSAIDs, such as ibuprofen or naproxen) may also provide some relief. For those whose toes don’t respond to do-it-yourself strategies or who have significant pain associated with the condition, surgical options may be offered to correct the alignment of the bones that caused the bunion in the first place. These are often same-day outpatient (no hospital stay) procedures, but it’s noted that recovery can take some time.

With that said, it’s also key to mention what can be done for prevention strategies to stave off this bony bulge if possible. Just as well-fitting shoes are a part of the treatment options, being mindful with shoe fit is also part of prevention. The American Academy of Orthopaedic Surgeons has some additional tips on how to find a shoe that fits, which could serve as a great companion to take on a future shoe shopping trip.

Hope this quelled the burning desire for more information on bunions!

Last updated Aug 31, 2018
Originally published Jan 31, 1997

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