The term “bunion” is one of those funny ones – we think of it as a “grandma” problem but bunions actually happen to active people and from a very early age.
It’s also the subject of many myths and much BS – wearing pointy shoes, “you’ll get bunions”…mother had bunions, “you’ll get bunions”.
It seems like they’re this mystery curse of destiny or a punishment for the fashion choices of youth.
But the truth is vastly different, and much more positive for your outlook.
So let’s cover “what is a bunion?”, “do you get them from your mother?” and “will pointy shoes cause a big toe bump?” before we dive into fixing bunions without surgery.
What is a bunion?
A bunion, referred to medically as Hallux Valgus, is a deformity of the big toe joint.
It causes the big toe to angle towards the smaller toes while the forefoot widens and the big toe joint forms a bony bump on the side of it.
To understand the deformity, and how to prevent it, you’ll need a quick tour of the foot.
Anatomy of the big toe joint, the “1st MTP”
The 1st metatarsalphalangeal joint (not surprisingly we just abbreviate it to 1st MTP) is the joint where the big toe joins the foot.
It’s a hinge-like joint designed to allow the toe to bend up and down. It’s got some capacity to tilt sideways and rotate slightly but these aren’t its main function.
The joint is under huge loads as it acts as a pivot point for propulsion during running and walking.
The body’s response to load
Our living tissues are constantly adapting to load. It’s mostly a positive process that helps us grow and thrive.
The flipside is that any consistent load can create change, whether we want that change or not.
Repetitive abnormal loading can cause bone to thicken and form bumps. It can cause joints to change shape and alignment.
Why do bunions happen?
Pronation is a complex movement but essentially it’s a flattening of the arch and an inwards tilt of the ankle.
Pronation is a normal and required movement that helps us store energy so we can walk and run efficiently.
The right amount of pronation reduces the energy required to walk/run and aligns the leg, ankle & 1st MTP for optimal drive off the ground.
If there is an excessive amount of pronation, the big toe is forced to move inwards as it bends. As this action is repeated several thousand times per hour of walking or running, the change in the angle of loading causes the body to adapt.
This adaptation includes thickening of the bone around the joint and bending of the toe towards the other toes.
The real cause of bunions
The main causes of poor pronation control are a combination of bad genetics, poor muscle control and dodgy footwear (old or poorly designed).
Why are bunions painful?
As the joint is forced inwards, it gets twisted and the bone is placed under a huge amount of pressure.
That causes an inflammatory response in the joint and surrounding bone, which also generates pain.
The reason bunions are so painful is that this process happens on every step, so the inflammatory reaction is constantly irritated and sensitive.
The inflammatory response also causes joint stiffness, which makes the joint even less resilient to excessive movement and more easily irritated.
It’s a cycle that heads downwards and at an increasing rate over time if it’s left untreated.
Can bunions go away?
The process of bunions happens due to abnormal loads placed on the joint, creating bony thickening and changing the joint alignment.
Unfortunately you can’t turn the clock back and take away those forces.
So once the bump has started to form, you can’t back up the truck and get the joint back to new again.
However you can prevent is getting worse and more pronounced, and you can definitely stop it causing pain.
What happens if a bunion is left untreated?
This is the unfortunate thing about bunions – as the joint deforms, it makes foot stability even harder and that leads to even more pressure on the joint!
It’s a self-reinforcing cycle that speeds up over time if it’s left untreated.
Pressure on the joint causes pain and a change of alignment -> the pain makes it harder to use the toe for stability, and the alignment means it’s not well placed to help anyway -> the less it stabilises, the more pressure it’s under -> more pressure means more pain and inflammation, and so it continues…
Who is prone to bunions?
There will always be those prone to bunions – those with excessive forces on the joint like endurance runners (due to fatigued leg stability) and overweight people (due to the excessive loading on the joint).
But in all cases, the bunion development can be slowed or stopped with appropriate measures.
Do bunions get worse with age?
Age alone isn’t a direct factor in bunions, but it does give you more time to expose the joint to more abnormal pressures.
As we age, we tend to lose muscle strength. Without that support from muscles, the foot and ankle aren’t well controlled and the big toe is under more pressure.
So a birthday doesn’t cause bunions to worsen, but it certainly gives you more time to overload it.
But aren’t bunions genetic?
It’s one of the most common reasons you’re told you have bunions – Mum had them so you got them.
But there’s no direct genetic link to the deformity!
Bunions aren’t in your DNA. But your parents aren’t off the hook yet.
The shape of your feet & legs and your muscle structure are inherited from your parents. And some legs are prone to poor biomechanics.
Poor biomechanics create abnormal loading and adaptations at the 1st MTP, which leads to bunions.
So it’s not purely genetic, but genetics may not make it easy for you to avoid them.
Does wearing pointy shoes cause bunions?
Pointy shoes are commonly blamed for bunions. And it looks plausible. The shoes force the toe inwards, much like the shape of a bunion.
But the amount of force they apply to the toe is very small compared to the forces experienced during normal walking. So the shoe alone can’t generate enough load to cause bunions.
When you’re wearing pointy shoes though, the toe is held on an abnormal angle while walking. They’re also not the most supportive shoes so they can allow the foot to roll inwards (aka. pronation).
This causes an increase in the force pushing the toe across. And if you spend enough time wearing and walking in pointy shoes, that volume of force can cause adaptation and bunions.
Can you prevent bunions?
Short answer, yes, but you have to start early when there’s pain but no change in alignment yet.
If you can improve your foot biomechanics to ensure that the joint is aligned well during activity, there’s no reason why a bunion should form.
Can you fix a bunion without surgery?
Most bunions are treated without surgery, and the earlier you start, the more effective the fix will be.
How shoes can help bunions
Good footwear is a given. Any shoe that allows your foot to function in a well-aligned position is helpful.
For some, a low profile shoe with improved ground feel allows them to control that position better.
For others, they need a more structured supportive shoe to assist in limiting the rate of pronation.
Occasionally footwear isn’t able to provide the necessary support and custom or prefabricated orthotics are needed for a short time.
If the cause is bony alignment due to unlucky genes, orthotics may become an ongoing requirement.
If the issue is poor muscle control or excessive weight, shoes won’t last long and seem to be destroyed within a few months.
The role of strength training
Strength exercises, specifically targeting the muscles and movement patterns that control hip and foot rotation, are helpful.
The trick is to challenge pronation control and hip rotation without adding further overload to the toe.
So the program needs to be designed carefully with just the right amount of loading.
Starting very gentle and gradually building up over an extended period of time is the best option.
Going too hard too early causes the occasional flare up, which means backing off the exercises and losing the gains you’ve made to date.
It’s important though that you don’t fall into the cycle of repetitive rest with each flare up, otherwise you’re constantly starting from scratch.
To understand more about why rest is the worst approach, have a read of this post.
Using medication to speed up your recovery
Anti-inflammatory medication can be a useful assistant in the recovery process, but there are a few words of caution as well.
The medication comes in a topical (cream or gel) form that can be applied directly to the joint. There are also oral (tablet) forms that you can take.
The medication acts on the inflammation that results from overload of the joint.
It takes away the pain and allows you to walk and exercise. And that’s good, right?
While the meds stop or reduce the pain, they don’t stop the process of a bunion forming.
Relying on medication alone means that you can often be completely unaware at the worsening alignment (other than needing wide fitting shoes over time).
So the best way to use meds is to take a short course of them to help you get started with an exercise program, then drop them when the program is taking effect and they’re no longer required.
The other benefit to training without meds is that you’ll have some feedback during the session on technique – if the toe hurts during an exercise, you’ve either lost form or you’re pushing it too far.
Other interventions that can help some, but not all
There are other helpful approaches – foot taping, altered exercise options and foot/ankle/hip mobility.
But each of these are case-specific and don’t work for all cases of bunions.
These approaches are best used once you’ve been assessed by a health professional and they’ve recommended the approach based on their findings.