A bunion —hallux valgus— is the progressive drift of the big toe towards the other toes. What sticks out on the inner edge of the foot is not a bone that grows: it is the head of the first metatarsal, exposed as the toe drifts. There is a clear hereditary component, and narrow or high-heeled footwear does not cause it on its own but speeds up its progression, and it is usually what makes it start to hurt.
It hurts for three different reasons, and it is worth knowing which one dominates: the bump rubbing against the shoe, overload of the second and third metatarsals when the big toe stops doing its job, and the joint itself as it wears. Podiatry does not correct the deviation —only surgery does that—, but it can slow the progression, remove the pain and prevent the problems that appear around it: hard skin, overlapping toes and overload in the sole.
What can be done
- Assessing the degree of deviation and which of the three causes of pain dominates.
- Reviewing footwear: toe-box width, materials and heel height.
- Treating the associated problems: hard skin, corns and rubbing between the toes.
- Spacers or silicone orthoses to reduce the conflict with the shoe.
- Insoles to redistribute the load the big toe has stopped taking.
Does the bunion bother you when you put shoes on, or is hard skin forming around it?
Book an appointmentFrequently asked questions
- Will it keep getting bigger?
- It usually progresses, but not at a predictable rate: some bunions change very little in ten years and others advance in two. What is known is what accelerates it, and there is room to act there: footwear that squeezes the toe box or a high heel kept up over time, and an overload of the big toe that nobody has corrected. Reducing that does not straighten what is already deviated — nothing but surgery does — but it changes the pace and, above all, prevents the problems that appear around it: the friction callus, the second toe riding over, and the overload in the sole, which in practice is what hurts.
- What footwear can I wear without it rubbing?
- The principle is that the shoe adapts to the foot and not the other way round, and that comes down to three concrete things. Enough width in the toe box so the deviated toe does not touch the inner wall; material that gives in that area — soft leather accommodates the bump, a rigid synthetic does not — and no seam right over the point that sticks out, because the seam is what opens the callus. A low heel, because a high one pushes the foot forward and against the toe box. Size alone is not a reference: two shoes of the same number can have very different shapes, and what decides is how that particular one fits you.
