What Causes Bunions?

Do Shoes Cause Bunions?

bunion cause
Bunions can cause pain with shoe wear.. bgwalker / Getty Images

Question: What Causes Bunions?

A bunion is a deformity of the big toe. People with a bunion have a toe that points outward, as well as a bump on the inner side of the foot. As the bunion becomes more prominent, pain can develop. Learn what causes bunions and what can be done if you have a bunion.

Bunion Causes

Bunions are a common problem that can cause foot pain and difficulty wearing shoes. Bunions occur in about 30% of the population of most Western countries.

They are seen most commonly in women and become more common as people get older.

1. Blame Your Parents: Genetics do play a significant role, and people who have bunions in the family are also much more likely to have bunion than people who do not. The shape and structure of your feet are probably the biggest culprit for an increased risk of developing a bunion. You have no control over that since it is inherited and you don't get to choose your parents. In one study, 83% of people with bunions had a family history of bunions. A similar number had bunions on both feet, which points to a cause being the shape and function of their feet increasing their risk of bunions.

2. Blame Your Shoes: Tight-fitting shoes are thought to be the cause of bunions in most patients. Shoes such as high heels or cowboy boots are particularly damaging to the toes. These shoes have a sloping foot bed and a narrow toe box.

The slope causes the front of the foot to be pushed with force into the narrow toe box, causing the toes to become squeezed together. Depending on factors such as duration of wearing constraining footwear, skeletal maturity, and individual factors, the toes can become adapted to the new position and lead to the deformity we know as a bunion.

3. Injuries and Inflammatory Conditions: Footwear is not the only cause of a bunion. Injuries to the foot can also be a factor in developing a bunion. People who have rheumatoid arthritis are more prone to bunions, as are people with neuromuscular conditions such as polio.

4. Contributing Factors: Many people who have a bunion have a combination of factors that makes them susceptible to having this condition. For example, women over the age of forty who have a family history of bunions, and often wear high-heeled shoes, would be considered likely to develop a bunion.

How Important Are Shoes?

It's difficult to know exactly how important footwear is in the development of bunions, but we know it is the only variable we can significantly control. Bunions are much less common in countries without Western footwear. Bunions occur in non-Western countries in about 3% of the population. In countries with Western footwear, the prevalence of bunions is over 30%. In countries where Western footwear has been introduced recently, the prevalence of bunions has risen to coincide with rates seen in Western countries.

Regardless of whether the shoes caused your bunion, changing them can help you reduce your pain now that you have one. Look for shoes with a wider toe box that is square rather than pointed. Orthotics and padded bunion shields can also help.


Coughlin MJ, Jones CP "Hallux valgus: demographics, etiology, and radiographic assessment" Foot Ankle Int. 2007 Jul;28(7):759-77.

Roddy E, Zhang W, Doherty M "Prevalence and associations of hallux valgus in a primary care population" Arthritis Rheum. 2008 Jun 15;59(6):857-62.

Steven L. Haddad, Bunions, American Academy of Orthopaedic Surgeons, February, 2016.

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