By Maggie Trevillion

What Causes Bunions?

In clinic, I meet people with bunions every single day, and one thing I’ve learnt over the years is that there is never just one reason they appear. Although bunions are known medically as Hallux Valgus, the cause is rarely medical in isolation. They tend to develop due to a combination of factors working together. Genetics often plays a part, as does hypermobility, certain types of arthritis such as rheumatic arthritis, foot injuries, and even the general structure of someone’s feet, including flat feet. Women are also affected more often than men, and bunions can affect children too.

When a bunion forms, it doesn’t just change the appearance of the foot. It can alter the way the foot functions. This can shift the timing of your stride and the pressure under your feet, and over time this may have an impact on joints higher up the body – knees, hips, the lower back – or cause problems locally, such as bursitis, joint irritation, sesamoiditis or the development of hammer toes. Interestingly, many of my patients have bunions without realising, and both small and large bunions can exist quietly without causing any discomfort.

There is currently no scientific evidence for any treatment that prevents bunions from developing, and the only way to correct the position of the toe is surgery. That said, I see great results when it comes to managing symptoms: orthotics, splints, toe props, appropriate footwear and targeted rehabilitation exercises can all help with day-to-day comfort, but they don’t change the size of the bunion itself.

Choosing Shoes When You Have Bunions

Footwear is always one of the biggest influences on comfort. The type of shoe you need depends on how advanced the bunion is and whether it is causing symptoms. A mild bunion usually presents as a small bump and often doesn’t require specialist shoes. As the bunion becomes more pronounced and the toe drifts further across, it can become increasingly difficult to fit into standard footwear, especially if there is also a hammer toe or swelling in the joint. When bunions reach this stage, orthopaedic styles or wider-fit shoes can make all the difference. Widerfitshoes.co.uk is a useful place to start.

Most people I assess are wearing shoes that are simply too small. I usually recommend trying a size up, as our toes lengthen out during walking and need the space to do so. Always stand up in the shoes when trying them on, because body weight increases the length and width of the foot.

If shoes feel uncomfortable in the shop, they will stay uncomfortable – shoes do not “break in” in a meaningful way. Tight or narrow footwear worn daily, especially when walking thousands of steps, is one of the main contributors to foot pain. Some women choose smaller shoes due to concerns about foot size, but this can accelerate the progression of bunions.

There are now many brands that offer supportive, cushioned, wider and more comfortable designs. The best choice is the one that fits properly in both width and length while still making you feel confident and comfortable in your style.

What Causes Clawed Toes?

Clawed toes, often called hammer toes, can develop for several reasons, and like bunions, they rarely have a single cause. They may develop due to muscular imbalance, tendon tightness, bunions themselves, arthritis, injury or trauma, or sometimes from shoes that are too short. Neurological or muscular conditions can also play a role.

Whether the toe can still be straightened helps guide the best treatment. Flexible clawed toes often respond well to orthotics. Fixed clawed toes usually need shoes that have a deeper toe box to prevent rubbing and friction, which can otherwise lead to blisters, corns, callus or even ulceration. Toe props and well-fitting footwear can help relieve symptoms.

Supporting Ageing Feet

As we age, our feet naturally undergo changes, and early care makes a big difference. I always encourage older patients to book a biomechanical and gait analysis appointment so we can spot and address issues before they become limiting.

The most common changes I see include reduced strength in the lower limbs, which can change the way someone walks and increase the risk of falls. The natural fat pads under the feet become thinner, which can cause discomfort under the heels and the balls of the feet. Many people also find it harder to care for their own feet as they get older.

Skin becomes drier because oil and sweat glands slow down, and this can lead to cracked heels. Arches may naturally lower as ligaments and tendons stretch over time, which often results in wider feet and aching arches. Circulation also slows, which affects healing and can lead to cooler feet and mild swelling. Nails commonly become thicker, slower-growing or discoloured, often due to reduced circulation or fungal infection.

Although these changes are a normal part of ageing, simple habits such as good hydration, stretching, supportive footwear and regular podiatry check-ups can go a long way in keeping feet healthy and comfortable.

Wearing Heels During Party Season

For anyone wanting to return to heels, the key is taking it slowly. Start by wearing them at home for short periods to build comfort. Look for styles that offer a wider toe box or ankle strap for stability. I often find that wedges provide height with much less pressure on the forefoot, making them a great option.

Gel cushions such as Party Feet can add comfort, and a regular exfoliation and moisturising routine helps prevent callus, which improves comfort in heels. Stretching your calves and arches before and after wearing heels is very helpful. Choosing the heel height based on your plans is a smart approach – a higher heel is fine for a seated dinner, whereas a lower heel is more sensible for a party where you’ll be standing. I also recommend carrying a backup pair of flat shoes; I always do this at events like Ascot.

For women with bunions who still want stylish shoes, Calla Shoes is a brand I love. Other brands that work well for comfort include Sole Bliss, Sketchers, On and Hoka.

Because bunions vary so much from person to person, there is no universal shoe solution – it’s about finding what works for you.