By Maggie Trevillion MRCPod BSc (Hons) MSc, Founder of Callen Olive
Bunions are very common and something that we see daily in our clinics. There are many different causes of bunions (also known as Hallux Valgus). From my clinical experience, these tend to be multi-factorial and may include genetics, hypermobility, rheumatic arthritis, foot injuries, flat feet and gender, as bunions are more common in women. Bunions are also prevalent in children.
Once you have a bunion it may also cause other conditions such as bursitis, osteoarthritis, sesamoiditis and hammer toes. Ultimately, bunions can change your foot function by altering your gait, which affects the timing of your walking and the way pressure is distributed through your feet. This can lead to pain and problems in your back, hips, knees, feet, and of course, the bunions themselves.
It is important to note that many people have bunions and do not know that they exist, while others have large bunions that cause no symptoms at all. Both can be completely asymptomatic and cause no issues.
There is currently no treatment available that has been proven to scientifically prevent bunions, and correction of a bunion can only be achieved surgically. Orthotics, splints, toe props, footwear and exercise rehabilitation are great treatment options that can successfully treat symptoms and pain, but they do not change the size or shape of the bunion.
The Different Stages of Bunions
Bunions can vary in severity, and understanding which stage you are at helps guide the best treatment or management options.
Stage 1 – Mild:
A small bump develops on the side of the big toe joint. The toe may begin to angle slightly towards the second toe, but there is usually no pain or limitation of movement. Footwear generally still fits comfortably at this stage.
Stage 2 – Moderate:
The bump becomes more noticeable, and the big toe drifts further towards the second toe. Some people experience mild pain, redness, or swelling around the joint, particularly after long periods of standing or wearing narrow shoes. Footwear may start to feel tighter across the forefoot.
Stage 3 – Severe:
The big toe overlaps or presses heavily against the second toe, often leading to callus formation or secondary toe deformities such as hammer toes. Pain and stiffness in the joint are common, and finding comfortable shoes becomes difficult. The joint may appear inflamed or swollen, and walking can become uncomfortable.
Stage 4 – Advanced or Rigid:
The bunion is large, the joint is often arthritic, and movement becomes limited. Chronic pain, inflammation, and secondary deformities are typical. At this stage, conservative treatments often provide limited relief, and surgical correction may be considered.
What Shoes Work Best with Bunions
The type of shoe that works best depends on which stage your bunion is at and whether symptoms are present. Mild bunions may not require specialist shoes, but as the condition progresses, you may need wider, deeper footwear or styles designed to reduce pressure across the forefoot.
I advise my patients nine times out of ten to get a shoe size bigger, as most people wear shoes that are one to two sizes too small for their feet. Our toes extend when we walk, and there needs to be a gap at the front of the shoe when standing up, as your feet are larger when bearing body weight due to ground reaction forces.
Always purchase shoes that fit and feel comfortable in the shop. I do not believe in “wearing in” shoes, as they will never truly become comfortable. Wearing shoes that are too small every day, taking thousands of steps, is one of the main causes of foot pain.
Some women have concerns about the size of their feet and will therefore always buy shoes that are too small. This habit encourages bunions to deteriorate more quickly. There are many different styles and designs of shoes that provide extra support, wide fit, cushioning and comfort. The most important thing is to purchase shoes that fit in width and length, provide support with a strap, lace or zip, and suit your foot health needs as well as your personal style. Shoes really do give women confidence and can completely finish the perfect outfit.
