Bunions, medically known as hallux valgus, are bony bumps that form on the joint at the base of your big toe. They occur when some of the bones in the front part of your foot move out of place, causing the tip of your big toe to get pulled toward the smaller toes and forcing the joint at the base of your big toe to stick out.

This joint, known as the metatarsophalangeal (MTP) joint, then becomes swollen and painful. Globally, about 19% of adults suffer from bunions, with women and people over 60 years more commonly affected.¹ While it’s not always known what causes bunions, your choice of footwear can significantly contribute to the development — and worsening of — bunions. What’s more, good shoes can help to prevent and treat them.

Aleena Kanner, one of the leading postural experts in the U.S. and a certified Postural Restoration Institute (PRI) practitioner, created “The Shoe Ebook” to help you make informed footwear choices for pain-free — and bunion-free — feet.

How Improper Footwear May Contribute to Bunions

Wearing shoes that don’t fit properly, or those that aren’t designed with foot health in mind, can take a toll on your feet. Kanner notes:²

“Our feet boast a remarkable design, consisting of 28 bones that enable movement in various directions. In addition to facilitating movement, our feet play a crucial role in communicating with the ground, transmitting vital sensory information to the brain. It’s fascinating how they interact with the ground, communicating vital feedback with each step we take.

From the moment we awaken, our feet are the first point of contact with the ground. Thus, the footwear we choose significantly impacts our overall bodily health and alignment.”

Shoes that are too tight or narrow, for instance, can squeeze your toes together, forcing your big toe into an unnatural position.³ This pressure causes the bones in your foot to misalign, potentially leading to the formation of a bunion at the base of your big toe. The same is true for shoes with pointed toes, which force your toes into an unnatural position and increase pressure and friction on the MTP joint.

High-heeled shoes are also problematic,⁴ as they shift your body weight forward, placing excessive pressure on the front part of your foot, including your toes. Not only does this force your toes into a cramped space but it increases stress on the MTP joint.

Wearing shoes that do not fit properly, whether they are too small, too large or lack adequate support, can also contribute to bunions. Small shoes squeeze your toes while large shoes can cause your foot to slide forward, putting excess pressure on the MTP joint.

Most Bunions Are Caused by ‘Years of Abnormal Motion’

Bunions are often said to have a genetic connection, as more than 70% of those with bunions have a parent who also had them.⁵ However, most bunions aren’t caused by genetics alone but rather involve abnormal or faulty movement patterns. Kanner explains:⁶

“Bunions are often attributed solely to genetics, but faulty movement patterns play a significant role as well. Now, I’m not suggesting that your mother and grandmother are exempt from the bunion club … But we shouldn’t place all the blame on them! Observing the movement patterns of our elders can influence our own, potentially leading to similar patterns.

When our feet lack the support and alignment they need, it can lead to abnormal pressure and stress on the joint at the base of the big toe, eventually resulting in bunion formation. While this may contribute to bunion development, labeling them as solely genetic might stem from a limited understanding rather than conclusive evidence.

Bunions develop due to Wolff’s Law, which suggests that bones adapt to mechanical loading. This makes it more plausible that movement patterns contribute to their development rather than genetics alone.”

The American Podiatric Medical Association also states that bunions are often the result of years of abnormal motion:⁷

“Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type or our shoes.

Although bunions tend to run in families, it is the foot type that is passed down — not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.”

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Lack of Arch Support May Contribute to Bunion Development

Proper arch support is important for proper foot mechanics and a key element that PRI evaluates, in partnership with the Hruska Clinic, for its recommended shoe list, which is updated at least twice a year. Arch support provides help with proper pronation — the natural movement of your foot as it rolls inward to distribute the force of impact during walking or running.

In normal pronation, your foot rolls inward about 15%, allowing your arch to absorb shock and support body weight.⁸ This movement helps the foot adapt to different surfaces and provides a stable base for the body. However, Kanner notes, “Lacking proper arch support and sufficient foot pronation can contribute to the development of bunions.”⁹ She explains:¹⁰

“Adequate arch support is crucial for promoting proper foot pronation and supporting neurological functionality. Foot pronation, which is the foot’s ability to flatten down into the ground and aid in propelling the body forward, is essential for healthy movement. When there’s a lack of pronation, it can manifest in various ways during a gait assessment.

We might observe individuals turning their feet outward as they try to find a way to push off their standing leg. Additionally, we might notice the development of bunions, both of which are related to the inability to pronate effectively. Without proper arch support, our foot’s natural movement patterns may be hindered, potentially leading to discomfort and alignment issues over time.”

A Barefoot Lifestyle Likely Caused My Bunion

While ill-fitting shoes or shoes that lack support may contribute to bunions, so, too, may wearing no shoes at all, particularly if done for long periods of time. I visited Kanner to address a bunion I’d been trying to treat for a year. After consulting with her, I believe adopting a barefoot lifestyle for more than a decade was a primary cause.

Going barefoot is great if you’re walking on the beach or grass — and is an important component of beneficial grounding — but I have tile floors in my home, and walking barefoot on hard, flat surfaces can lead to problems much like unsupportive shoes can, as there is no supportive structure for the foot. Kanner explains:¹¹

“It’s been a huge [trend] lately, in the last, I’d say 10 years, to be wearing barefoot minimalist shoes, or no shoes. No shoes are fine if you are out in nature. I love grounding. We all know that there’s an exchange of frequency from the earth into our bodies, and that’s great if you are outside … in sand, in grass.

However, our society is not built like that. We are not walking outside in grass and sand all the time. We are walking on flat surfaces, and the problem with that is our feet have arches, and we need to be able to give [them] the proper contact with the ground.

It ends up actually just slapping the ground and not creating that proper movement, range of motion in the foot, where we should have pronation, supination, pronation, supination. When we’re missing that range and that flow, it can lock up your neck. It can lock up your rib cage.

Wearing a specific shoe can open up that ability to have better range of motion at the feet, which can transfer up the chain. It’s a really hard topic for people because the minimalist shoes have a great marketing scheme. They’re saying our ancestors were barefoot. But you have to think about the context of that. They were not walking on pavement all day long in cities.

They were outside in nature, where the foot’s ability to pronate and supinate was still there because nature is uneven surfaces. So, I want to get across, it is OK to be outside barefoot if you’re walking on an uneven surface on the beach.

But if you are in society and you’re walking in barefoot minimalist shoes or no shoes at all, and you’re having pain or symptoms … hormone issues, et cetera, a shoe with proper ability to ground, the sensory ability to ground, is going to most likely, almost always, make a positive change for that person’s well-being.”

Proper Footwear Can Help Prevent and Treat Bunions

Surgery, pain relievers and cortisone injections are common conventional treatments for bunions. But there are safer, less invasive options for relief, including choosing the proper footwear. “When I change the shoes on people, they can’t believe it because it’s such a simple thing you wouldn’t think about,” Kanner says. She notes:¹²

“When I see a bunion, in general, I know that person is most likely lacking an arch of their foot. A bunion is when the toe is coming inwards towards the other toes. That person’s ability to feel the ground with their arch is going to be limited most likely, especially if it’s on the right foot.

When I give that person an arch where it should be, and if they’re not normally sensing that, we don’t necessarily see a huge decrease in the bunion. Maybe with time. It’s not an immediate change because it took time for that person to get a bunion in the first place. But we see major changes in that person’s brain’s ability to feel their feet on the ground.

Somebody with a bunion has really lost that ability to pronate, which is to flatten the arch into the ground and then use their right glute to push off and get the body weight to the left. When I see bunions, I know that there have been bony changes to adapt to somebody’s gait pattern or postural breathing pattern. Gait, posture and breathing are all tied together.”

According to Kanner, essential components of proper footwear include:¹³

• A heel counter for calcaneal guidance, supporting the way the heel bone moves and aligns during walking
• Arch support for a better ability to pronate
• A flexible midfoot for fluid movement
• Proper heel lift
• A wide toe box for optimal alignment and comfort

You can consult PRI’s recommended shoe list for examples of shoes that fit these requirements. However, a personalized approach is best, as the right shoes for you will likely be different from your neighbor’s.

Ideally, have a professional test you to make sure you’re wearing footwear that has the desired effects to support proper foot biomechanics and address your individual needs. For more details, be sure to read Kanner’s “The Shoe Ebook” to help you make informed footwear choices.