Are bunions hereditary? What runs in families and what you can do

Are bunions hereditary?

A bunion (hallux valgus) is a bony bump on the inside of the foot at the base of the big toe. It forms slowly as the big toe drifts toward the second toe and the long bone behind it, the first metatarsal, angles outward. The bump is the end of that bone pushing against your shoe.

Yes, bunions are partly hereditary. Research on families, including the long-running Framingham Foot Study in the US, has found that the tendency to develop bunions is strongly inherited in both women and men. In studies of people with bunions, many report a parent or grandparent with them too.

What you inherit

You don’t inherit a bunion. You inherit the kind of foot that is more likely to develop one, for example:

• loose ligaments or very flexible joints, which let the big toe joint drift out of line more easily
• a loose, unstable joint at the base of the first metatarsal
• flat feet, which can put more pressure on the inside of the big toe joint (see flat feet: when to worry)
• the shape of the bones that make up the big toe joint

If a parent has bunions, will you get them?

Not necessarily. A family history raises your chances, but it doesn’t mean you’ll definitely get a bunion, or that yours will be as big or as painful as your parent’s. The shoes you wear and other health conditions also play a part.

Bunions in children and teens

Bunions that start in childhood or the teen years, called juvenile or adolescent bunions, are especially likely to run in families. They often show up in girls around the early teens, though boys get them too.

• Treatment usually starts with shoes that give the toes plenty of room, and padding or inserts if the bump hurts.
• Surgery is usually put off, when possible, until the bones have stopped growing, because bunions corrected earlier are more likely to come back.
• Have it checked if the bump hurts, is getting bigger quickly, or makes it hard for your child to find shoes or play sports.

Our guide to children’s foot health covers other common foot problems in kids.

What else causes bunions?

Genes load the dice, and other factors can tip them.

Do high heels cause bunions?

Not on their own. Plenty of people who have never worn heels get bunions, and plenty of people who wear heels don’t. But in someone who is prone to them, tight, pointed shoes and high heels can make a bunion form sooner, grow faster and hurt more. They also rub the bump, which causes redness, calluses and swelling.

Can you prevent bunions if they run in your family?

You can’t change the foot you inherited, so there’s no sure way to prevent a bunion. What you can do is take pressure off the big toe joint, which may slow a bunion down and keep it comfortable.

Choose shoes that give your toes room

• A wide, deep toe box. Your toes should lie flat and be able to wiggle.
• A low heel, ideally about an inch or less for everyday wear.
• Soft uppers over the big toe joint, or stretchable material.
• Shop later in the day, when your feet are at their largest, and fit the longer, wider foot.
• Save narrow or high-heeled shoes for short periods and special occasions.

Many walking and running shoe brands make wide sizes.

Arch supports and orthotics

If you have flat feet, an arch support or a custom orthotic may ease pain around the big toe joint and the ball of the foot. They can help with comfort, but there’s no good evidence that they stop a bunion getting bigger. See do I need orthotics?

Toe spacers, splints and bunion correctors

Toe spacers, night splints and bunion correctors can ease pressure and discomfort while you wear them. They don’t permanently straighten the big toe in adults, whatever the packaging says.

Foot exercises

Exercises such as spreading your toes, towel scrunches and heel raises can keep your feet strong and flexible and may ease stiffness. There’s little evidence that they prevent a bunion or reverse one.

Treating a bunion that hurts

Most bunions can be managed without surgery. A podiatrist may suggest:

• roomier shoes, or having shoes stretched over the bump
• bunion pads or gel sleeves to cushion the bump
• toe spacers to ease rubbing between the toes
• arch supports or custom orthotics
• ice and over-the-counter pain relievers such as ibuprofen or acetaminophen, if they’re safe for you
• a steroid injection, occasionally, for an inflamed fluid sac (bursa) over the bump

Surgery is for bunions that stay painful and limit what you can do despite these measures. It isn’t usually done for looks alone. If you’re considering it, our guide to bunion surgery recovery time explains what to expect, and you can read about bunion and hammertoe correction at Evolve Health.

Bunion or something else?

Not every painful bump at the big toe is a bunion:

• Gout causes sudden, severe pain, redness, heat and swelling in the big toe joint, often starting at night. See sharp pain in the foot.
• Hallux rigidus is arthritis of the big toe joint. It causes a bump on the top of the joint and a stiff, painful big toe.
• A bunionette, or tailor’s bunion, is a similar bump on the outside of the foot at the base of the little toe. It can run in families too.

When to see a podiatrist

Get seen the same day if:

• the big toe joint suddenly becomes red, hot and swollen, especially with a fever
• you have diabetes and notice a sore, blister, open skin or color change on or near the bunion

Book a visit if:

• your bunion hurts on most days, or keeps you from walking or exercising
• the bump is getting bigger, or it’s hard to find shoes that fit
• your second toe is starting to bend, cross over or under the big toe, or you have pain under the ball of the foot (see ball of foot pain)
• your child has a painful or fast-growing bunion

A podiatrist will examine your foot, watch how you walk and may take an X-ray to see how far the big toe has drifted. Evolve Health podiatrists have digital X-ray on site. If bunions run in your family and you’ve noticed a bump starting, an early visit can help you choose shoes and supports that keep it comfortable. You can find a podiatrist near you and book online.