Why do we have bunions? Blame an evolutionary toe failure.
For millennia, people have suffered from bunions, a painful condition that’s uniquely human. Here’s why—and how to ease the pain.
Bunions have plagued human feet since ancient times. A brief glimpse at archaeology and history points to their presence, from prehistoric footprints in England to ancient Egyptian mummies with bony bumps.
A whopping 27 percent of burials in and around Cambridge, England, during the 14th and 15th centuries showed skeletal evidence of bunions, compared with just 6 percent in earlier centuries. The likely culprit? Researchers attribute the difference to the medieval emergence of “poulaine” shoes, long leather footwear with a pointed tip.
But why do we get them in the first place—and why haven’t we figured out how they’re caused or cured without surgery? Here’s how our feet developed one of their most common woes—and why they still perplex scientists.
What are bunions?
Also known as hallux valgus, bunions are a type of foot problem in which one of the toes—usually the hallux, or big toe—leans in toward the other toes, widening the foot as the big toe joint begins protruding from its side.
This misalignment impacts other toes, leading to nerve pain, numbness, inflamed skin, calluses and corns, swelling, and redness. It can even cause other foot malformations such as hammer or claw toes. Less common bunionettes or tailor’s bunions, cause similar symptoms with the joint of the little toe.
These days, bunions are one of the most common human foot maladies. Though estimates on their prevalence vary, they appear to affect about a quarter of the modern adult population, occurring more commonly in women and people over 65.
National Geographic History Magazine
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Most cases are mild or present no symptoms, but they can also affect quality of life, limit mobility, and lead to chronic pain and falls.
Bunions don’t exactly make evolutionary sense—natural selection should favor those whose foot structures don’t deform over time. Some scientists blame the unique structure of the human foot. In a 2017 study, researchers looked at the structure and function of the metatarsal bones of humans, chimpanzees, and gorillas in museum collections.
Compared to their primate cousins, the researchers found, humans display a “significant reorganization” of the big toe. While primates use their big toe to grasp, human toes all make contact with the ground, and with increasing stress the human big toe can override the muscles, tendons, and ligaments that surround it, drifting out of place and leading to a bunion.
Why do people get bunions?
Researchers are still unclear on what exactly causes bunions. Genetics do appear to play a role. A 2007 study of 350 people with painful bunions found that 90 percent had a family history within three generations.
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There’s more than genetics at play, says Timothy Miller, DPM, a podiatrist and foot and ankle surgeon with a practice in Orlando, Florida. “The second most common cause is foot type,” he says. People with low arches are more disposed to bunions due to laxity in the ligaments and muscles surrounding the big toe.
Can footwear bring them on too? Definitely, says Miller. “We were really made to walk on grass and soft surfaces,” he says. “Nowadays, we walk on hard floors and concrete, and a lot of shoes are not supportive at all.”
Unsupportive footwear leads feet to adapt, “sacrificing” themselves in a bid to protect the hips and back while making them more prone to bunions and other foot deformities.
Bunion treatment
People can slow the development of bunions by wearing shoes that are supportive and treat the pain with stretching, icing, or medication. But once a bunion forms, there’s only one way to make it go away.
“Unfortunately, if you have a bunion, the only true way to get it back into alignment is surgery,” Miller says. He performs hundreds of bunion surgeries a year, usually on an outpatient basis.
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Though every case varies, most surgeries involve removing a portion of the bone, realigning the support structures of the foot, and shoring up the connective tissue with plates or wires. In some cases, joint replacement or fusing is necessary, but most surgeries are less severe.
Recovery can take months, and podiatrists stress that surgery isn’t a cosmetic procedure. Over the years, however, it has become less invasive, and new surgical techniques claim less recovery time and better results. But Miller emphasizes that every case is different.
With surgery the only real fix, it’s not surprising that the Internet abounds with wild and often useless advice for soothing bunion pain. Miller laughs when asked what his patients have told him about at-home cures.
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“They think that Epsom salt cures everything,” he says. “They soak their feet in apple cider vinegar.” Neither is a cure—and it turns out that the Internet is actually one of the worst places to get reliable information on bunions.
A 2013 study classified just 24 percent of bunion-related websites as accurate and up-to-date, and a 2022 analysis found that nearly two-thirds of bunion information sources online lack transparency.
Treatment myths
That rubs up against the DIY ethos encouraged by social media and would-be “footfluencers” who proclaim the benefits of the latest device or procedure. Miller notes that many sufferers invest in splints that only treat the symptoms of bunions, not the cause.
“They do not work,” Miller says of the splints. “The second you take it off, it’s going to come back.” Instead of spending money on quick and ineffective fixes, he recommends seeing a doctor as soon as a bunion becomes painful, since early intervention leads to the best results for patients. “Patients regret not coming to see me sooner,” he says.
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If you find yourself searching for ways to relieve or prevent a bunion, you’re not alone. You’re participating in a $730 million-a-year industry and sharing an affliction that has haunted humans and their non-grasping toes throughout history. Just don’t perpetuate a stereotype that can drive sufferers away from treating, or even acknowledging, their ailment: the mistaken concept that bunions are exclusively a condition of the old or infirm.
“I’ve had patients as young as 10 and as old as 98,” says Miller. So if you’re in pain, set aside the shame and seek medical attention for bunions—you’re in good company.
