Podiatrist · Specialist in Biomechanics · Founder of VOLKAN
"We inherit the shape of our feet. But the way we live with them also influences how they evolve."
There is a phrase I hear constantly in consultation.
—"I have bunions because my mother had them too."
Or just the opposite.
—"Bunions appear from wearing tight shoes."
Who is right?
The reality is that both statements contain part of the truth.
And, precisely for that reason, neither explains alone why a bunion appears.
What the evidence says
Hallux valgus —the medical name for bunion— is a progressive deformity in which the big toe deviates towards the other toes while the first metatarsal shifts in the opposite direction.
We know there is a significant hereditary component.
We do not inherit the bunion.
We inherit certain characteristics of the foot.
The shape of the first metatarsal.
Ligamentous laxity.
Joint mobility.
Bone structure.
All of this can make a person more predisposed.
But predisposition does not mean destiny.
Evolution also depends on other factors.
So… does footwear influence?
Yes.
But it is important to understand how.
A shoe does not create a bunion on a completely healthy foot overnight.
What it can do is favor the progression of a deformity that was already tending to develop.
When the toe box compresses the fingers for years, the big toe remains displaced inward.
That repeated stimulus can accelerate the deformity.
Especially if there was already a anatomical predisposition.
That's why footwear is not usually the only culprit.
But we also can't say it has no influence.
What I see every day in consultation
As a podiatrist specializing in biomechanics, I often treat families where several generations have bunions.
Grandmother.
Mother.
Daughter.
Genetics exists.
But I also observe something interesting.
Not all evolve the same.
Some present very mild deformities even after many years of evolution.
Others develop significant pain in a short time.
And many times the difference is not only in the inheritance.
It's in the type of footwear.
In the activity.
In the mobility of the foot.
In the muscle strength.
And in the way that foot bears loads every day.
That's why it's never enough for me to just look at an X-ray.
I need to understand how that foot functions.
The most common mistake
Many people believe that, since the bunion "is hereditary," they can do absolutely nothing.
And that is not always true.
We cannot change genetics.
But we can act on many of the factors that influence its evolution.
Choose footwear with enough space.
Avoid constant compression.
Maintain good mobility.
Work on the foot muscles when indicated.
In many cases, small changes made in time can help slow down progression and improve symptoms.
What can you do
If there is a family history, pay attention to the evolution of your feet, but do not assume that you will develop a severe bunion.
Use footwear with a wide toe box that allows the toes to maintain their natural position.
Consult if pain, difficulty walking, or significant changes in the alignment of the toe appear.
Do not wait for the problem to be very advanced to seek advice.
Remember that treatment should be tailored to how your foot functions, not just to the appearance of the bunion.
Conclusion
Bunions do not depend only on genetics.
Nor only on footwear.
As a podiatrist, I try to explain to my patients that most musculoskeletal problems arise from the combination of several factors.
Heredity can mark the starting point.
But our habits also influence the path.
My job is not to find one single culprit.
It consists of understanding why that foot is evolving in that way and what we can do to help it continue functioning as well as possible.
Because many times we cannot choose the shape with which our feet are born.
But we can decide how to take care of them throughout our lives.