Podiatrist · Specialist in Biomechanics · Founder of VOLKAN
"For years we have blamed the bone. But a bunion does not start when the bone protrudes. It starts much earlier, when the biomechanics of the foot stop working in balance."
There is a question I hear practically every week in consultation.
—"Why have I developed a bunion?"
Most people expect a simple answer.
"It’s hereditary."
"Or it’s because of the shoes."
And it is true that both genetics and footwear can influence.
But, as is the case with almost all musculoskeletal problems, the reality is much more complex.
As a podiatrist specializing in biomechanics, I rarely find a single cause.
What I usually find is the sum of many small factors that, over the years, have been modifying the way that foot bears loads.
Because a bunion does not appear overnight.
It is the result of a process that, in many cases, has been developing for decades.
What biomechanics says
The medical name for a bunion is hallux valgus.
It occurs when the first toe begins to progressively deviate towards the other toes, while the first metatarsal shifts in the opposite direction.
The result is that bony prominence that many people identify as "the bunion bone."
However, that bone has not grown.
What has changed is the position of the joint.
And that difference is important.
Because the problem is not only that a bump appears.
It is that the mechanics of the first toe start to change.
The big toe plays a fundamental role during walking.
It participates in balance.
In stability.
And in the final phase of the push when walking.
When that joint stops aligning correctly, the entire functioning of the foot can be affected.
That’s why a bunion is not just an aesthetic issue.
It is a biomechanical alteration.
Why does it appear?
There is no single explanation.
The appearance of a hallux valgus typically depends on several factors acting at the same time.
Genetic predisposition.
Certain anatomical characteristics.
The mobility of the joints.
The way of walking.
The stability of the first ray.
Ligamentous laxity.
The strength of the musculature.
And, of course, the type of footwear used for years.
Each of these elements can increase or decrease the load that the big toe joint bears.
And the longer that load remains unbalanced, the greater the likelihood that the deformity will appear.
That’s why two people can wear exactly the same type of shoes their entire lives.
And only one develops a bunion.
What I see every day in consultation.
As a podiatrist specializing in biomechanics, one of the first things I try to convey is calmness.
Many people arrive thinking that the bunion appeared "suddenly".
But, when we explore the foot, it is often evident that the process has been evolving for years.
Sometimes I discover that the person has a family history.
In other cases, significant hypermobility of the first metatarsal.
Or a walking mechanics that favors the progressive deviation of the toe.
I also frequently observe that pain does not always correlate with the size of the bunion.
I have seen very striking deformities that hardly cause discomfort.
And small bunions that generate significant pain.
This shows that the real problem is not always the appearance of the foot.
But how that joint is functioning.
The most common error
One of the biggest mistakes is thinking that the bunion appears solely because the shoe "pushes" the toe inward.
If that were true, all people who wear tight shoes would have bunions.
And we know that is not the case.
Footwear can accelerate a process when there is already a predisposition.
It can increase discomfort.
It can favor progression.
But it rarely explains by itself the appearance of the deformity.
Similarly, we cannot think that a change of footwear will make an already formed bunion disappear.
Biomechanics is much more complex.
And simple solutions almost never reflect that complexity.
Why do some people develop a bunion and others do not?
This is one of the most interesting questions.
And probably one of the most important.
Because it reminds us that we do not treat diseases.
We treat people.
Each foot has a different anatomy.
A distinct mobility.
A particular way of distributing loads.
A unique history.
That’s why two people with an apparently similar bunion may need completely different recommendations.
As a podiatrist, I never make decisions based solely on an X-ray or a photo of the foot.
I need to see them walk.
Analyze how they move.
Understand why that joint is bearing certain loads.
Only then can we decide what the best strategy is.
What you can do
If you notice that your big toe begins to deviate, don’t wait for intense pain to consult. The sooner it is assessed, the more options there are to slow its progression.
Use a shoe with a wide toe box that allows the toes to maintain a natural position and reduces pressure on the joint.
Maintain good mobility of the big toe and work on the foot muscles when indicated. A functional foot tolerates loads better.
Do not choose treatments solely based on the appearance of the bunion. What matters is understanding how that joint is functioning.
Go to a podiatrist for a complete biomechanical assessment. Each bunion has a different story and not all need the same treatment.
Conclusion
Bunions do not appear because one day the bone decides to grow.
They appear when, for years, multiple factors modify the way one of the most important joints of the foot works.
As a podiatrist, I distrust explanations that seek a single cause for such a complex problem.
Not everything depends on genetics.
Not everything depends on footwear.
The reality is often found in the balance between anatomy, biomechanics, and the loads that that foot has endured over time.
My job is not just to observe a bunion.
It consists of understanding why it has appeared and what we can do to keep that foot functioning in the best possible way.
Because, many times, the real problem is not the bump we see on the outside.
It is everything that has happened in silence long before that bump started to become visible.