What is hallux valgus, and how do shoes influence its development?

Over the past few weeks, I’ve found myself talking about hallux valgus, or “bunions,” several times with friends. Not in a doctor’s office, but in completely ordinary conversations, and each time I realized that the questions and myths were always the same. So I decided to put together the most important points in one place: what is actually happening to the foot, what role shoe shape plays, and why a wide toe box can be so important.

What Is Hallux Valgus?

It is a gradual change in the geometry of the front of the foot: a deformity of the big toe in which the big toe gradually deviates toward the other toes, while the first metatarsal bone moves in the opposite direction. As a result, a pronounced bump forms along the inner edge of the foot by the big toe joint, commonly called a “bunion.”

It is important to understand that this is not simply a new bony growth. The position of the bones and joints relative to one another changes. As the deformity becomes more pronounced, the big toe may press against the other toes, alter the distribution of pressure across the forefoot, and cause pain, friction, or difficulty finding comfortable shoes, as well as change the biomechanics of walking.

Why Does Shoe Shape Matter So Much?

Look at your foot from above. In a healthy foot, the big toe continues the line of the inner edge of the foot straight forward. Now look at many everyday shoes—not just high-heeled pumps, but also sneakers, running shoes, comfortable ankle boots, and even hiking boots. Most of them begin to narrow at the front precisely where the foot itself becomes wider. In short, they have absolutely nothing to do with the actual shape of the foot. 

For the foot to fit into such a shoe, the big toe is pushed toward the other toes. One day will not change anything, and neither will one evening in dressier shoes. The problem begins with hours, days, and years in which the toe is repeatedly held in a position that does not match its natural alignment.

And this is not merely a theoretical assumption. Specialists and medical institutions draw attention to it. For example, the American Academy of Orthopaedic Surgeons recommends choosing shoes whose shape resembles the shape of the foot, rather than expecting the foot to adapt to the shoe. Harvard Health

But “My Mom Had Bunions Too”

This is a very common argument, and it contains some truth. Cleveland Clinic and Harvard Health both point out that genetics and foot anatomy are significant risk factors. Cleveland Clinic

Hallux valgus really is a multifactorial problem, and genetics play a role. Foot shape, joint mobility, arch structure, and other anatomical characteristics can increase the likelihood and extent of the deformity.

But “my mom had bunions” and “therefore shoes don’t matter” are not the same thing.

In fact, the opposite may be true: if the foot already has an anatomical predisposition to hallux valgus, shoe shape deserves special attention, and it is even less sensible to keep the big toe in shoes every day that mechanically push it in exactly the same direction in which it already tends to deviate.

Harvard Health puts it very precisely: narrow shoes are not the only cause, but for a susceptible foot they can become a factor that triggers or accelerates the deformity. Harvard Health

And It’s Not Just High-Heeled Shoes

I think this is especially important to keep in mind, because when people talk about hallux valgus, everyone immediately thinks of pointed pumps and high heels. But toes can also be squeezed by an athletic and seemingly “comfortable” shoe.

We judge comfort based on what we are used to. If the toes have been held tightly together every day for years, this position may not seem painful or particularly uncomfortable. A much more objective test is simply to take off the shoe and compare the shapes.

Stand on a piece of paper and trace your foot. Then place your shoe over the outline of the foot or, even better, remove the insole and stand on it. Does the big toe fit straight? Are the little toes extending beyond the edge of the insole? Does the front of the shoe really follow the silhouette of the foot?

A running shoe can be soft and expensive, yet still have a tapered toe box. The same applies to everyday sneakers, boots, and hiking shoes. The feeling of comfort does not always mean that the foot is in an anatomically free position—“comfortable” is a very, very relative concept here.

And this is where the saying “beauty requires sacrifice” is entirely appropriate, because this is precisely why the shape of conventional shoes is designed in complete opposition to any logic concerning foot anatomy. We are used to the shape of traditional shoes, and for many people the anatomically correct shape of barefoot shoes seems wide and unacceptable. But it is interesting to look at shoes that, by design, cannot squeeze the toes at all, such as flip-flops. They are almost always wide at the front, and no one finds this shape strange. We calmly accept the shape of the foot in an open sandal, but in a closed shoe we suddenly want to make it narrower. This is more a matter of fashion and habit than anatomy.

What Do Barefoot Shoes Offer?

In the context of hallux valgus, the most important feature of barefoot shoes is not the thin sole or even zero drop, but the shape. In a good barefoot shoe (and I want to emphasize “good” once again, because barefoot shoes are gradually becoming a marketing gimmick too), the inner edge of the foot does not turn toward the center of the toe box, so the big toe does not have to move away from its natural alignment to fit inside the shoe. The toe box is wide enough for the foot to retain its shape rather than gradually adapting to the shoe.

This does not mean that barefoot shoes can “cure” established hallux valgus. If the position of the bones has changed significantly, changing shoes alone will not straighten the foot again. However, it is very difficult to find any logic in trying to reduce the progression of the deformity while continuing to wear shoes that push the big toe farther toward the center of the foot every day. The NHS and other medical institutions also recommend choosing wider shoes with enough room for the toes in cases of hallux valgus. Harvard Health

What Would I Do If Hallux Valgus Were Just Beginning to Appear?

First, I would look at every pair of shoes in which I spend a lot of time. Not just dress shoes. If I spent my days in an office, I would start with my office shoes. If I moved around the city mostly in sneakers, I would change my sneakers first. If I spent most of the day in hiking boots or work shoes, those would matter more than shoes I wore once a month.

The main criterion would be that the big toe does not have to move toward the second toe inside the shoe and that the forefoot has enough room. In the case of hallux valgus, it is especially important for the shoe to be wide where the foot actually needs it to be, rather than simply buying a larger size.

Then I would look at foot function—whether the big toe is still mobile, whether it can actively move away from the other toes, and how the foot muscles are working. Depending on the situation, it may make sense to start foot exercises, a wide range of which can be found on social media, YouTube, and similar platforms using the search terms toe yoga, foot health exercises. You can also use toe separators or spacers, but then it becomes even more important to choose shoes that are wide enough to give the toes genuine space. There is not much point in trying to position the toes more freely for several hours and then keeping them compressed in a narrow shoe for most of the day again. In addition, the foot must be able to bear weight normally while moving, and the big toe must be able to participate in walking. And if there is pain or the deformity is progressing, consult a physiotherapist or a knowledgeable foot and ankle orthopedist.

But shoes would be the very first thing I changed. Not because barefoot shoes are some kind of miracle therapy, but because it makes little sense to try to restore the big toe’s movement for half an hour a day and then spend the remaining ten hours doing again what contributed to the deformity.

Maybe the Problem Isn’t the Shape of Our Feet

It seems to me that hallux valgus is one of the topics where the entire barefoot-shoe principle becomes especially easy to understand and obvious.

We have become so accustomed to shoes that narrow at the front that a shoe shaped like the foot initially seems wide and strange. But when you place a bare foot and both types of shoes side by side, it becomes quite difficult not to understand which one actually has the unusual shape.

Hallux valgus does not develop solely because of shoes. Genetics, foot anatomy, joint mobility, age, and other factors all play a role. But we cannot choose our genetics.

But we can choose whether to place the big toe in a shoe every day where it can stand straight or to push it toward the other toes.

And perhaps that is exactly where it is worth starting.