Bunions: what they are, who gets them, what shoes and splints can and cannot do and what surgery involves

Bunions affect about one in five adults, and an analysis published on June 9, 2026, in the journal BMC Musculoskeletal Disorders revisited an old argument over how much shoes are to blame, tying narrow-toed shoes to bunions more strongly than high heels. For a person who already has a bunion, the questions are different: how to ease the pain, and whether surgery helps.

The research answers the first question more plainly than the second. Roomier shoes, pads and insoles can make a bunion hurt less, though the reviews agree that they do not move the toe back, and exercises combined with taping shifted it by a few degrees in small trials. Surgery corrects the deformity, and in the one trial that compared it with waiting, most patients who had it felt better a year on. But there are more than 100 operations, none has been shown to be best, and bunions can return.

What a bunion is

A bunion is the bump on the inner edge of the foot at the base of the big toe. Doctors call the condition behind it hallux valgus: hallux is the Latin word for the big toe, and valgus describes a part angled away from the midline of the body.

The bump is not a growth. As a 2019 review in the journal Foot & Ankle Orthopaedics explains, it appears because two bones have moved. The first metatarsal, the long bone that runs along the inner side of the foot to the big toe, drifts inward, toward the other foot, while the toe on the end of it leans the other way, toward the second toe. That leaves the head of the metatarsal sticking out at the joint.

The visible bump, the review stresses, is only one component of the 3-dimensional deformity: the toe also rotates, and the small bones under the joint shift out of place. Hallux valgus can lead to considerable pain and changes in how the joint moves, the review says, and other problems often travel with it, including flat feet and hammertoes, smaller toes that stay bent at the middle joint.

Doctors grade a bunion from X-rays taken with the person standing, measuring the angle between the big toe and the metatarsal behind it. On the review’s figures, an angle under 20 degrees is mild, 20 to 40 degrees is moderate and over 40 degrees is severe.

How common bunions are and who gets them

The most widely quoted figures come from a 2010 analysis of 78 papers reporting results of 76 surveys from around the world, which together covered 496,957 participants. It estimated that 23% of adults aged 18 to 65 had the condition and 35.7% of people over 65.

A 2023 update drew on more databases, including Chinese ones, and came out a little lower: its overall pooled estimated prevalence was 19%, with a range from 13% to 25%. The individual surveys disagreed widely, partly because they defined and measured bunions in different ways.

Both analyses found the same pattern by sex and age. In the 2010 analysis, prevalence increased with age and was higher in females, at 30% of women against 13% of men, and the 2023 update put the figures at 23.74% of women and 11.43% of men.

Family history is a strong signal. The 2019 review cites a study of 350 people in which 90% of those with a bunion had at least 1 similarly affected family member.

Exactly why bunions form is still debated, according to the review, which lists the factors that make one more likely: female sex, age, constricting footwear, and family history.

Shoes are the factor people can change, and the 2026 analysis tried to size it. Pooling 23 observational studies, it found that people who wore narrow-toed shoes had about 2.3 times the odds of a bunion and those who wore high heels about 1.7 times, while female sex carried about 2.6 times the odds. Its authors concluded that bunions are mainly linked to female sex, aging, and the mechanical squeeze of narrow footwear, which they judged a greater risk than high heels. Those are associations: observational studies record who has bunions and what they wear, and they cannot show that the shoes came first.

What shoes, pads and splints can do for bunions

The first line of treatment is to stop the bump being rubbed. The review treats care without an operation as symptom control, starting with comfortable shoes with a wide toe box (the front part of the shoe) to ease pain, blistering and inflammation. Toe spacers and cushions can also help, it adds, by easing pain further.

None of this straightens the toe. Changing shoes and activities may ease the symptoms, the review says plainly, but it does not fix the underlying problem and thus will not reduce the deformity.

The trial evidence for these measures is thin. A 2009 Cochrane review, a systematic summary of trials from an international research network, looked at every randomized comparison it could find, and only three trials involving 332 participants had tested non-surgical treatments against no treatment. They found no evidence of a difference in outcomes, and the review concluded that orthoses and night splints did not appear to help any more than no treatment did. That leaves the case for wider shoes and pads resting on the 2019 review, a summary by specialists.

Orthoses, shaped insoles or supports worn in the shoe, have been tested in one sizable trial, and the relief it found was short-lived. Finnish researchers enrolled 209 consecutive patients with a painful bunion that was not severe, meaning a toe angle of 35 degrees or less. Their average age was 48 and 93% were women. One group was given orthoses, one had surgery and one was put on a year-long waiting list.

On a pain scale from 0 to 100, pain had fallen 14 points more in the orthosis group than in the waiting group at six months, but by one year the differences the trial reported were between surgery and the other two groups. The authors’ verdict on insoles was that they provide short-term symptomatic relief.

Exercise is the newest candidate. A 2025 analysis pooled 11 small trials with 401 patients who did exercise therapy, alone or with taping or orthoses. Exercise alone reduced the toe angle by about 3 degrees compared with a placebo treatment, and exercise combined with taping did best, reducing the angle by about 7 degrees, with exercise plus orthoses close behind. The trials involved mild and moderate bunions, and the authors asked for larger studies and for checks on side effects before the result is relied on.

When surgery for bunions is considered

Looks alone are not a reason to operate. The 2019 review says the appearance of the foot, without other symptoms, is not an indication for surgery, meaning it is not in itself a medical reason to operate.

In the review’s account, surgery comes after shoes and pads have been tried, for people with persistent pain or continuing trouble finding shoes they can wear. Its aims are pain relief, correction of the deformity, a more stable first ray (the big toe together with the metatarsal behind it) and better quality of life. The 2024 Cochrane review of bunion surgery describes the same order, with non-surgical options treating pain rather than curing deformity usually tried first.

What bunion surgery involves and what the trials show

There is no single bunion operation: the 2019 review counts more than 100 different procedures described for the condition. Most involve an osteotomy, in which a bone is cut so that it can be moved into a better position and fixed there. The cut can be made near the toe, in the middle of the metatarsal or near the ankle end, and some operations, such as the chevron, are named for the shape of the cut. Others fuse a joint, joining two bones so they heal as one.

The choice depends on the severity and location of the deformity, and also on what the surgeon prefers. In general, the review says, cuts near the toe are used for mild bunions and cuts or fusions further back for severe ones.

The Finnish trial is still the only one to have tested surgery against doing nothing, and its operation was a chevron osteotomy, a V-shaped cut near the toe. A year later, 83% of the surgery group thought they had improved compared with how they started, against 46% of the orthosis group and 24% of those left waiting.

When the 2024 Cochrane review went back to that trial’s data, average pain at 12 months was 21 points out of 100 in the surgery group and 39 in the untreated group. Function scores were 75 against 66 on a 100-point scale where higher is better, and quality of life was 93 in both. The reviewers chose careful words, saying surgery may bring a clinically important reduction in pain, and they rated the evidence as low in certainty because patients knew which treatment they had received and the numbers were small.

That review covered 25 trials with 1,597 participants in all, most of them comparing one operation with another. Grouping the operations into simpler and more complex bone cuts, it found little to separate them: complex and simple osteotomies gave similar results for pain, though the more complex ones may lead to more repeat operations. The earlier Cochrane review had reached the same verdict, finding that when one bone cut was compared with another, no technique was shown to be superior.

Keyhole surgery is the main recent change. These minimally invasive operations work through small punctures in the skin with a fine burr, a small rotating cutter, in place of a long incision. A 2025 analysis pooled six studies with 342 patients that compared a keyhole chevron with the open version. Pain in the first weeks was a little lower after keyhole surgery and one X-ray measure slightly favored the open operation, but the authors judged every difference small and unlikely to matter clinically, and complication rates were comparable between the techniques.

A group of anesthesiologists and surgeons known as the PROSPECT Working Group, which writes procedure-by-procedure guidance on pain control, opens its 2025 update on bunions by noting that the surgery is associated with moderate-to-severe pain afterward. Its guidance covers the nerve blocks and medicines used around the operation, and it now favors keyhole techniques over open ones on pain grounds.

Risks of bunion surgery and how often bunions return

Surgery does not always satisfy. The 2009 Cochrane review pointed out that in some trials a consistently high share of participants, 25 to 33%, were still dissatisfied at follow-up even when the toe angle and pain had improved.

The bunion can also come back. The 2019 review calls recurrence the most common complication, with reported rates anywhere from 8% to 78%. The spread reflects different operations, different lengths of follow-up and different definitions. In one series the review cites, patients who had a scarf osteotomy, a Z-shaped cut along the middle of the metatarsal, were doing well ten years later on pain and function scores, and 30% of them had a toe angle back above 20 degrees.

Other complications in the review include pain shifting to the ball of the foot if the metatarsal ends up shorter, stiffness, a toe that is over-corrected and points inward, and, rarely, loss of blood supply to the head of the bone.

What the bunion evidence cannot show

Whether shoes cause bunions. The link with narrow shoes and heels comes from surveys and other observational studies. It is an association.

Whether surgery beats a sham. The Cochrane authors found no trials comparing surgery to placebo or sham surgery, a pretend operation used to separate the effect of the surgery from the effect of expecting to get better. The one comparison with waiting comes from 140 of the trial’s 209 patients, who knew what they had received.

Which operation is best. The trials were mostly small and short, and the 2024 review found that most trials were susceptible to bias. The earlier review noted that results were mostly measured at one year, for a joint people will walk on for decades.

How well exercise works. The exercise trials were small, and what was measured was mostly an angle on an X-ray.

Who wrote the 2019 review. The 2019 paper is a narrative review, a summary by specialists of the studies they selected. Its conflict statement says four of its eight authors are paid consultants for Treace Medical Concepts, a company, and the text states the authors’ own preference for one newer fusion technique whose outcome studies were still under way.

Whether surgery makes sense for a bunion in a particular person is assessed by their doctor.

A bunion can be made to hurt less without an operation, small trials suggest exercise moves the toe a few degrees, and the trials have yet to say which operation corrects it best.