Over 8,000 years ago, humans walked barefoot along what is now the coast of northwest England, leaving their indelible footprints behind. We may not have much in common with these prehistoric hunter-gatherers , but one of the footprints, that of a teenage boy, provides a surprising connection between past and present: evidence of a bunion protruding from the side of his foot.
Bunions have plagued human toes since ancient times. 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 the question of bunions still perplexes scientists.
An eternal ailment
Need proof that humans have always had bunions? A brief glimpse at archaeology and history points to their presence since ancient times. Evidence abounds, from the prehistoric footprints in England to ancient Egyptian mummies with bunions. 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.
What are bunions?
Also known as hallux valgus, bunions are a type of foot deformity 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, and even other foot malformations such as hammer or claw toes. A less common type of bunion, the bunionette or tailor’s bunion, causes 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, bunions appear to affect about a quarter of the modern adult population, occurring more often in women and people over 65. Most bunions are mild or present no symptoms, but bunions 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 metatarsals 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 and ligaments that surround it, drifting out of place and leading to bunion.
Why do people get bunions?
But 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 of bunions in a family member within three generations.
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, and people with low arches are more disposed to bunions due to laxity in the ligaments and muscles surrounding the big toe.
Can footwear bring on bunions, 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.
How to treat bunions
People can slow bunion formation with supportive shoes 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 such surgeries a year, usually on an outpatient basis.
Though every case varies, most bunion 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 bunion surgery isn’t a cosmetic procedure. Over the years, however, it has become less invasive, and new surgical techniques boast of less recovery time and better results. But Miller emphasizes that every case is different.
With surgery the only real fix for bunions, 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 bunion cures.
“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.
Foot fact and fiction
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 bunion splints that only treat the symptoms, 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.
If you find yourself searching for ways to relieve 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 bunion 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—you’re in good company.
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