Battling bunions? It may be time to see a specialist

This story first appeared in Healthy You - January 2026, The Gazette’s quarterly health publication.

Tina Thurston, an active Clarence resident, had been ignoring her symptoms for months, hoping they would go away.

She understood she had bunions — a hereditary condition she got from her mother — as she had already had them surgically fixed when she was younger.

“It’s painful. It would hurt running and just walking in general. At some point, it’s just too much,” she said.

While taking her dad to a podiatrist, she showed the doctor her foot and the inflammation of the padding under her toes. By ignoring the pain, the bunion had worsened and was starting to affect her other toes: her second toe was becoming a hammer toe, moving over the top of her big toe. Her little toe was moving outward from her other toes, and corns were forming on some of her toes from constantly rubbing against each other.

“He told me, ‘If your foot’s hurting at any point in your life, you need to go get (it) looked at. You’re on your feet every day. You need them,’” Thurston said.

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A bunion is an angular deviation or deformity of the big toe joint. It appears as a bony bump at the base of the big toe. It happens when some of the bones in the front part of the foot move out of their regular position. This causes the big toe to get pulled toward the smaller toes, and the first metatarsal — metatarsals are the long bones behind each of our toes — sticks out.

Dr. Bradly Bussewitz, a foot and ankle fellowship-trained surgeon at Steindler Orthopedic Clinic in North Liberty, sees anywhere from 20 to 40 patients with bunions each month. A lot of these patients think they’re forming extra bone from getting more calcium, not realizing it is their bones moving out of place.

Another common misconception is that bunions are caused by wearing heels or shoes that are too tight. While tight shoes can exacerbate the problem and contribute to discomfort, most of the time — other than after a traumatic injury to the foot — it is caused by genetics.

“It’s not causing the bunion, it’s causing the bunion to happen much sooner in life than it otherwise would have without tight or restrictive shoe gear,” Bussewitz said.

Dr. Ryan McBride of Physicians’ Clinic of Iowa agrees.

“There are populations in the world where people don’t wear shoes, and they still have bunions,” McBride said. “As with other traits we inherit, like eye color, height, etc., we can also inherit the bone structure that causes a bunion.”

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In Thurston’s family, her mother, two sisters and a niece also have bunions. The rate is twice as high in women than in men, with about 14 percent of women in the United States affected by bunions.

Unfortunately, there is no known way to prevent bunions, and we can’t choose our genetics.

There are two ways to approach treatment for bunions. The first involves conservative methods that can reduce discomfort, such as wearing a wide or roomy toe box shoe and modifying activities that rub or otherwise bother the bunion. For example, replacing runs with something like an elliptical.

While there are a lot of different braces, splints and toe separator devices that claim to “reverse” or “cure” bunions, studies show there have been no permanent effects that change the position of the bones, although they may hold the big toe in a better position that reduces some stress on the soft tissue.

Surgery is recommended when patients start having trouble wearing shoes, if the pain has increased to the point that daily activities become difficult or if the bunion is severe enough that doctors are certain it will lead to other problems. The type of surgery will depend on the severity of the bone deviation and whether there is arthritis.

“Many people will have a bunion for many years without pain, then they may become increasingly painful over months or years. To me, the goal of surgery is to eliminate or significantly reduce pain and restore function,” McBride said.

Thurston is on her second round of surgeries for both feet, having done her left foot last November and her right foot this December.

When a bunion returns, it is called a reoccurrence. Although the chance of reoccurrence was around 30 percent 15 years ago, a big drive to improve outcomes led to more research and insights into how to pick the appropriate procedure for each patient. Now the chance of reoccurrence has dropped into single digits.

“We want to do this one time and have a more satisfied patient, and so the goal is to push forward with surgeries or procedures that have a higher likelihood of lasting a lifetime,” Bussewitz said.

Most podiatrists have two to four years of surgical training for the correction of bunions. Some orthopedic surgeons have specialized training on the surgical treatment of the foot and ankle, like Bussewitz, who performs anywhere from 50 to 100 bunion surgeries a year.

“We’re in a golden age of bunion surgery,” Bussewitz said. “Patients can expect a more reproduceable, lasting bunion procedure where they can walk immediately in a boot after their surgery. The hope is that we can be much more confident saying (that) this has a high chance of being successful for you and not reoccurring.”