My mother and grandmother both had terrible bunions on both feet. I never developed them so I didn’t give it much thought. But now my 14-year-old daughter is starting to show signs of bunions. And she is always running around barefoot. Does this make the problem better or worse?

Hallux valgus, otherwise known as “bunions” is found more often in women than men and especially Caucasian (white) women. It tends to run in families but it can skip a generation or appear for the first time in any family.

What happens in this foot deformity is that the two bones that form the big toe lose their anatomic relationship with each other. Instead of lining up with each other, they start to angle outward. The result is the odd-shaped bump you see along the inside of the big toe. The muscles get unbalanced and the soft tissue (e.g., ligaments, joint capsule) get stretched out.

The question of shoe wear always seems to come up in relation to bunions. There are some studies that show a link between wearing high heels and narrow (or “pointy”) shoes and bunions. But there just as many people who wear this type of shoe who never develops a bunion so it can’t just be the shoe, right?

Studies show two types of factors that contribute to the development of bunions. The first are extrinsic factors. These are events outside of the feet that contribute to the problem. Shoe wear is one extrinsic factor. Excessive weight (obesity) and load (being on your feet a lot) is another.

Intrinsic (internal) factors that may contribute to the formation of bunions include heredity, tight Achilles tendon, and flat feet. Other anatomic features such as ligament laxity (looseness) or hypermobility (excess motion) of the big toe may be important.

In juveniles (teens) with hallux valgus, there’s no evidence that shoe wear makes a difference (better or worse). Juvenile hallux valgus has a different cause and effect.

For the best results, seek the advice of a qualified health care professional. See a board certified podiatrist or orthopedic surgeon for an evaluation and proper treatment.