Bunions (hallux valgus)
An abnormal gait (walking in a way that puts pressure on the heel) can cause pain. Continually doing high-impact exercise like running, jogging, and jumping, especially on hard surfaces, commonly causes heel pain. Wearing ill-fitting or unsupportive shoes can also cause heel pain or make it worse.
One of the most likely causes of pain on the bottom of your heel is plantar fasciitis. This condition develops when inflammation affects the plantar fascia, a piece of connective tissue that runs under your foot.
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A bunion is a deformity of the big toe joint in which the toe drifts toward the second toe and a bony bump forms on the inside of the foot. It develops when the first metatarsal bone (the long bone behind the big toe) gradually shifts outward over time.
Genetics play a major role — the tendency to develop bunions runs in families. Tight or narrow shoes can accelerate progression, but shoes alone don't cause bunions. Flat feet, hypermobility, and arthritis are contributing factors. Bunions are progressive and will not reverse without treatment.
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Diagnosis is made on physical exam. Your doctor will assess the range of motion of the big toe joint, evaluate for joint stiffness or arthritis, and check for any associated hammertoe deformity of the second toe.
Weight-bearing X-rays are essential — they show the exact angle of the deformity (hallux abductus angle and intermetatarsal angle) which determines severity and guides treatment. Mild, moderate, and severe bunions are managed differently.
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Conservative options — wider shoes, toe spacers, bunion pads, and custom orthotics — can reduce pain and slow progression, but cannot correct the underlying deformity. These are good long-term management tools for patients who aren't surgical candidates.
Surgery is the only way to correct a bunion. Modern minimally invasive bunion surgery (MIS) uses small incisions and specialized instruments to cut and shift the bone back into alignment, secured with small titanium screws. Compared to traditional open surgery, MIS typically results in less swelling, faster return to a shoe, and less post-operative pain.
Most patients are walking in a surgical boot the same day. Return to regular shoes occurs around 6–8 weeks, and full activity by 3–4 months.
