Bunions are one of the most common reasons people ask why the side of their big toe hurts, even after switching to wider shoes or trying padding.
A bunion, medically called hallux valgus, is a change in the alignment of the big toe joint. Over time, the big toe gradually drifts toward the second toe while the joint at its base angles outward. The bump you see is not extra bone growing. It is the joint moving out of position.
Pain can come from shoe pressure, inflammation, joint irritation, or overload of the surrounding tissues. What often goes unaddressed is why that joint keeps getting stressed in the first place.
After more than two decades of treating bunions in clinical practice, one pattern shows up again and again. When we focus only on the bump itself, relief is usually limited. When we look at how the foot functions during walking, the picture becomes much clearer.
The Mechanical Issue Most People Never Hear About
A major contributor to bunion pain is overpronation.
Pronation is the natural inward rolling of the foot as you walk. Some pronation is normal and necessary. Problems arise when the foot rolls inward too much or stays there too long.
When that happens, the arch collapses more than it should. This shifts body weight toward the inside of the foot and places repeated stress on the big toe joint. With every step, that joint is pushed slightly out of alignment. Over time, that stress adds up.
I often explain it to patients like this. The bunion is where the pain shows up. The way the foot moves is often why it keeps coming back.
That does not mean everyone with a bunion overpronates. It also does not mean pronation is the only factor. Genetics, ligament laxity, foot structure, and shoe choices all play a role. But mechanics are frequently overlooked, and when they are ignored, treatment tends to fall short.
What I See in the Office
Bunion patients do not all look the same.
Some people have a noticeable bunion that barely bothers them. Others have a smaller bump but significant pain. In many of the painful cases I see, excessive pronation is clearly part of the picture.
One patient had tried wider shoes, padding, and toe spacers for years. Those helped reduce rubbing, but the soreness always returned. When we focused on stabilizing how the foot functioned during walking, the joint stopped getting overloaded with every step, and symptoms gradually improved.
Another patient was active and worried the bunion was getting worse quickly. What stood out was not the size of the bump, but how unstable the foot was during gait. Once that instability was addressed, the joint calmed down, even though the bunion itself did not magically disappear.
These situations are common.
Why Many Common Approaches Fall Short
Many bunion treatments fail because they focus only on the visible deformity.
Toe spacers can help temporarily reposition the toe, but they do not control how the foot moves during walking.
Padding reduces friction and pressure from shoes, which can be helpful, but it does nothing to reduce joint stress.
Stretching can improve flexibility, but flexibility without stability often does not change symptoms.
Wide shoes matter, but shoe width alone does not correct faulty mechanics.
This is something I tell patients often. If the foot keeps collapsing inward, the joint keeps getting stressed, no matter how roomy the shoe is.
What Actually Helps from a Conservative Standpoint
The goal of conservative care is not to force the bunion back into place. The goal is to reduce abnormal stress on the joint.
That usually starts with addressing mechanics.
In practical terms, that often means supporting the arch so the foot is not collapsing inward with every step. When the foot is more stable, the big toe joint is not being pushed out of alignment as aggressively during daily activity.
When mechanics are addressed early, symptoms are often easier to manage. In some cases, this may also help slow progression of the deformity over time. That is not guaranteed, and results vary, but reducing repetitive stress on a joint is rarely a bad strategy.
How I Think About Support in My Own Patients
When bunion pain is tied to excessive pronation, my focus is on reducing the forces that keep irritating the joint.
That thinking is what led me to help design Samurai Insoles. I wanted an insole that provided meaningful arch support without being bulky, rigid, or difficult to wear in everyday shoes.
Samurai Insoles are designed to support the mechanics of the foot during normal walking, not to act as a brace or a medical device. For people whose bunion pain is related to overpronation, that support can reduce ongoing stress on the big toe joint.
They tend to be most helpful for people who notice their feet roll inward when they stand or walk, feel soreness at the big toe joint during or after activity, and want a conservative option before considering more aggressive care.
They are not a cure, and they are not a replacement for medical evaluation. They are simply a practical tool aimed at a commonly overlooked mechanical issue.
When an In Person Evaluation Matters
Not all bunions behave the same way.
If pain is worsening, limiting daily activity, present at rest, or associated with significant swelling, redness, or numbness, an in person evaluation is important. Long standing pain that does not respond to conservative care also deserves closer assessment.
Joint arthritis, nerve involvement, or structural differences can change the treatment approach, and those details are best evaluated clinically.
A Reassuring Thought
Many people live comfortably with bunions for years when the mechanics of the foot are addressed thoughtfully. You do not need to panic, and you do not need to ignore the problem either.
Understanding how your foot moves is often the first step toward feeling better. In my experience, that clarity alone can change the trajectory for many patients.
If you focus on support, stability, and reducing unnecessary stress on the joint, you are moving in a sensible direction.
Common Questions About Bunions
Can bunions be reversed without surgery?
No. A bunion is a structural change in joint alignment. Conservative care focuses on reducing pain and stress on the joint, not reversing the deformity.
Do insoles help bunion pain?
In many cases, yes. Insoles can help when bunion pain is related to excessive pronation by improving foot stability and reducing repetitive joint stress.
Are bunions caused by shoes?
Shoes alone do not cause bunions, but narrow or unsupportive shoes can aggravate symptoms and make existing deformities more uncomfortable.
Should I wear insoles all day?
Most people benefit from wearing them during the activities that trigger symptoms. Comfort and tolerance matter, so gradual use is often best.
When is surgery considered?
Surgery is typically considered when pain persists despite appropriate conservative care or when function is significantly limited. This decision is individualized and made after an in person evaluation.
Can bunions get worse over time?
They can in some people. Addressing mechanics early may help reduce ongoing stress on the joint, which can matter over the long term, though outcomes vary.
If You’re Wondering What to Do Next
If symptoms have been lingering and you suspect mechanics may be part of the issue, focusing on support and stability is a reasonable place to start.
For some people, that means learning more about conservative options designed to reduce unnecessary stress during everyday walking. For others, especially if pain is worsening, persistent, or limiting activity, an in person evaluation may be the better next step.
There is no single right answer and no rush. The goal is to understand what is driving the problem and choose an approach that fits where you are right now.
My goal is to help people understand what their feet are doing and why it matters, so they can make calm, informed decisions about their care.
Explore arch support options designed to support mechanics during daily walking.
Dr. Thomas Lembo, DPM
Board certified podiatrist
