Causes of Bunions New York City

Bunions are generally NOT caused from a excess growth of bone.

Bunions are caused by a misalignment of the big toe joint, resulting in the big toe joint pushing out from underneath the skin.

You can see in the following illustration, comparing a foot without a bunion to one with a bunion, that the 1st metatarsal is mal-positioned from the base (bottom) of the bone. The 1st metatarsal is not crooked, bowed, or deformed – it’s straight and just mal-aligned from the base (bottom).

Skeleton with Bunion (Inner most metatarsal is mal-aligned)

Skeleton with Bunion
(Inner most metatarsal is mal-aligned)

Skeleton without Bunion (Metatarsal bones are all aligned straight)

Skeleton without Bunion (Metatarsal bones are all aligned straight)


While the visual appearance of a bunion occurs at the big toe joint, it’s this midfoot joint that is thought (by some) to cause the bunion. Also, some believe that this joint (1st metatarsocuneiform joint) is malstructured or too mobile causing the bunion in the first place.


Bunions are thought to occur for several reasons. In most situations, a bunion is caused by a combination of factors leading the deformity.


  • Genetics
  • Family history
  • Evolutionary influence


  • Females are more likely to develop bunions
  • Men may develop bunions too


  • Biomechanical
  • Flatfeet or fallen arches
  • Pronation
  • Unequal Limb lengths


  • Morton’s foot
    • A type of foot where the 1st metatarsal is shorter than the others
  • Loose ligaments in the foot
    • May be associated with a genetic condition
    • May occur with prenancy
  • Bone structure deformities
    • Malshaped bones
    • Malshaped big toe joint
    • Congenital absence of certain foot bones – particulary the tibial sesamoid
    • Tight calf muscle and achilles tendon
      • This often occurs from long-term high heel shoes

Improper Shoe gear

  • Small shoes
  • Pointy shoes
  • Shoes with a tight toe box
  • High heels


  • Acute injury
  • Chronic injury
Dr. Neal Blitz | Foot & Ankle Surgery
NEW YORK  800A 5th Ave., 4th Floor | New York, NY 10022
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