Do Bunions Only Happen to Older People?

Bunions tend to carry a certain image. If you picture someone with a bunion, there’s a reasonable chance you’re picturing someone older, like your grandmother, maybe, wincing in her shoes. It’s one of those conditions that gets quietly filed under “things that happen when you’re old,” alongside creaky knees and reading glasses.

But that picture isn’t quite right. Bunions can and do develop in younger people – including teenagers – and the underlying factors that cause them have very little to do with age. What age does affect is how long someone has been living with the condition, which is a different thing entirely.

Here’s what’s actually going on.

What a bunion actually is

A bunion, known clinically as hallux valgus, is a structural deformity of the big toe joint. The first metatarsal (the long bone running toward the big toe) gradually drifts outward, while the big toe itself angles inward toward the second toe. The result is the characteristic bump on the inside of the foot at the base of the big toe, which is the head of the first metatarsal becoming more prominent as the joint shifts out of alignment.

It’s not a growth, and it’s not just a lump of skin. It’s a change in the actual position of the bones and joint, which is why it tends to be progressive – once the alignment starts to shift, the forces going through the foot with every step tend to push it further in the same direction over time.

So why do people assume it’s an old person’s condition?

Partly because bunions are more visible in older populations. The deformity takes time to develop to the point where it’s obvious, and by the time most people are seeking treatment, the bunion has been quietly progressing for years or even decades. So, the people you see with significant bunions tend to be older, even if the process started much earlier in their lives.

There’s also a historical association with narrow, pointed, high-heeled footwear – shoes that were far more common in previous generations and that can accelerate bunion development in people who are already predisposed. That association has contributed to the older-person stereotype.

But the underlying cause of bunions has more to do with genetics and foot mechanics than with age.

Genetics plays a much bigger role than most people realise

If one of your parents has bunions, there’s a significantly higher chance you’ll develop them too. What’s inherited isn’t the bunion itself, but the foot structure and joint mechanics that make someone prone to developing one – things like ligament laxity (how loose the joints are), the shape of the metatarsal head, and the way the foot pronates during walking.

This is why bunions sometimes appear in teenagers or young adults who have never worn narrow or ill-fitting shoes. The structural predisposition was there from the start, and the deformity simply begins to express itself as the foot matures and is loaded over time. These are sometimes called juvenile or adolescent bunions, and they’re more common than most people expect.

Who else is at higher risk?

Beyond genetics, there are several factors that contribute to bunion development regardless of age:

• Flat feet or overpronation: feet that roll inward significantly during walking place altered load through the big toe joint, which over time can contribute to the drift in alignment that leads to a bunion
• Hypermobile joints: people with naturally looser ligaments are more prone to joint instability in the foot, which can allow the deformity to develop more readily
• Footwear: narrow, pointed, or high-heeled shoes don’t cause bunions in feet that aren’t predisposed, but in feet that are, they can accelerate the process considerably by squeezing the forefoot and adding pressure to the big toe joint
• Being female: bunions are significantly more common in women than men, which is likely a combination of anatomical differences in foot structure and historically different footwear patterns
• Inflammatory joint conditions: conditions like rheumatoid arthritis can affect the integrity of the joints in the foot and contribute to deformity developing earlier or more severely

Does it matter when a bunion starts?

In some ways, yes and earlier is actually more concerning in certain respects, not less.

A bunion that begins in adolescence has the rest of a lifetime to progress. Because the deformity tends to worsen gradually over time without intervention, someone who develops a bunion at 15 is likely to be in a significantly worse position by the time they’re 40 than someone who developed one at 55. Catching it early, even when the deformity is mild and not yet painful, creates the most opportunity to slow progression and potentially avoid more significant intervention later.

This is worth knowing because younger people often dismiss a developing bunion as not worth worrying about yet. By the time it becomes painful or limits footwear choices noticeably, the structural change is usually well established. The window for the most effective conservative management is earlier than most people think.

Can bunions be treated without surgery?

This depends on the severity, how quickly it’s progressing, and what the person’s goals are. It’s worth being straight: conservative treatment cannot reverse the structural change that has already occurred. Once the bones have shifted, non-surgical options won’t move them back.

What conservative treatment can do, and does quite well, is slow or halt progression, manage pain, improve function, and reduce the likelihood of the bunion worsening to the point where surgery becomes necessary. That’s a meaningful outcome, especially in younger people where the stakes of long-term progression are higher.

Conservative management typically involves some combination of:

• Footwear advice: choosing shoes with a wider toe box that don’t compress the forefoot
• Orthotics: to address any contributing biomechanical factors such as overpronation
• Toe spacers or splints: to reduce pressure between the toes and provide some comfort, though these don’t correct alignment
• Exercises: to maintain joint mobility and strengthen the muscles around the big toe
• Padding or offloading for areas of skin irritation or callus

Surgery is considered when conservative management hasn’t controlled symptoms adequately and the deformity is significantly affecting quality of life or function. It’s a reasonably effective option when appropriate, but recovery is not trivial and it’s not a decision taken lightly.

How Hurst Podiatry can help

Whether you’ve noticed a bump developing on the inside of your foot, have a family history of bunions and want to understand your own risk, or have had a bunion for years and are wondering whether anything can be done – a podiatry assessment is a sensible starting point.

We’ll look at the severity of the deformity, the contributing factors in your foot mechanics, and give you a clear picture of what conservative management can realistically achieve for your situation. Early review gives you the most options.

Book an appointment with the team at Hurst Podiatry today, at our Kilsyth or Healesville clinic.