Footwear Recommendations for Bunions (Hallux Valgus)
For individuals with bunions, the primary footwear recommendation is to wear shoes with a wide, soft toe box that accommodates the deformity and minimizes friction on the painful prominence. 1, 2
Initial Conservative Management
The first-line approach for symptomatic bunions should always be non-operative, centered on appropriate footwear modifications 2:
- Wide toe box shoes are essential to accommodate the medial prominence and prevent pressure on the bunion 1, 2, 3
- Soft-toed shoes or sandals help reduce friction and irritation over the bony prominence 1
- Hard-soled shoes or rigid inserts may be beneficial if hallux rigidus (stiffness) coexists, as they restrict painful motion across the metatarsophalangeal joint 3
- Avoid constrictive footwear that generates friction between the bony prominence and soft tissue, which can lead to keratosis, inflammation, pain, and ulceration 4
Additional Supportive Measures
Beyond footwear selection, several adjunctive treatments have evidence supporting their use 2:
- Orthotics/cushioning shoe inserts can help redistribute pressure and provide additional comfort 1, 2
- Toe spacers and splints/braces have demonstrated benefit for symptomatic relief 2
- NSAIDs (nonsteroidal anti-inflammatory drugs) can be used temporarily for pain management 1, 2
Key Footwear Features to Prioritize
When selecting appropriate footwear, ensure 1, 3:
- Plenty of room in the toe box to prevent compression of the deformity 1
- Minimal friction on painful areas 1
- Adequate width to accommodate the increased forefoot width from the bunion 3
Important Clinical Considerations
A common pitfall is patients seeking surgery for cosmetic reasons alone—this is not an indication for operative management. 2 Surgery should only be considered when:
- The patient has exhausted non-operative treatment options 2
- There is persistent painful prominence despite appropriate footwear modifications 2
- The patient is a suitable operative candidate 2
For pediatric or adolescent patients with juvenile bunions, surgery should be delayed until skeletal maturity is reached 2.
Smoking is a relative contraindication to bunion surgery, and cessation should be strongly recommended before considering any operative intervention. 2