The most common cause of hallux valgus is poorly fitting shoes, according to the American Academy of Orthopaedic Surgeons. Shoes with a tight toe box that push the toes together can lead to the formation of a bunion. High-heeled shoes are the worst for this condition. In fact, the American Academy of Orthopaedic Surgeons state that studies have shown that the majority of women in the U.S. wear shoes that are too small, and over half of them have bunions. Other factors like improper foot mechanics due to altered arch height play a role. Hallux valgus can also result from genetic factors and conditions like arthritis and neurological disorders. Conservative treatments (e.g., orthoses and night splints) did not appear to be any more beneficial in improving outcomes and preventing progression than no treatment (4). Evidence suggests that custom-made orthoses are a safe intervention that may slightly decrease pain at 6 and 12 months (but no continued decrease in pain after 12 months) compared to no treatment; however, this improvement is less than that seen with surgical interventions (see below) (6). When bunions occur in children or adolescents, the condition may be termed juvenile or adolescent hallux valgus, respectively, and is thought to have an etiology different from that in the adult population. A fencing athlete was seen with her big toes (hallux) turned outwards (valgus), hence crowding into her second toe. She was lucky as she did not have any symptoms of pain usually seen in the prominent bunions. Gymnasts and dance athletes often suffered from painful bunions. She could consider using nights splints for the big toe, taping during training and some icing after training to assist her. If she wanted something off-training, she could buy a broad forefoot footwear and use a silicone gel spacing device between the toes. Reddened skin over the base of the great toe. Pain over the joint where the great toe joins the foot (MPJ) This patient has a marked hallux valgus deformity in bothfeet. As the first toe migrates more and more to valgus, it presses againstthe second toe, and may aggravate dorsal clawing of the second toe, whichis usually initiated by overload of the second metatarsal and synovitisof the metatarsophalangeal joint. Also note the relative hyperostosis ofthe second metatarsal shafts compared to the third and fourth, as well asdorsal rotation of the fibular sesamoids. Hallux valgus occurs commonly in osteoarthritis which is due to wear and tear of the joints. As a result of disease in the joint, the big toe can more easily become hallux valgus. Bunions. Many people think that you get bunions from wearing ill-fitting shoes (which certainly does not help!), but bunions are actually a genetic deformity. A bunion forms when the bone or tissue at the base of your toe becomes enlarged. Sometimes the bone of the big toe angles towards the little toe (a deformity known as hallux valgus). In either case, bunions can lead to significant pain as well as difficulty walking. Use of over the counter items such as a toe spacer and bunion sleeve can be used for symptomatic treatment. However, these devices will not affect the size of the bunion or prevent progression or the deformity. Suggestions to reduce the wear high-heeled shoes to the problems caused by the body, and experts put forward proposals as follows.Looking for a pair of high heels is consistent with your foot shape please. The pain caused by wear high heels for excessive sliding forward. The inside of the shoe should reserve enough space, inappropriate high heels would cause feet move forward and cause sufficient pressure stimulus causing pain. While wearing high-heeled shoes for your foot type can help relieve pain, correct the cause of foot pain. You should make sure that the shoes and feet, walking foot sliding will bring pressure to bear more toes. Bösch et al 5 first performed this technique in 1984. In a study of 114 patients with long-term follow-up, they demonstrated satisfactory correction of the intermetatarsal and metatarsophalangeal angles with no complications of hallux varus, pseudoarthrosis, or osteonecrosis of the metatarsal head. Magnan et al 7 reported on 118 patients with an average follow-up of 36 months, with good clinical results (91%) and a low recurrence rate (2.5%). The average angular correction obtained was 5° and 7.5° for the intermetatarsal and metatarsophalangeal angle, respectively. 7 Always select well fitting comfortable shoes for wearing and always make sure that your shoes are not irritating or rubbing your pedal skin.