In 2025, Edna Yong spent an unplanned $700 on three pairs of increasingly wider shoes because of her bunions. The 39-year-old tax manager and avid hiker was getting ready for a hiking holiday in Georgia.

She had lived with bony protrusions from the base of her big toes since secondary school, wearing mostly wide-cut shoes and sandals for comfort.

In 2025, the bunions began giving her discomfort on practice hikes ahead of her trip. She bought and discarded two pairs of hiking shoes before finding a third pair that fit, spending between $700 and $800 for comfortable footwear for one trip.

After her holiday, she opted for bunion surgery to keep up with her outdoor hobby.

“I knew I wanted to continue hiking, so I decided it was time to solve the problem rather than just live with it,” she says. She has been on two hiking trips in Johor Bahru in 2026, without discomfort.

About 20 per cent of people worldwide have bunions, a deformity of the big toe bone and joint that affects more women than men.

People with mild cases may not notice any symptoms, but as the bunion progresses, it can cause discomfort while standing, walking and running. It can affect the morphology of other toes and contribute to decreased levels of activity.

Conservative treatment such as rest and painkillers can relieve symptoms, but Yong’s doctor James Siow says the problem does not go away. “Bunions are known to worsen over time,” says the senior consultant orthopaedic surgeon at Oxford Orthopaedics.

With more older people hoping to stay active as they age, it then becomes important to consider various options, including keyhole surgery to straighten the toe, he adds.

Bunions are seen as bony prominences near the base of the big toes. They are known by the scientific term “hallux valgus”, which refers to the “hallux” or big toe bending or twisting out.

Siow says that as the big toe deviates towards the smaller toes, the ligaments are stretched and other structures tighten up, forcing a deformity.

As the deformity worsens, the second toe may bend or curl in a hammertoe, or cross over or under the big toe.

Some people may develop a “bunionette” or “tailor’s bunion” on the opposite side of the foot at the base of the little toe, he adds.

Senior consultant orthopaedic surgeon Tay Guan Tzu says bunions can be hereditary and seen in members of the same family.

Women have a higher risk of developing bunions, adds Tay, who is with private practice Pinnacle Orthopaedic Group under Foundation Healthcare.

Having flat feet or high flexibility in the joints (hypermobility) can also lead to the formation of bunions.

Apart from genetics and biomechanics, repeated impact or ligament injury can lead to the formation of bunions.

Siow says some of his male patients with bunions play football and have the condition on the kicking foot.

Tan Ken Jin, orthopaedic surgeon from Mount Elizabeth Novena Hospital, says many of his patients are ballerinas or people who spend time pushing off the toes, such as runners or players of high-impact sports.

Another risk factor more common to women is wearing tight shoes or heels.

Aerobics instructor and retired office worker Christina Low, who is in her 60s, blames her bunions on her preference for heels.

“I used to wear high-heeled shoes that were pointed and narrow,” she says of her corporate days. “I could walk to the bus stop in three-inch heels.”

When she was in her 40s, her bunions began giving her problems.

She is an avid runner who has completed 12 marathons and three half-marathons. As the bunions worsened, she had to switch her regular run distance from 8km to 3km.

“It was so frustrating because running is my first love,” she says.

Tay says that while not everyone with bunions complains of symptoms, those who do may find the pressure of footwear painful over the bunion. The toe joint, too, may ache.

Flat feet are often seen alongside bunions, which makes matters worse.

“People may find it difficult to find comfortable footwear or be able to engage in activities that require longer periods of standing or walking,” he says.

Callouses and wounds also build up as the bunions rub against the inside of the shoe.

Over the years, Low gave up on her preferred narrow-cut shoes. She wore plasters to reduce the friction, but also developed callouses in that area.

“The cost for constant pedicures to shave down the callouses added up to quite a lot,” she recalls.

She had bunion surgery some years ago. She is now back to walking, standing and travelling without discomfort.

She also teaches a cardio class once a week, works out at the gym twice a week and runs up to three times a week.

“I love travelling, moving around and staying busy, so being able to move comfortably is very important to me,” she says.

Personal trainer Neha Mehta, 46, noticed a pinching sensation on the sides of her feet after running more than 8km.

“I started to need wider shoes,” she says. “Previously, my feet were not that wide.”

As a bunion worsens, it can lead to muscle imbalance and pain in other parts of the leg.

Siow explains that with bunions, the push-off from the big toe is affected. Pressure is not transmitted evenly throughout the foot and the outer borders of the foot have to compensate. The stride shortens and the ankle, knee and hip are affected.

To make up for her bunions, Mehta works out at a gym, Tribody Fitness, where she can stay barefoot when strength training. This allows for better grounding and foot awareness to ensure proper form.

She also stretches several times a day to alleviate the strain on her toe joint. The stretches include pressing the big toes downwards while lifting the other toes, and vice versa.

Tay says conservative treatment should be considered first when it comes to bunions. These can include wearing wider shoes and customised insoles to compensate for other issues such as flat feet.

Some people like footwear with toe separators. Mehta prefers sandals that have toe straps, for example.

Tan says resting and elevating the feet and icing the bunions can provide relief.

Orthotic insoles can help support the foot arch or otherwise improve movement.

Jackie Tey, director and chief podiatrist of Straits Podiatry, says that insoles and proper footwear can help manage bunions but not correct them. They can be corrected only through surgery.

However, strengthening foot muscles and wearing the right shoes, with or without customised insoles, can help delay the progression of bunions.

How do you know if you need insoles?

Tey says that if switching to supportive sports shoes does not provide comfort, or if the bump becomes more prominent over six months, customised insoles are recommended.

In people with mild bunions, these insoles can improve structural stability for the foot and the function of the big toe joint during the push-off phase of walking.

Insoles can be designed to reduce pronation if people have flat feet.

“For later-stage painful cases, the insoles can be designed to specifically offload and redistribute pressure away from the painful areas, whether it is the big toe joint or the lesser toe joints,” Tey says.

Good insoles can last a client two to five years, he adds. The client may feel slightly odd for a day or two with insoles, as these are designed to help correct foot movement.

However, insoles should not cause pain, he says.

Surgeon Tay calls bunion surgery the “nuclear option” for treatment. It should be performed only to alleviate symptoms. He turns away requests from people who want this surgery for aesthetic reasons.

“There are many with bunions who are asymptomatic and only need to be reassured,” he says. “There is also a large group who do very well with conservative measures and are able to return to the activities they enjoy, such as running, dancing and skiing.”

Surgery is considered when conservative measures fail, such as in the case of orthodontist Geraldine Lee.

The 46-year-old sees up to 60 patients a day at her practice, The Orthodontic Clinic. Apart from being on her feet for a long time every day, she goes for weekly tennis lessons, a weekly long walk or run, and a weekly gym workout or pilates session.

In 2025, her right foot developed a painful bunion. “I brushed it off thinking it was just a muscle strain. Unfortunately, it became progressively worse and I couldn’t play tennis anymore or even run more than 1km,” she says.

Lee opted for bunion surgery in February and had a minimally invasive procedure. This allowed her to return to work within days, though her nurses had to wheel her from one treatment room to another in her orthodontist chair.

Her doctor Tan says this minimally invasive surgery works when the bunion is not too severe. An instrument known as a burr is used to make cuts on the bone and correct the alignment of the big toe.

“More than 50 per cent of the time, we do this as day surgery,” he says. “Even if we do both feet, patients are able to walk immediately, wearing a special, thick, post-operative sandal.”

More serious cases might need open surgery with a long incision to lay the bone bare.

This is why he recommends early intervention with bunions when the deformity is less severe.

Another reason for early intervention is that bone density tends to drop in women with menopause, affecting the effectiveness of the surgery.

Lee says the surgery has helped her return to active life without discomfort. Before it, she could not play tennis for 10 minutes with her two sons. She thought twice before going out for a leisure run and had to ice her foot some nights to reduce discomfort and get to sleep.

“Being an active person, it frustrated me when I was unable to work out or perform my usual activities,” she says.

“My biggest piece of advice is, don’t wait until the pain is unbearable to see an orthopaedic surgeon to have your bunions treated. Listen to your body before the damage worsens.”