Do Pointe Shoes Cause Bunions? What Dance Medicine Says

Ask a room of dancers what causes bunions and you will get one answer. Pointe shoes. It is such a settled belief that most foot products aimed at dancers — including, until recently, some of ours — are sold on it.

The dance medicine literature is much less sure.

What a podiatrist found when she went looking

In 2017 the International Association for Dance Medicine & Science published a summary of a literature review presented at its 2016 conference. The author is a podiatrist who has bunions herself. She notes, almost in passing, that hers were never a problem while she was dancing — they got worse after she stopped.¹

Her review reports that while hallux valgus is particularly common in dancers, much of the research suggests that dancing is not a likely cause of it. Under a heading titled "common misconceptions", she lists four things that have been shown not to be significantly associated with hallux valgus in dancers:

• average dancing hours per week
• hours of pointe work per week
• total years of doing pointe work
• the age at which pointe work started

Read that list again. It is every variable a dancer worries about.

Why this is strange, and worth sitting with

Bunions really are more common in dancers. Reported prevalence ranges from 36.8% to 54.9% depending on the study.² The general adult population sits around 12% between the ages of 20 and 60.³

So dancers get more bunions — but not in proportion to how much they dance, how long they have danced, or how young they started. Something is elevating the rate, and by these findings it does not appear to be the accumulated exposure everyone assumes.

It gets less settled still. A radiographic study has been reported to find hallux valgus angles in both active and retired professional dancers similar to non-dancers. Much of the prevalence data also comes from dancers aged 8 to 16, measured by different methods across studies.

What this means for anyone selling you something

If hours on pointe are not significantly associated with bunions in dancers, then a product sold on the premise that it counteracts those hours is selling you a story the evidence does not support.

We used to tell that story. An earlier version of this article opened with retired ballerinas looking back with regret, and promised that our product would slow or prevent the progression of bunions and hammertoes. It cited the IADMS review above in support. We had not read past the title.

So, plainly: we do not claim Toe-Rx prevents bunions. No trial has tested prevention — in dancers or in anyone else. The conservative-treatment research that does exist was done in people who already had hallux valgus and were not dancing.

What we do claim

Something narrower, and better supported. MRI comparisons of ballet dancers and non-dancers found only two plantar intrinsic muscles consistently larger in dancers — the flexor digitorum brevis and the lumbricals.⁴ Both flex the toes. Years of pointe work build the muscles that curl your toes. They do not build the ones that spread them.

And spreading is trainable. In an eight-week trial, 24 people with hallux valgus all wore an orthosis; only half also performed a toe-spread-out exercise. The orthosis-only group showed no significant change in anything measured. The group that added the movement improved in all three measures, including the size of the abductor hallucis.⁵

That is the whole claim. Toe-Rx works a direction ballet does not go. Whether that has any bearing on bunions is not something anyone has tested, and we are not going to imply that it does.

If you are worried about your feet

Take it to a clinician rather than a product page. That advice costs us a sale and we would still give it, particularly to this audience — dancers are documented as reluctant to seek medical attention, which is exactly the problem. Pooled data from 13 trials of foot muscle training found no significant improvement in pain.⁶ Whatever this kind of work does, relieving pain is not the thing it has been shown to do.

And read the IADMS piece yourself. It goes on to discuss technique and other factors specific to female dancers, which is more than we have covered here.

The longer version

We have written up the full research on dancers' feet separately — every figure sourced, every limit stated, including the studies that argue against us.

Strong feet, in one direction — the research on dancers' feet

*These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease. Nothing here is guidance on pointe readiness, which belongs to your teacher and a clinician who can see you dance.

References

1. Maddocks M. Bunions in ballerinas: it's not really the shoes! International Association for Dance Medicine & Science, 2017. Read it
   A blog summary of a literature review presented at the 2016 IADMS conference, not a peer-reviewed paper. It cites its own underlying sources, which we have not individually verified.
2. Liu Z, Okunuki T, Yabiku H, Chen S, Hoshiba T, Maemichi T, et al. Hallux valgus in preprofessional adolescent dancesport athletes: prevalence and associated training factors. Journal of Foot and Ankle Research. 2024;17:e12043. Read it
   The source of the range quoted. Note that the prevalence figures it collects come from studies using different measurement methods, several of them in dancers aged 8 to 16.
3. Global prevalence and incidence of hallux valgus: a systematic review and meta-analysis. Journal of Foot and Ankle Research, 2023. Read it
4. Fukuyama H, Maeo S, Kusagawa Y, Sugiyama T, Kanehisa H, Isaka T. Differences in the size of individual plantar intrinsic foot muscles between ballet dancers and non-dancers. Journal of Dance Medicine & Science. 2025;29(2):91–97. doi:10.1177/1089313X241273887. Read it
   Cross-sectional MRI. It found which muscles were larger; it did not test an intervention, and it does not say the others are weak.
5. Kim MH, Yi CH, Weon JH, Cynn HS, Jung DY, Kwon OY. Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus. Journal of Physical Therapy Science. 2015;27(4):1019–1022. doi:10.1589/jpts.27.1019. Read it
   24 participants, none of them dancers, all with hallux valgus already established. Both groups wore an orthosis, so this shows what adding the exercise did — not what the exercise achieves alone.
6. Jaffri AH, Koldenhoven R, Saliba S, Hertel J. Evidence for intrinsic foot muscle training in improving foot function: a systematic review and meta-analysis. Journal of Athletic Training. 2023;58(11–12):941–951. doi:10.4085/1062-6050-0162.22. Read it
   13 trials pooled, in the general population rather than dancers. Pain was measured and did not significantly improve.