I saw a friend of mine at a coffee shop and he introduced me to his wife. He explained to her I was a foot surgeon. She launched into a tale of nightmare shoe shopping episodes, of pain with every new pair, and thinking that each would make her bunions gets worse. Then she asked, "Do shoes cause bunions?"

As a foot surgeon, this is one of the most frequent questions I get. The fact is, that shoes do not cause bunions; genetics cause bunions. If you have bunions you likely inherited them from your mother, father or grandparents. If you take a close look at the feet at a family gathering you can likely figure out who gifted you with the genes that led to your bunions.

Now, having said that shoes don't cause bunions, let me clarify by saying that shoes can (and often do) make them much worse. Wearing high-heeled shoes can significantly increase the stress on your big toe joint. All of that increased stress can lead to instability in the joints of the mid-foot that actually accelerates the speed with which a bunion forms.

So although it might have taken 40 or 50 years to develop a bunion wearing flat shoes, the same person may develop bunions 10 to 20 years earlier just because of the extra strain caused by high-heeled shoes. Even if the shoes don't have a gigantic heel, the shape of the shoe itself can also contribute to the early formation of a bunion. For example, cramped pointy toe shoes can push the big toe into a position that does contribute to the development of a bunion.

In addition, tight shoes and those with a seam that runs right over the bump (bursa) can make the bunion much more painful and irritated. Often times, tight shoes will cause bursitis (irritation of the bursa) or inflammation of the big toe joint. When this happens the bunion can become red, tender and inflamed.

The obvious solution to this is to avoid shoes that will likely cause bunions by increasing the amount of stress on the big toe joint. This means wear sensible shoes. Shop for shoes that have only a moderate heel; two inches or less. Use common sense.

If you have a function to attend such as a wedding, formal ball or charity event, it is unlikely that one night in pretty shoes will do any long-term harm. Just don't wear stilettos every day. You also want to make sure that you avoid shoes that have seams or stitching that will press or rub against the big toe joint, further irritating the bunion.

So, what is the bottom line when it comes to shoes and bunions? Well, have fun, shop for shoes, dress up when you need to be don't go overboard on the high heels or pointy shoes. Even though you might not be able to do much about the genes that you inherited, you don't necessarily have to end up with painful bunions.