Why do bunions come back? I was told to wear open toed shoes or shoes with a wide box (place for the toes). I've done all that and still got the problem back.

Bunions. They are more than just ugly toes. The medical term is hallux valgus. Hallux refers to the big toe. Valgus describes the awkward angle that forms as the base of the metatarsal bone drifts away from the rest of the foot. Surgery for the deformity is more than just for cosmetic reasons. Hallux valgus can be very painful and disabling.

What causes them? Narrow, pointy shoes has been suggested as a potential cause. Reducing pressure from shoes rubbing against the misaligned bones is a definite part of why these deformities develop. But since not everyone who wears high heels or cowboy boots develops bunions, there must be other factors at play. Scientists are still looking at various possibilities to help us find better ways to prevent the problem.

Surgeons are also aware that there's an unacceptable rate of recurrence of this problem after surgery to correct it. Why is that? We're not sure but we may have a piece of the puzzle. In a recent study, surgeons from Japan have discovered that the position of the sesamoid bones is an important part of the problem.

The sesamoids are two tiny, pea-sized bones that sit just under the main joint of the big toe. They are embedded in the soft tissues and play an important role in how the foot and big toe work. If the sesamoid bones are not properly realigned after bunion surgery (called a bunionectomy), the deformity we call bunion is more likely to come back.

It's possible that these bones shifted after surgery, pulling the muscles, tendons, ligaments, and bones back out of place. If these bones aren't lined up exactly where they belong, the correction might not hold. Surgeons from Japan showed how this happens in a study of women with known hallux valgus compared with a similar group who did not have this deformity. When it was all said and done, they suggested closer attention by the surgeon to the position of the sesamoid bones. They must be put back in their proper place under the big toe to recreate normal foot biomechanics and avoid recurrence.