Pilates for bunions: the big toe, footwork and shoes, what Pilates can and can't change, what the evidence shows, and the moves to start with

Pilates won't straighten a bunion

No trial has tested Pilates, or yoga, for bunions. The NHS: "You cannot get rid of bunions or stop them getting worse yourself", and surgery is the only way to get rid of one.

Sources 1, 2

Exercise may ease pain a little

Across 18 studies, less pain was more likely than a straighter toe, at low certainty. The best exercise trial, in 56 women, used toe mobilisation, big toe strengthening, toe grip, an ankle stretch and a toe separator.

Sources 3, 4

Shoes first

The NHS's self-care is wide shoes with a low heel and a soft sole, bunion pads, ice and painkillers, and not wearing high heels or tight, pointy shoes.

Source 2

Surgery is for pain, not looks

A year after surgery, 83% of people in one trial felt better, against 46% with insoles and 24% waiting. About 1 in 10 aren't happy with the result, and bunions can come back.

Sources 5, 6, 7

Protect the big toe joint in class

Skip toes tucked under your weight, stop heel raises and footwork short of full tiptoe if the joint hurts, and stand with your feet parallel if the Pilates "V" rolls you onto the big toe (our suggestions). The reformer's knee stretches kneel on bent-back toes.

Source 8

Know the warning signs

A sudden hot, red, swollen big toe joint needs help the same day: it may be gout, but it could be a joint infection. With diabetes, any new foot problem needs checking. The full list is below.

Sources 9, 10

A bony lump, and a big toe that leans inStrong evidence

A bunion (hallux valgus) is a big toe that angles towards the second toe, with a bony lump on the side of the foot at the base of the big toe. The Royal College of Podiatry says it is mostly an inherited foot shape made worse by tight shoes, and that "only surgery can correct the defect".

Sources 2, 11

Who gets themEmerging evidence

About 23% of adults aged 18 to 65 and 36% of those over 65 have one: 30% of women and 13% of men. In 3,077 older adults, 44% of women and 22% of men had one, but only 11% and 3% a painful one. Bunions run in families. In 2,627 women recalling their shoes, a narrow toe box in their twenties went with bunions later, an association rather than proof of cause. A 2026 review of 36 studies found that almost all the evidence on causes is from snapshot studies.

Sources 12, 13, 14, 15, 16

How they changeMixed evidence

In 1,482 people aged 50 and over followed for 7 years, 1 in 5 developed a bunion and a third of existing ones got worse, and nothing measured at the start predicted which. US surgeons' patient information says non-surgical treatment can "keep the bunion from getting worse"; the NHS says you can't stop one getting worse yourself, which fits the cohort better.

Sources 17, 2, 18

Bunions, toes and balanceEmerging evidence

Across 15 studies, older people who fell were more likely to have a bunion, foot pain or bent toes. In 312 people aged 60 to 90, a bunion went with more than twice the risk of falling, though the estimate was imprecise. In 1,253 adults, only foot pain, not the bunion itself, went with repeated falls. Toe strength, foot comfort and balance are what exercise can work on.

Sources 19, 20, 21

Big toe arthritis is differentStrong evidence

In big toe arthritis (hallux rigidus) the toe is stiff and "the bone bump is normally over the toe joint, not on the side as in bunion/hallux valgus deformity"; the Royal College of Podiatry says it "can also interfere with exercise such as yoga or pilates or even push ups". Our big toe arthritis guide covers it. A bump on the little-toe side is a tailor's bunion.

Source 22

What Pilates asks of the big toe

The big toe joint bends back in heel raises, balances on the toes, the toes position of reformer footwork, and kneeling with the toes tucked under. The classical reformer knee stretches kneel with the toes against the shoulder blocks, and the manual's precaution includes "inability to flex the foot or toes". Joseph Pilates designed "Toe and Finger Correctors"; the "Pilates bunion correctors" sold today are toe separators or stretchers, and no study has tested them under that name.

Sources 8, 23, 1

No Pilates studyStrong evidence

Our searches of PubMed, Europe PMC and ClinicalTrials.gov in October 2026 found no trial of Pilates, yoga or barefoot training for bunions, and none registered. Most mat Pilates is done off your feet, so it is unlikely to harm a bunion either.

Source 1

Exercise: pain more than the angleMixed evidence

A 2022 review of 18 studies rated the evidence low certainty: pooled analyses found no clear effects, and "a reduction in pain appears more likely than improvement in HV angle" (HV is hallux valgus). The best single trial: 56 women with moderate bunions had 36 sessions over 3 months of foot mobilisation, big toe strengthening, toe grip, an ankle stretch and a toe separator, and did better than a waiting list on pain, function, strength and the X-ray angle at 3 months and a year; it is one small, unblinded trial, and its summary gives no effect sizes. In smaller trials, a toe-spreading exercise added to a foot orthosis changed the angle more than the orthosis alone, in 24 people; supervised exercise beat a home programme; and adding electrical stimulation added nothing.

Sources 3, 4, 24, 25, 26

One review's estimate: about 3 degreesEmerging evidence

One 2026 review of 11 small trials (401 people) reported that exercise reduced the angle by about 3 degrees, and more with taping or insoles added. A letter about it and the authors' reply have been published, and we couldn't read either, so treat the number with caution. An earlier review of 11 studies ranked exercise with a toe separator, night splints and dry needling highest, without giving sizes in its summary. A few degrees is a small change, of uncertain importance.

Sources 27, 28

Keeping it up is the hard partEmerging evidence

In a 2023 pilot of shoes, insoles and a 14-exercise foot programme (3 times a week for 12 weeks, about 30 minutes a session) in 28 women, few finished it: 7% did 24 of the 36 sessions by the app's count, 43% by their diaries. The authors called for "making the exercise program less burdensome". A short daily routine of a few toe moves is easier to keep.

Source 29

Splints, separators and shoesEmerging evidence

A dynamic splint eased walking and running pain but "showed no effect on hallux valgus position" in 70 people. A silicone toe separator worn 6 hours a night for a year reduced the angle by 3.3 degrees while it worsened by 1.9 degrees without, and eased pain, in 90 people. A review of toe separators found 10 small studies, often poorly reported. The NHS says a GP or podiatrist can advise on insoles, toe spacers and splints, after shoes and pads.

Sources 30, 31, 32, 33, 2

Surgery: for pain that affects daily lifeEmerging evidence

In 209 people with painful bunions, 83% felt better a year after surgery, against 46% with insoles and 24% on a waiting list; insoles gave short-term relief. A Cochrane review found surgery may reduce pain against no treatment, at low certainty. About 1 in 10 people are dissatisfied, and how often bunions come back (from about 1 in 20 to about a quarter) depends on how it is measured and for how long. The National Institute for Health and Care Excellence (NICE) allows minimally invasive surgery, noting that pain and recovery time appear the same as with open surgery; small reviews agree, though their comparisons are fragile. Our bunions and bunion surgery guides cover this in full.

Sources 5, 34, 6, 35, 7, 36, 37, 38

Toes tucked under your weight

Our bunions guide: "Pressing the toes back under your body weight loads the bunion joint (editorial): ease in, or skip it." That includes kneeling with the toes tucked under and the reformer's knee stretches.

Full tiptoe

The slow calf raise's own caution: "With pain in the ball of the foot or big toe arthritis, stop short of full tiptoe." Doing the same with a painful bunion, in heel raises, footwork and balances on the toes, is our suggestion.

The Pilates stance

If standing with your heels together and toes turned out rolls you onto the inside of the big toe, stand with your feet parallel instead (our suggestion).

Forcing the toe straight

Our bunions guide on toe spacers and correctors: "Splints may ease pain, but any change in the angle is uncertain." Swap hard toe stretches for gentle big toe mobilisation.

Bare feet on hard floors

If standing work hurts barefoot, wear roomy, soft shoes for it (our suggestion, following the NHS's advice to wear wide shoes with a low heel and soft sole).

With numb feet or diabetes, do standing work and footwork in shoes and check your feet before and after (our suggestion; our Pilates for diabetes guide covers foot care).

Source 2

Footwork

The toes position (the balls of your feet on the bar) bends the big toe back under spring load. If it hurts, use the arches or heels position and lighter springs (our suggestion; no study). The classical manual suggests a pad over the footbar for "Sensitive feet".

Source 8

The knee stretches

The knee stretch series kneels with the toes bent under against the shoulder blocks, and its manual lists "inability to flex the foot or toes" as a precaution. Skip it if your big toe won't bend comfortably (our suggestion).

Source 8

Standing work and the jumpboard

Both push off the big toe. Keep them if they're comfortable, and leave them out while the joint hurts (our suggestion).

Bunion correctors and toe stretchersEmerging evidence

No study has tested "Pilates" bunion correctors under that name. Splints and toe separators eased pain in small trials, with no change or about 3 degrees of change in the angle. The Royal College of Podiatry says "there is no evidence they can correct the underlying deformity". Use one for comfort if it helps.

Sources 1, 30, 31, 11

Toe socks

No study has tested toe socks for bunions. Grip socks are fine on a mat if they don't squeeze your toes (our suggestion).

Source 1

ShoesStrong evidence

The NHS: wear wide shoes with a low heel and soft sole, try bunion pads, hold an ice pack wrapped in a tea towel to the bunion for up to 5 minutes at a time, take paracetamol or ibuprofen, and lose weight if you're overweight; don't wear high heels or tight, pointy shoes.

Source 2

Ask your surgical team first

The NHS says you'll usually need to keep your feet raised as much as possible for at least 2 weeks and avoid sports for 3 to 6 months. The British Orthopaedic Foot and Ankle Society says "It may take up to one year to recover fully".

Once your team agrees, lying and seated work that keeps weight off the foot usually comes first; standing work, footwork and heel raises come later (our suggestion). Our bunion surgery guide has the stages.

Sources 2, 7

Call 999 or go to A&E

• Call 999 or go to A&E: after an injury, you heard a crack, the foot or ankle has changed shape or points at an odd angle, a bone is sticking out, there is a bad cut over it, you're in severe pain, or the toes look blue or white, feel numb or are cold to touch. These can mean a broken bone. Don't drive yourself.
• Call 999 or go to A&E: you have diabetes and a foot ulcer with a fever or signs of sepsis, an ulcer with poor circulation, a possible deep infection of the soft tissues or bone in the foot (with or without an ulcer), or gangrene. The National Institute for Health and Care Excellence (NICE) asks for these to go straight to hospital.

Source 39

Get help the same day

• Same day: a sudden, very painful, hot, swollen, red joint, often the big toe but sometimes the middle of the foot (the midfoot) or the ankle, especially with a high temperature, feeling shivery or being unable to eat. It may be gout, but it could be a joint infection (septic arthritis), which is urgent.
• Same day: skin on the foot that is painful, hot and swollen. It could be a skin infection (cellulitis).

Sources 9, 10

With diabetes

• Same day: you have diabetes and a new foot problem, such as an ulcer or wound, signs of infection, or a hot, swollen foot with a change in colour, even if it doesn't hurt. Contact your diabetes foot team or GP: NICE asks for these to reach a specialist foot service within 1 working day, and a suspected Charcot foot is kept off weight until it has been checked.
• If you have diabetes, see your local foot team urgently, within 24 hours, for a change in the colour or shape of your foot (especially a red, hot, swollen toe, ankle or foot), part of your foot feeling much colder or hotter than usual, new blisters, cuts or wounds (especially ones you can see but don't feel), a cut or wound that smells bad or is leaking fluid or pus, or new or unexplained pain in your foot. Meanwhile sit or lie down, take the weight off it and raise it.
• Any foot pain if you have diabetes: foot problems can be more serious.

Sources 39, 40

See a GP or podiatrist

• See a GP if bunion pain hasn't improved after a few weeks of home treatment, is stopping your normal activities, or your bunions are getting worse, or if you have bunions and diabetes.
• See a GP if you have symptoms of gout for the first time, or your usual gout treatment isn't helping.
• Pain in one spot under the big toe joint that hurts with every step and later at rest or at night, especially after a rise in training: a possible stress fracture of a sesamoid, which heals slowly. Take the load off it until it has been checked.
• Pain that isn't better after 2 weeks of looking after it yourself, is getting worse, keeps coming back, or stops you doing normal things.
• Tingling or loss of feeling in the foot, or a foot that feels weak.

Sources 2, 9, 41

After bunion surgery

The toe drifting back, metalwork you can feel that rubs, or pain under the ball of the foot that isn't settling: see your team.

Our bunion surgery guide has the full list.

Chest pain or fainting while exercising: call 999

Call 999 if:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 42, 43

Unusual breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

Stop the session if

You feel any pain or become unwell, as the NHS advises for its Pilates videos, and especially for chest pain or pressure, unusual breathlessness, dizziness or fainting. If you have a health problem, an injury or any symptoms, get advice from a healthcare professional, such as a GP, before you start.

Source 44

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

Source 44

"Toe exercises, or Pilates, straighten bunions"Strong evidence

Non-surgical care eases pain more often than it straightens the toe, and single small trials report changes of a few degrees. The NHS says you can't get rid of a bunion yourself, and no trial has tested Pilates.

Sources 3, 4, 2, 1

"A bunion corrector or toe separator will fix it"Emerging evidence

A dynamic splint eased pain without changing the toe's position; a night separator changed the angle by about 3 degrees in one trial. Podiatrists say there's no evidence they correct the deformity.

Sources 30, 31, 11

"Bunions are caused by high heels"Emerging evidence

Bunions are mostly an inherited foot shape. Narrow toe boxes and past high heels go with them, but that is an association, not proof of cause, and men get them too.

Sources 14, 11, 15, 13

"Exercises stop a bunion getting worse"Mixed evidence

No trial has shown that. Over 7 years, nothing measured at the start predicted which bunions got worse. The NHS says you can't stop one getting worse yourself, though a US patient page says treatment can.

Sources 17, 2, 18

"Bunion surgery is for how your foot looks"Strong evidence

It's for pain that affects daily life. In one trial, 83% felt better a year after surgery, but about 1 in 10 people are dissatisfied, and the NHS says your toes may be weaker or stiffer afterwards.

Sources 5, 6, 2

"Pilates is bad for bunions"Mixed evidence

There's no evidence either way, and most mat work is off your feet. Change the moves that bend the big toe back under your weight.

Source 1