A U.S. study shows that big toe osteophytes are linked to family, not shoes. The Framingham Foot Study looked at 1,370 adults and found a significant family history of bunions. British podiatrists noted that the study supports their view that shoes may make the condition worse, but that shoes are not the root cause of the condition. The main manifestation of a bunion is the big toe pointing toward the other toes, which forces the metatarsal bones to protrude. This change in appearance can cause swelling, tenderness and pain in the foot. If the symptoms are unbearable, surgical intervention is required to remove the cyst. Women have a higher incidence of this condition, so it is mistakenly believed that high heels or sickly fashionable shoes are responsible for this condition. However, this is only because shoes can aggravate the symptoms by causing pain due to pressure rubbing on the toes, but it is not the wearing of shoes that causes this disease.