Hallux valgus

Hallux valgus is a foot deformity. Many people have only mild symptoms, or no symptoms at all. But for others it can cause a lot of pain. Wearing well-fitting shoes and splints should relieve the symptoms. If that doesn’t help, surgery is also worth considering if there is a lot of pain.

At a glance

  • Hallux valgus is also known as a bunion and is one of the most common foot deformities.
  • With hallux valgus, the first metatarsal bone gradually moves out towards the other foot.
  • Treatment is only needed for the deformity if it causes problems.
  • Hallux valgus is more likely to happen in women.
  • It is estimated that about 1 out of 3 people over the age of 65 have a bunion to some degree.
  • If well-fitting shoes and splints do not alleviate the symptoms, surgery is an option.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Hallux valgus: shot of a woman’s two feet standing on the ground. The bigger toes on one foot are splayed and deformed.

What is hallux valgus?

People’s feet often change as they get older. Sometimes the big toe starts leaning in towards the other toes, and the joint at the base of the big toe bulges out more and more.

Hallux valgus is also known as a bunion. It is more likely to occur in women and is one of the most common foot deformities. Many people have a bunion with only mild symptoms, or no symptoms at all. But for others it can cause pain and pressure.

Wearing suitable shoes can relieve the symptoms. Surgery is the only treatment that can get rid of bunions.

What are the signs of hallux valgus?

In people who have hallux valgus (a bunion), the first metatarsal bone gradually moves sideways towards the other foot. As a result, the front of the foot becomes wider and the joint at the base of the big toe bulges out. The big toe leans in towards the other toes, sometimes deforming them too.

Bunions can be painful, but not all of them are – even if they are very big.

Bunions can increase the likelihood of osteoarthritis in the big toe joint and lead to chronic pain. The resulting deformity can make those affected unsteady on their feet, increasing the risk of falls.

What causes hallux valgus?

Ursachen für einen Hallux Valgus: familiäre Vorbelastung, ein schwaches Bindegewebe, andere Gelenk-Erkrankungen, verkürzte Achillessehnen und Wadenmuskeln

Several factors influence the risk of developing a bunion. Some people are more likely to have bunions because of their genes.

Contrary to popular belief, tight shoes aren’t the main cause. But they can contribute to the development of bunions and make the problem worse – especially shoes with high heels and pointed toes.

But some people regularly wear tight shoes and never get bunions. And some people nearly always wear comfortable shoes that are wide enough, but develop a bunion anyway.

The risk of bunions is greater in people

  • who have weak connective tissue,
  • a joint disease such as rheumatoid arthritis,
  • a short Achilles’ tendon, or
  • short calf muscles.

But they can also develop as a result of having a splayfoot or flatfoot.

How common is hallux valgus?

Bunions are far more common in women than in men – probably because they tend to have weaker connective tissue in their feet and are more likely to wear tight, high-heeled shoes.

Schätzungsweise 1 von 3 Menschen über 65 Jahren haben einen Hallux valgus.

It is estimated that about 1 out of 3 people over the age of 65 have a bunion to some degree. 

How can hallux valgus be prevented?

To prevent bunions, people are advised to wear comfortable, flat shoes. If there’s enough room for the front of the foot, there’s less pressure on the toes and the ball of the foot.

Other advice includes walking barefoot in order to strengthen the foot muscles and allow the feet and toes to be in their natural position.

Some doctors recommend using orthopedic shoe inserts (insoles). But there’s not a lot of research on how well this can prevent bunions.

How is hallux valgus diagnosed?

To determine whether foot problems are being caused by a bunion, the doctor will check whether the joint at the base of the big toe is bulging, look at the position of the toes in relation to each other, and see how well they can move. He or she will also look at the position of the legs.

The examination is done while the patient is standing, walking and sitting. The doctor also looks at the state of the skin on the foot, checks for signs of osteoarthritis, and, as part of the examination, asks about the symptoms and how they affect everyday life activities. To get a clearer diagnosis, the foot is x-rayed in a standing position.

Bunions can vary a lot in severity. The severity is determined based on the angle between the big toe and the foot bone leading up to it (the first metatarsal bone).

Important: The difference between a “normal” big toe joint and a bunion isn’t always clear. Many people have mild bunions that never cause any problems.

How is hallux valgus treated?

Bunions can get worse over time. But treatment is only needed if they cause problems.

The most suitable treatment will depend on a number of factors, including the symptoms, the type of deformity, and whether the person has other medical conditions such as rheumatoid arthritis, diabetes mellitus or vascular (blood vessel) disease.

It is worth first of all trying the following treatments to relieve the symptoms of bunions: splints, well-fitting shoes, physiotherapy and painkillers.

Splints

These are used to keep the big toe in a normal position. The aim is to relieve the symptoms and slow down the progression of the bunion – although it’s not clear whether this is possible. They can’t correct the misalignment. Splints are typically used at night.

Well-fitting shoes

People are advised to wear flat shoes that give the toes enough room. If the toes or big toe joint hurt, bunion pads can be used. If the middle part of the foot hurts (metatarsalgia), the toes can be cushioned or supported using shoe inserts or wearing special “rocker bottom shoes”. Walking barefoot as much as possible is also recommended.

Physiotherapy

Special exercises can be done to try to strengthen and stretch the foot muscles.

Painkillers

These may include non-steroidal anti-inflammatory drugs (NSAIDs) in the form of tablets or an ointment. Due to potential side effects, tablets should only be used over a short period of time.

Important: There have only been a few studies on these treatments so far. The study results suggest that measures such as physiotherapy, wearing well-fitting shoes and using splints can only provide very little relief.

If the symptoms are severe and don’t get better, surgery can relieve them. Surgery is the only way to treat the cause of the symptoms, by correcting the misalignment. But there’s no guarantee that surgery will make the symptoms go away completely, and it can also have side effects.

For more detailed information about hallux valgus, such as when it has to be corrected with surgery, visit gesundheitsinformation.de.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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