What is Hallux Valgus?
Hallux Valgus is the medical name for bunion. It is where the big toe moves towards the smaller toes, creating an increased angle at big toe joint. The big toe joint then becomes more prominent. Hallux Valgus can be symptomatic or asymptomatic, i.e. not everyone who has hallux valgus has pain, and the condition can range from mild to severe.
How common is Hallux Valgus?
It is a common condition which affects 23% of adults between the ages of 15 – 65, increasing to 36% for over 65’s. Women are more commonly affected than men. (1)
What are the risk factors for developing Hallux Valgus?
There is no single reason for developing hallux valgus, it is believed there are many contributing factors; e.g:
- Family history – others in your family may have the same condition. (2)
- Foot shape – Long 2nd toes or flat feet may contribute to this condition.
- Muscle strength – weak muscles within the foot may contribute to developing hallux valgus.
- Ligament laxity – some conditions such as hypermobility can allow joints to move out of line more easily.
- Footwear – narrow shoes which constrict the forefoot can push the toes together. (3)
What are the symptoms of Hallux Valgus?
Not everyone who has hallux valgus has pain, and the condition can range from mild to severe. Sometimes they can cause;
- Pain, stiffness or swelling at the big toe joint.
- Difficulty walking due to discomfort
- The forefoot may widen (splay), which can lead to problems finding comfortable footwear which are wide enough for your foot.
- Skin problems such as callous and corns can develop due to pressure and friction from your shoes rubbing against your joint.
- The joint may develop a soft fluid filled swelling, called a bursa.
- Pain under the ball of your foot, under the small toes.
How long will it take to get better?
Hallux valgus unfortunately does not go away. Mild cases of Hallux Valgus are not known to cause any impact on foot function. Once you have hallux valgus, it may gradually increase in size and angle over time in some cases. Luckily many people do not have pain with their hallux valgus and continue with all their normal daily living activities.
What can I do to help my Hallux Valgus?
Treatment options for Hallux Valgus can be surgical or non-surgical. It is recommended you try all non-surgical treatment for Hallux Valgus before considering any surgical interventions.
Treatment is aimed at reducing stress through your toe joint to help reduce inflammation and improve function. Changes in lifestyle can also be helpful in reducing pain and discomfort. The one person who can help you manage your symptoms is you.
- Footwear
One of the most important changes you can make is to your footwear.
- Avoid narrow shoes
- Avoid high heeled shoes or shoes with a flexible sole as these place increased stress on the joints of the forefoot.
- Avoid shoes which have seams at the toe box that may irritate the toe joint.
Look for a shoe that has the following qualities;
- Heels should be broad and have a small heel, no more than 1.5 inches high.
- Soles should be firm and non-pliable.
- Wide fitting footwear to provide plenty of room for your toes and accommodate any potential toe deformity. You may want to consider shoes with an EE or EEE fitting, there are a number of specialist suppliers of footwear that provide wide fitting footwear.
- Lacing or Velcro straps to hold the shoe firmly to the foot. E.g. running or walking shoe
- A rocker at the forefoot can limit bending of the joint during gait and therefore reduce pain- see picture below. (3) Please click HERE to see footwear video. Please click here for further footwear advice with printout.
- Padding / Night splints
Bunion shields and toe separators can help to reduce symptoms of pain. Night splints may impact on shape positively and slow progression if your bunion is mild.
- Strengthening and Stretching Exercises
Targeted strengthening and stretching exercises for the small muscles in and around your foot and ankle can help to improve your symptoms and delay the progression of hallux valgus. (4) Local NHS Ayrshire & Arran podiatrists have devised exercise videos to help with strengthening the correct muscles. Please click HERE to access these videos.
- Activity Modification
Avoiding high impact activities and replacing with low impact exercise (e.g. replace running with swimming) until pain settles.
- Weight Management
If you have a higher than average body mass index (BMI) you may be more at risk. Please click here for further support with managing weight.
- Foot Orthoses
Foot orthoses may be considered if self-management and exercises have not improved your symptoms. Your local MSK podiatrist may prescribe some foot orthoses to wear in your shoes to try and offload the joint. Relief can be felt from a firm insole or one which provides support at the painful joint. (5)
Investigations / Surgery
Do I need a scan?
Hallux valgus is usually diagnosed primarily via a physical examination and patient history. Your clinician will assess your foot and toe positions when seated and when standing and walking. X-rays and additional imaging tests such as diagnostic ultrasound are not usually indicated unless non-surgical treatment has failed to improve your symptoms.
Will I need Surgery?
Surgical management is not usually considered unless you have tried all of the above measures and continue to have difficulty walking. If all non-surgical treatment has failed and you continue to have pain that is affecting your daily living then it may be appropriate for a referral to an orthopaedic surgeon to consider a surgical intervention. Surgery may be offered to reduce pain and correct your toe position. Recovery from this type of surgery usually takes between 3 to six months before getting back to normal activity, but everyone recovers differently. There are several surgical procedures for this condition, and the method used would depend on the size and severity of your hallux valgus.