Hallux valgus (bunion)

Hallux valgus is a condition whereby the big toe leans over towards the other toes. It is usually caused by a splay foot and weakness in the connective tissues. The crooked position of the big toe causes the pressure on the foot to be unevenly distributed across the foot arch. As a result, the foot arch sags and the balls of the large toes are pushed outwards. The balls of all the toes become calloused, while pain and inflammation make it difficult to wear shoes.

A hallux valgus deformity (bunion) is a condition whereby the big toe becomes crooked. Hallux is the Latin word for the big toe and valgus means ‘turned outwards’.  So the big toe points away from the body, towards the other toes. It is usually caused by a congenital weakness of the connective tissue and the ligaments. This weakness promotes the development of a splay foot, which means the foot arch becomes more flat. As the foot arch flattens, the head of the first metatarsal bone gets pushed inwards (towards the other foot). This creates an unhealthy tension on the tendons of the big toe, which gradually pulls the big toe outwards (towards the smaller toes). The result is the typical hallux valgus position.

Women are affected by bunions far more frequently than men. In part this is attributed to women’s slightly more pronounced connective tissue weakness, however women’s footwear is overwhelmingly thought to be the cause of the condition. Tight shoes with high heels promote the development of splay feet and incorrectly positioned toes.

Common symptoms of hallux valgus include the development of calluses on the inner side of the balls of the feet, sensitivity to pressure when wearing shoes and pain caused by the inflammation of the joint bursa. Over time, it can lead to osteoarthritis of the joints in the first and second toes. Bunions often also result in the development of hammer toes or claw toes.

The diagnosis is based on the appearance of the foot and the symptoms. An x-ray examination is used to determine the extent of the bunion and identify any changes in the joints.

The treatment of hallux valgus depends on the extent of the deformity and the level of pain and discomfort. Mild cases can be corrected using targeted physiotherapy and special shoes or a bunion splint that is worn at night.

But often bunions can only be corrected with an operation. Bunion surgery involves straightening (and potentially shortening) the metatarsal bone. Hammer toes or claw toes can also be surgically treated. Find out more about the surgical treatment options in the hallux valgus surgery section.