Hallux valgus (bunion)

Hallux valgus or a 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. This deformity is painful and requires treatment or surgery.

Causes

It is usually caused by a congenital weakness of the connective tissue in combination with a splay foot. The crooked position of the big toe causes the pressure on the foot to be unevenly distributed across the foot arch. The foot arch then starts to sag. The ball of the large toe is pushed outwards and the head of the first metatarsal bone is pushed inwards.

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 encourage the development of splay feet and incorrectly positioned toes.

Symptoms of hallux valgus

This creates an unhealthy tension on the tendons of the big toe, gradually pulling the big toe outwards. The result is the typical hallux valgus position. The balls of all the toes become calloused, while pain and inflammation make it difficult to wear shoes.

Characteristic symptoms of hallux valgus are:

  • Development of calluses on the inner side of the ball of the foot
  • Sensitivity to pressure when wearing shoes
  • Pain caused by the inflammation of the joint bursa

Over time, this can lead to osteoarthritis in the first and second toes. Bunions often also result in the development of hammer toe or claw toe.

Hallux valgus restricts the ability of the big toe to provide support, which puts excessive strain on the second metatarsal bone.

Diagnosis

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.

Conservative treatment

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 exercises and physiotherapy, and with special shoes or a bunion splint worn at night. However, where surgery is concerned, sufferers should not wait too long.

With more severe cases, the symptoms may worsen despite the use of a bunion splint. Malposition of the toe also results in wear to the metatarsophalangeal joint (osteoarthritis) and deformation of the neighbouring toes, possibly bringing about further symptoms.

Surgical treatment

Hallux valgus can frequently only be corrected with an operation. Hallux valgus surgery corrects the malformation of the metatarsal bone and the toe bone. Irritating soft tissue enlargements (ball of the foot) are also usually reduced in size during this procedure. Hammer toes or claw toes can also be surgically treated.

Surgery for deformities of the foot and toes is low-risk and generally takes place without complications. Find out more about the surgical treatments available in the Hallux valgus surgery section.