Hallux valgus (bunion)
Abnormal position of the big toe

A hallux valgus is a very common condition. It involves an abnormal position of the big toe. In addition to the fact that this can be troublesome and painful, some patients also find it unsightly.

An estimated 33 % of all adults have a certain extent of hallux valgus position abnormality. It is more common in women than in men.

Description of the condition

Hallux valgus is a condition that involves a deviation of the big toe in the direction of the other toes. The metatarsal bone that is located just before the big toe is rotated in the other direction (outwards). This results in a bump on the outside of the big toe. This is called a 'bunion'.

Cause and origin

It is not entirely clear exactly how hallux valgus develops. It can be the result of a congenital abnormality in the foot, hypermobility of the joints and excessive inward sagging of the foot. Tight, narrow shoes or shoes with high heels appear to increase the risk of developing a hallux valgus.

It is more common in some families. In addition, hallux valgus is more common in association with diseases that cause inflammation of the joints, such as rheumatoid arthritis.

Signs & symptoms

• Pain or difficulty walking.
  
• The pain is usually located along the side of the big toe.
  
• The big toe is bent inwards (towards the other toes).
  
• There is a painful bump at the base of the big toe that protrudes slightly (bunion). This bump can be inflamed and become red and swollen.
  
• Some patients have trouble finding shoes that fit.
  
• Narrow, pointed shoes and shoes with high heels make the pain worse.

Diagnosis

Treatment

Treatment is usually conservative. This means that the patient will be given the advice to wear wider shoes with low heels. Foot exercises can preserve joint mobility. Insoles or a night-time splint can combat the skewed position.

A surgical procedure can be considered if the condition causes severe pain or nuisance. Various techniques are used, which generally yield good results.

Exercises

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your area.

References
Barg, E.C., Eekhof, J.A.H. & Knuistingh Neven, A. (2008). Hallux valgus. Kleine kwaal. Huisarts & Wetenschap. Feb; 51(2):96-98.
Verhaar, J.A.N. & Linden, A.J. van der (2005). Orthopedie. Houten: Bohn Stafleu van Loghum.