Hallux Valgus: What Can a Podiatrist Do About a Bunion?
Your toes play an important role for your feet. They provide balance and are essential for the movement of your feet when walking. One of the most common conditions affecting the toes is hallux valgus. You may not recognise the name, but you’re likely familiar with the condition. Hallux valgus is a foot condition where the big toe bends towards the other toes, forming a bump (also known as a bunion) at the metatarsal joint on the inside of the foot. It’s a condition that affects about half of adults to some extent.
Symptoms of Hallux Valgus
‘Valgus’ means that something ‘deviates outwards’, and ‘hallux’ is the Latin medical term for the big toe. So, hallux valgus literally translates to ‘a big toe deviating outwards’. Due to the misalignment of the big toe, a bump forms at the base of the toe, at the metatarsal joint, which we call a bunion. The bunion can cause pain while walking, as it rubs against the shoe. Some patients with hallux valgus even experience pain across the entire forefoot.
The misalignment of the big toe can also push the other toes aside or even cause the big toe to overlap the second toe. This creates even more tightness in the shoe and can ultimately result in a misaligned second toe. In extreme cases, the big toe can even dislocate the second toe.
Causes of Hallux Valgus
We don’t know exactly what causes hallux valgus, but there are certain patterns in people who are more likely to develop it:
- The condition is more common in women than in men.
- It is more frequent in older people due to weaker foot muscles.
- It can be genetic and run in families. In such cases, it often presents at a younger age.
- The condition can occur due to (congenital) foot abnormalities such as rheumatoid arthritis, a shortened Achilles tendon, or flat feet. In the case of flat feet, the foot rolls differently when walking, placing more pressure on the inside of the big toe, causing it to push outwards.
- Wearing pointed shoes over many years can weaken and deform the muscles, contributing to the condition.
Treatment of Hallux Valgus
The severity of hallux valgus is determined by the doctor based on the angle of the hallux valgus. If the angle is below 19°, it’s considered a mild form of hallux valgus, 20° to 40° is moderate, and anything above 40° is classified as severe. Based on the patient’s preferences and the severity of the condition, the doctor will decide between conservative treatment or surgery.
*Pronation refers to the way your foot rolls inwards to absorb the impact of landing.
**Interdigital: between the toes.
Conservative treatments for hallux valgus are chosen based on the level of discomfort and the cause of pain.
- If discomfort is caused by shoe width or heel height: recommendations may include adjusting your footwear, such as using standard or (semi)orthopaedic shoes.
- If discomfort is due to intrinsic factors such as pronation* or hypermobility: functional foot orthotics, shoe advice and modifications, and physical exercises may be recommended.
- If discomfort is caused by skin irritation: an interdigital** silicone orthotic may be suggested.
- If discomfort is due to restricted movement in the ankle muscles or joints: physiotherapy or manual therapy may be recommended, possibly alongside footwear adjustments (e.g., a raised heel).
- If discomfort is related to pain and foot function: alternative treatment methods should be considered if no pain relief or improvement in foot function is observed within a month.
Surgical treatment may be necessary if pain and reduced foot function persist or worsen. However, surgery should be a last resort. Try not to wait too long before seeking treatment for hallux valgus: the smaller the bunion, the easier it is to manage with conservative treatment. So, book an appointment with one of our podiatrists soon, and get back on your feet with a straight toe!