Hallux valgus or Bunion

Hallux Valgus Genève

What is it?

Hallux valgus, more commonly known as a “bunion”, is a very common progressive deformity of the foot. It consists of the rotation of the first metatarsal around its base and of the shifting of the first toe towards the second. This results in the development of a painful bulge on the inside of the foot (= bunion). It is sometimes believed that this is a painful growth extending out of the edge of the foot. It is, in fact, a deformity between the metatarsal and phalanx that creates this lump. The lump is formed by the progressive pressure of the metatarsal head against the skin.


Pied normal vs Hallux Valgus - Oignon pied
  • Fig. 1

    Normal foot. Note the relative parallelism between the five metatarsal bones and their respective toe.

  • Fig. 2

    Hallux valgus (bunion) with rotation of the first metatarsal and toe

The causes of this deformity are multifarious and not fully understood. There seems to be a family link which suggests that hallux valgus may have a genetic component. Mainly affecting women (9 women for every 1 man), it is usual to find the condition in both mothers and daughters.

In all variants of hallux valgus, the first metatarsal fails to provide the necessary support. An important part of this stability is linked to the correct alignment of tendons in the feet and the hallux valgus, as a result of this deviation, alters the balance. In normal circumstances and in a standing position, the first metatarsal supports twice the load of the others metatarsals. When instability occurs, it tends to be noticed when walking or when putting weight on the foot and, in such cases, the metatarsal in question will only receive a fraction of the body’s weight. The remainder of the weight is supported by the next metatarsals along, which are not designed for such a load. For this reason hallux valgus is often associated with pain under the forefoot, thereby revealing the chronic stress on the central metatarsals due to this compensation overload (see transfer metatarsalgia). This is even more obvious in patients presenting with significant instability of the internal column (unstable internal column, hypermobile flatfoot, etc.).

Clinical presentation

The main problem is usually at the bony projection on the inner edge of the foot (= pseudo exostoses). It causes a conflict in the shoe, especially when wearing high heels or narrow shoes.

As explained above, many hallux valgus cases involve a shifting of the load from the first metatarsal to the next ones along, causing pain under the forefoot (metatarsalgia). And this is a common complaint.

When the condition is advanced and as the deformity progresses, the big toe will come into contact with the second toe and this can also become a source of conflict.

When should you consult a specialist?

Although non-surgical treatment options exist (such as changing footwear, etc.), hallux valgus is a progressive disorder and the discomfort it causes will generally increase over time. For many years doctors believed that patients should wait until the pain became unbearable before consulting; however, this is not currently true. This approach was indeed the case when techniques were not very effective and particularly painful.
The situation has now changed and leaving a hallux valgus untreated for too long can trigger other conditions (such as arthritis, hammertoe, etc.) or involve the need for more complex corrective surgery.

We advise that a specialist should be consulted when the discomfort causes a change in the quality of life or usual activities, when putting on shoes becomes difficult or when the deformity progresses rapidly.

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