What is Hallux Valgus (Bunions)? Why It’s Common in Women and Treatment Options You Should Know

Hallux valgus (bunions) is a foot deformity where the base of the big toe protrudes outward, caused by the middle bone angling inward and the tip bone angling outward. It typically develops from childhood.
Hallux valgus (bunions) is found in approximately 10-15% of the general population, with women being 3 times more likely to develop bunions than men.
The primary cause is often related to genetics and is associated with flat feet in some cases.
Symptoms include deformed big toe, wide forefoot, and pain at the base of the big toe from shoe friction. Patients are unable to wear narrow shoes or high heels as they worsen foot pain. In severe cases, inflammation may occur and cause pain even when walking barefoot.
Diagnosis includes physical examination and may require X-rays in some cases to assess the degree of angulation and plan treatment.

“Hallux valgus” or bunions is a physical deformity that many people may not be familiar with despite its commonness. It can be found in approximately 10-15% of the general population and occurs in women about 3 times more frequently than men. While this condition isn’t life-threatening, if left untreated without proper care and management, it can cause big toe pain. Especially at the base of the toe, the pain can lead to walking difficulty and affect the efficiency of daily activities.

Therefore, this article will help you understand what hallux valgus is and what symptoms to look for, enabling everyone to self-monitor their condition. We’ll also cover proper treatment methods so that all patients can return to normal daily life.

Table of Contents

What is Hallux Valgus?

Hallux valgus is a condition where the middle bone of the big toe angles inward while the tip bone angles outward, creating a protruding bump at the base of the big toe. When this bump hits the shoe wall or rubs against it during walking, it can cause foot pain. Hallux valgus is a genetic condition that typically becomes noticeable around the age of 8-9 years old. Parents may observe that their child’s big toe has an abnormal angle compared to normal children’s toes and often seek medical consultation.

Hallux valgus is a hereditary condition. While it doesn’t pass directly from parents to children 100%, it commonly runs through female relatives in families. For example, if a mother and aunt have the condition, daughters or nieces may also develop this foot deformity.

Additionally, hallux valgus or bunions are related to flat feet. People with bunions often have a higher chance of also having flat feet. However, this occurs only in some cases of hallux valgus patients. Other patients may have either flat feet or bunions, just one of these conditions.

What are the Symptoms of Hallux Valgus?

Typically, we can observe hallux valgus with naked eyes from childhood. If patients (or their parents) consult a doctor while not yet experiencing foot pain, the physician will recommend care methods to prevent the toe from angling further and developing painful symptoms. For cases with early symptoms, there is usually big toe pain from the protruding base rubbing against shoes while walking. Hallux valgus makes the patient’s forefoot wider than normal, making it impossible to wear narrow shoes. The tighter the shoes, the more compression and friction occurs, causing increased foot pain while walking. For women who like wearing high heels, the risk increases even more. Higher heels put more weight pressure on the forefoot, causing the protruding toe base to be compressed and hit the shoe wall more. This potentially results in foot pain.

The recommended footwear for patients with hallux valgus or bunions is “wide toe box shoes” to reduce the chance of toe friction against shoes and minimize pain. If left untreated or not properly cared for, the angled big toe will experience more friction and increased pain, potentially leading to inflammation. It may progress to the point of causing pain even when walking barefoot, preventing patients from walking, playing sports, or performing normal activities. Furthermore, if we leave the big toe to angle more, it may become severe enough to cause the big toe to cross over the index toe. This creates pressure sores where the big toe nail presses against the underside of the index toe.

How is Hallux Valgus Diagnosed?

The diagnostic examination and treatment planning for hallux valgus involves the following steps:

Medical history and physical examination: Hallux valgus is a condition that can be easily diagnosed. When visiting a doctor, patients simply remove shoes for examination as the abnormally wide forefoot and angled big toe are clearly visible.
Additional diagnosis for treatment planning: Doctors will perform additional X-rays on patients to plan appropriate treatment approaches based on the severity of the condition. Visual examination alone cannot determine how severe the internal bone angulation is. Therefore, X-rays help determine the degree of angulation, leading to appropriate and effective treatment planning.

What are the Treatment Options for Hallux Valgus?

Hallux valgus treatment approaches are divided into 2 main methods:

1. Non-surgical treatment methods

Non-surgical hallux valgus treatment is the approach doctors always use in priority. Most patients with this condition usually come to doctors with foot pain along with the angled big toe. Here are non-surgical treatment methods for hallux valgus:

Shoe replacement: Choose to wear wide toe box shoes instead of narrow shoes to reduce friction and decrease pain.
Wearing thick, soft socks: Combine this with wearing wide toe box shoes to minimize friction as much as possible.
Big toe stretching: This creates joint flexibility, helps reduce pain, and decreases the chance of increased toe angulation. Self-administered physical therapy for hallux valgus can be done easily by stretching the big toe in 3 directions and 3 angles: stretching up, pressing down, and pulling outward. Hold each position for 10 seconds and repeat this approximately 8-10 times per day.
Anti-inflammatory medication: Take as prescribed by the doctor.

2. Surgical treatment method

Doctors will perform surgical treatment for patients with hallux valgus only when foot pain interferes with daily life and treatment with medication, shoe changes, or physical therapy has not relieved the pain, or when pain continues to worsen.

Hallux valgus surgery involves bone realignment surgery, adjusting both the proximal and distal bones to straighten the toe. This eliminates the protruding bump at the base of the big toe, narrows the forefoot, and reduces foot pain. After surgery, metal fixation hardware must be placed internally to keep the bones in position and allow them to heal in the new position. Patients cannot immediately bear weight on the foot after surgery and must rest as well as avoid walking for approximately 4-6 weeks until the bones heal properly. Then, the patients begin to practice walking again.

In Summary

Hallux valgus is a condition that, even without painful symptoms that interfere with life, patients should care for properly to prevent the big toe from angling further and causing injuries that affect quality of life. Therefore, if you notice that your big toe appears abnormally angled, your forefoot is wide, you cannot wear normal shoes like other people, or you experience pain when wearing shoes and walking, you should promptly consult a doctor for diagnosis and treatment recommendations. This helps prevent foot pain from becoming more severe and interfering with daily life. This is especially important for women who have a higher risk of developing this condition than men, or those who enjoy wearing high heels and narrow fashionable shoes, which are significant factors that can worsen big toe angulation and increase foot pain.

An article by Korakot Thamphongsri, M.D., Experienced Foot and Ankle Surgeon, Sports Medicine and Shoulder Surgeon

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