Hallux valgus: definition, symptoms, causes and treatment

By Cristiano Antonino On Feb 14, 2023

Although it is not talked about too often and is underestimated in most cases, hallux valgus is not just a cosmetic problem, but a condition that can affect anyone and cause serious complications ranging from intense pain to difficulty walking

Looking at the data (source: GVMnet), it emerges that more than a third of Italian women suffer from this disorder; inadequate footwear, incorrect posture and individual predisposition are all accomplices.

Specifically, women are the gender most affected with a ratio of 15:1 compared to men.

According to estimates, about 40% of women in Italy are affected and the most affected age group is between 40 and 60 – with a peak between 45 and 50 – although it can occur at any age. In fact, there are also juvenile forms that appear around 20-25 years of age or forms that appear in conjunction with degenerative diseases such as arthrosis, which then appear at a later age.

What is hallux valgus?

Hallux valgus is a deformity that affects the first toe – at the level of the metatarsophalangeal joint – which is deviated laterally in the direction of the other toes; this results in a medial protrusion of the first metatarsal bone that appears as a bulge at the level of the medial side of the foot.

The angle that is formed between the big toe and the second toe gradually changes, resulting in the base of the big toe moving outwards.

Over the years, the deformity may also affect the other toes. Usually, this change in bone structure is associated with constant or intermittent inflammation of the bursa serosa located at the base of the big toe, thus causing pain. In addition, the medial protuberance – the so-called ‘onion’ – tends to worsen with shoe rubbing and it is not surprising that, if neglected, this problem tends to become chronic and degenerate. The cases (75% of the total) in which hallux valgus affects both feet are particularly frequent.

Prevention: is it possible?

It is not easy to prevent the onset of hallux valgus, because most causes are a genetic predisposition and incorrect posture.

However, the deformity may occur due to wearing narrow, high-heeled and pointed shoes, so you can reduce the likelihood of developing the condition by wearing comfortable, functional shoes.

It is important to ensure that they are the right size, that they leave the correct space for the toes to move freely and that they balance the weight between the heel and the front of the foot well.

Hallux valgus symptoms

Obviously, the most obvious symptom is the deformation of the metatarsophalangeal joint of the first toe.

The progressive change in the angle of the big toe leads to various complaints: in the initial or less severe forms, there is inflammation of the 1st metatarsal with the onset of the typical swelling on the medial side of the foot (the so-called “onion”), which can be reddened and oedematous due to rubbing shoes, causing pain and difficulty in walking.

In advanced forms, the deviation of the big toe becomes increasingly pronounced, to the extent that the other toes are also affected: the load is transferred to the middle toes, causing pain (metatarsalgia) and further deformities (hammer toes).

From an aetiological point of view, the main cause of the onset of hallux valgus can be traced back to genetic factors, such as flat or hollow feet.

In addition, the weight of risk factors such as wearing unsuitable footwear must be evaluated.

In the event that the disease arises in adolescence or even childhood, the causes can certainly be attributed to a genetic predisposition.

The secondary cause – as mentioned earlier – of hallux valgus is the use of unsuitable footwear: when the bare foot is placed on the ground, the load is divided 55% on the heel and the remaining 45% on the toes.

If we use a 2cm heel the load is rebalanced, dividing equally between the two areas, but if we raise the heel, for example to 9cm, the load will be totally unbalanced: 80% on the forefoot and 20% on the heel.

The situation gets even worse when the shoe, in addition to having a high heel, also has a narrow toe: in this way the big toe and 5th toe are pushed towards the centre of the foot, in the “in valgus” position for the big toe.

To recapitulate, the causes can be:

Congenital: alterations in the morphology of the foot present from birth, such as flat or hollow foot. Those who suffer from these disorders are more likely to develop hallux valgus. Those who are familiar with the problem also fall into this category, a sign that the development of the pathology is in some way linked to hereditary factors.
Secondary: footwear that is unsuitable for the physiology of the foot, such as shoes with high heels and narrow toes or shoes that are too small, forcing the big toe into an unnatural position.
Consequences of diseases such as rheumatoid arthritis and gout.

Consequences

In addition to chronic and recurring pain and inflammation, hallux valgus can lead to bone lesions, ulcers, calluses and, in severe cases, a functional impairment of the dynamics of the foot.

Over time, this disorder can turn into a true postural syndrome, since correct positioning of the big toe is a fundamental condition for correct walking.

We can thus divide the consequences of hallux valgus into two broad categories:

Local consequences, which affect the foot specifically, such as joint degeneration, bursitis, metatarsalgia, deformities and dislocations of the toes.
Postural consequences, such as a tendency to valgus knee, resulting in pain in the internal components of the knee, stiffness in the hips, accentuation of the lumbar curve associated with chronic low back pain.

Hallux valgus, diagnostic investigations to be performed

Typically, the course begins with an outpatient examination in which the doctor will assess the patient’s general condition, checking the posture both when standing and when walking.

The way the patient’s foot rests on the ground may be assessed.

An X-ray will then be taken, again in the standing position, in order to check the load on the foot, which makes it possible to establish the angle of valgus in order to direct the patient towards the most appropriate treatment.

After these initial investigations, if the doctor considers it appropriate, further instrumental investigations such as ultrasound, MRI or CT scan may be necessary.

Only after obtaining a clear and complete picture of the situation, also taking into account the patient’s lifestyle, habits and needs, will the doctor be able to propose a personalised treatment plan that succeeds in taking all factors into account.

Treatment: conservative treatment or surgery

In the early stages of the pathology, conservative treatment can be used to avoid worsening, but the pathology can only be resolved with surgery.

Therefore, at first, the use of comfortable shoes with wide soles and low heels will be recommended, as well as orthotics, braces and appropriate medical devices, but also pain-relieving drugs for the eventual management of painful symptoms.

In more severe cases, surgery will be recommended. Today, there are many techniques and the choice will differ from case to case: the surgical procedure suitable for each patient will be identified, which the doctors will determine on the basis of various parameters including age, extent of the deformity and general condition of the foot.

The post-operative course

In principle, thanks to post-operative footwear and bandages, the patient will be able to put his feet on the ground immediately without the use of crutches.

Checks will then be made after a few days to assess the progress of the situation.

Generally, a new X-ray check will be carried out after about 45 days.

Complications

As mentioned earlier, hallux valgus cannot be resolved without surgery, however, if treated early, rapid degeneration can be avoided.

A delay in the start of treatment can worsen the symptoms, leading to the onset of further complaints such as arthritis in the joints and deformity of the other toes, which are ‘pushed’ by the big toe out of their physiological location.

Surgery may also be associated with certain complications, such as infection, stiffness in the toe joints, healing of the bone in the wrong position, thickening of the scar tissue, or recurrence of hallux valgus with the need for further surgery.

Reactive Arthritis: Symptoms, Causes And Treatment

Arthrosis: What It Is And How To Treat It

Septic Arthritis: Symptoms, Causes And Treatment

Psoriatic Arthritis: How To Recognize It?

Arthrosis: What It Is And How To Treat It

Juvenile Idiopathic Arthritis: Study Of Oral Therapy With Tofacitinib By Gaslini Of Genoa

Rheumatic Diseases: Arthritis And Arthrosis, What Are The Differences?

Rheumatoid Arthritis: Symptoms, Diagnosis And Treatment

Joint Pain: Rheumatoid Arthritis Or Arthrosis?

The Barthel Index, An Indicator Of Autonomy

What Is Ankle Arthrosis? Causes, Risk Factors, Diagnosis And Treatment

Unicompartmental Prosthesis: The Answer To Gonarthrosis