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  • Writer's pictureDaniel Selin

Hallux valgus

Bunion pain, hallux valgus, big toe pain, high heels, big toe turning, foot pain

Hallux valgus (bunion) refers to a foot problem where the big toe turns towards the other toes. It is the most common foot deformity, and affects women in particular. The condition is associated with pain in the area of the base joint of the big toe, which can also radiate to the foot arch or sole. Pain worsens when the big toe is loaded, but it can also ache during rest if the condition persists for a long time. Wearing high heels, engaging in walking or running activities, or any other activity that increases extension and pressure on the base joint of the big toe can exacerbate the symptoms.



Hallux valgus can be caused by a congenital predisposition, but often it is associated with a biomechanical dysfunction of the lower limb, which leads to excessive loading of the forefoot and inner part of the foot. Increased load in the first metatarsophalangeal joint can cause cartilage changes and osteoarthritis. The inner part of the joint capsule, ligaments, and abductor hallucis muscle usually stretch due to the increased load, leading to a deviation of the first toe towards the other toes. The bursa of the first metatarsophalangeal joint may also become inflamed and swollen. These changes are visible as a deviation of the first toe, joint swelling, and redness of the skin.

In addition to the biomechanical challenges, the development of hallux valgus is often associated with a general lack of support for the foot. Weakened support of the foot arches is a predictor for the development of hallux valgus, as the first toe is allowed to deviate and twist during push-off. Muscle weakness and restricted range of motion in the ankle or foot may also contribute to increased loading of the inner part of the foot during walking or running.

Wearing shoes that are too small or ill-fitting can also worsen symptoms and increase the angle of deviation in hallux valgus. There may be a correlation between the use of high-heeled shoes and the prevalence of hallux valgus, but the research is unclear. Pregnancy-related weight gain and loosening of ligaments can also predispose to the development of hallux valgus. These might be a few reasons to why the condition is nearly 10 times more common in women than in men.



The initial symptoms of hallux valgus are often structural and individuals may seek treatment due to cosmetic changes observed in their foot, rather than pain. Before the toe begins to turn, changes in the width of the forefoot are often seen, which are due to a weakening of the transverse arch structure of the foot.

A symptomatic hallux valgus often causes radiating pain from the big toe to the foot. The pain may be dull, throbbing, burning, or sharp. A bunion that has progressed and is now turned under or over other toes can eventually cause changes in the other toes.

Typical symptoms of a bunion include:

  • Pain: pain in the joint of the big toe during weight-bearing activities

  • Changes in appearance: widening of the forefoot and the big toe starting to grow towards the other toes

  • Inflammatory changes: redness and warmth in the joint of the big toe

  • Degenerative changes: enlargement and stiffness of the joint of the big toe

  • Changes in gait: difficulty in walking often results in changes in gait, which aim to reduce the load on the joint of the big toe. Typically, weight is shifted towards the outer edge of the foot and propulsion no longer occurs through the big toe.

  • Muscle changes: weakening of the abductor muscle of the big toe and shortening of the toe flexors. The support of the foot is weakened, causing the load to shift towards the joint of the big toe.


Risk Factors:

  • Gender: the condition is about 10 times more common in women than in men.

  • Footwear: tight, constricting, or high-heeled shoes.

  • Congenital malformations and genetics.

  • Anatomical and biomechanical factors.

  • Limited ankle mobility.

  • Pregnancy.

  • Flat feet or other foot structural abnormalities.

  • Systemic disease.

  • Osteoarthritis of the hip or knee joints.

  • Overweight or obesity.



The primary treatment for hallux valgus is conservative. The goal of hallux valgus treatment is to alleviate pain and improve the patient's function. The big toe can be straightened using support or taping techniques. Proper shoe selection and custom orthotics can also reduce the load on the area and ease pain. Improving the stability of the foot by strengthening the foot muscles and examining the biomechanical characteristics of the lower leg as a whole should also be pursued.

Hallux valgus tend to worsen with age, so early treatment is often more effective.

Surgical procedures should only be considered when conservative treatment fails to achieve the desired result, or if the patient experiences severe pain that significantly impairs function. However, it should be noted that bunions are a condition caused by a combination of factors that lead to overloading and pain, and tissue-based treatment may not provide a comprehensive solution to the problem. Therefore, postoperative rehabilitation is absolutely critical. Approximately 20% of bunion cases recur even after surgery.



Physiotherapy always starts with a thorough background check, on the basis of which an individual plan is developed to overcome the problem. The treatment is based on reducing painful movement and improving functionality. The physiotherapist can also create an exercise program to improve lower limb biomechanics and foot stability. Through exercise, the muscles needed to support the foot can be strengthened, so that the load on the foot does not shift excessively towards the big toe.

Joint restrictions, muscle tension, and pain can be treated with manual therapy, and taping or orthotics may also be helpful if the pain is severe.

Individual orthotics can be used to support the transverse arch structures of the foot, which maintain the firmness of the forefoot and reduce the load on the big toe. Orthotics can also be fitted with wedges that reduce the need for the big toe joint to extend during walking or toe raises. This support reduces pain and allows normal movement, even if there are degenerative changes restricting movement in the big toe. Orthotic supports are always individually designed to make them as effective as possible.

Shoe advice may also be part of physiotherapy. A person suffering from hallux valgus pain may benefit, for example, from shoes that have a slightly curved sole, which reduces the extension movement of the metatarsophalangeal joints during walking and other activities. This reduces the load on the foot and the base of the big toe, giving irritated tissues time to recover."


Self care

  1. Use the right footwear: Make sure to wear shoes with a wide toe box, low heels, and good arch support. Avoid high heels, shoes that are too tight, and shoes with a pointed toe.

  2. Use cold therapy: Apply cold therapy for 15-20 minutes three or four times a day to reduce pain and possible inflammation.

  3. Massage: Gently massage your foot with your hands or a massage ball to reduce muscle tension and improve fluid circulation.

  4. Take breaks: Avoid activities that worsen symptoms and take long enough breaks from activities that cause pain to allow tissue recovery.

  5. Do exercises to strengthen foot and toe muscles.

  6. Pain medication: Ibuprofen and paracetamol can relieve pain and inflammation.

  7. Orthotics: Use orthotics that balance foot load and support transverse arch structures of the foot.

  8. Try toe spacers or separators that help align toes and reduce pain. However, avoid supports that turn other toes outward.

Remember that if your pain continues or worsens, it is important to consult a healthcare professional for further examination and treatment. To receive an individual program, I recommend that those suffering from the condition contact a physiotherapist specialized in the lower limbs.

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