Hallux Valgus (Bunion)
Hallux valgus is a condition in which the great toe leans towards the other toes and the joint at its base makes a prominence on the inner side of the foot. It is commonly known as a bunion. It is not simply a bony lump; it concerns the whole alignment of the forefoot.
How Does It Develop?
When the balance at the joint at the base of the great toe is lost, the first metatarsal drifts inwards while the great toe rotates outwards. This two-way drift creates a marked prominence on the inner side of the joint. Over time the great toe may ride over or under the neighbouring toes.
Predisposition is largely related to the structure of the foot and to inheritance. Narrow, high-heeled shoes are not a cause on their own; however, they can accelerate an existing predisposition and markedly increase symptoms.
Symptoms
- A prominence at the base of the great toe, with redness and pain where the shoe presses
- Difficulty finding shoes; the shoe stretching in this area
- Pain increased by long walks and standing
- The great toe leaning towards the second toe and, in advanced cases, riding over it
- Hammer toe deformity of the second toe, with callus and pain under the forefoot
- In some patients stiffness and restricted movement of the great toe joint
The severity of symptoms does not always match the degree of the deformity: there are patients with marked deformity and few symptoms, and the reverse. Treatment is therefore planned according to symptoms and functional limitation, not appearance.
Diagnosis
- History: site and duration of pain, problems with footwear, walking distance, similar problems in the family.
- Examination: assessment of alignment standing and sitting, range of movement of the great toe joint, examination of the second toe and forefoot, assessment of calf tightness.
- Weight-bearing X-ray: the basis for measuring the angles and assessing any accompanying osteoarthritis; a film taken lying down can be misleading.
The examination also assesses load distribution across the sole and any flatfoot, since these affect surgical planning.
Treatment
Non-surgical treatment
Non-surgical treatment does not correct the deformity; its aim is to reduce symptoms and make daily life more comfortable. This expectation is made clear from the outset.
- Footwear: a wide, soft toe box and a low heel — the most effective step
- Pressure-relieving pads and toe spacers
- Arch support and, where needed, a custom insole
- Calf and Achilles stretching exercises, and work for the intrinsic foot muscles
- Pain management
There is no reliable evidence that night splints and toe spacers permanently correct the deformity; they may be used for comfort.
Surgical treatment
Surgery is considered when pain and functional limitation cannot be managed with non-surgical measures. Surgery is not recommended for appearance alone.
The method is not uniform; depending on the degree of deformity, the measured angles, whether there is osteoarthritis in the joint and the overall alignment of the foot, bone correction (osteotomy), soft tissue balancing and, where needed, joint fusion are among the options. There is therefore no single “bunion operation”; the plan is individual.
During recovery, special footwear, a weight-bearing regime and the settling of swelling all take time. Swelling can take months to resolve completely. Outcomes vary from person to person; no guarantee of a specific result or timeframe is given.
Daily Life Suggestions
- Try shoes at the end of the day, when the foot is most swollen
- Make sure the widest part of the shoe matches the widest part of your foot
- Limit high-heeled and narrow shoes to the occasions when they are necessary
- Do calf stretching exercises regularly
- If callus is forming under the forefoot, load distribution should be assessed
When Should You Seek Assessment?
- If wearing shoes has become difficult because of pain
- If your great toe has begun to ride over the second toe
- If pain and callus are developing under the forefoot
- If your walking distance has shortened
- If you have diabetes and there is a risk of a pressure sore on the foot
When to Seek Medical Help Without Delay
- Redness, warmth, widespread swelling and fever in the foot (suspected infection)
- In people with diabetes, an open wound or colour change at a pressure point
- Sudden severe pain, coldness and colour change in the foot
These findings require urgent assessment. Outside office hours, go to the nearest emergency department.
Frequently Asked Questions
Did my shoes cause it?
Narrow, high-heeled shoes are not a cause on their own; the main determinants are the structure of the foot and inheritance. However, unsuitable footwear can accelerate an existing predisposition and markedly increase symptoms.
Do splints and toe spacers correct the deformity?
There is no reliable evidence that these products permanently correct the deformity. They may provide comfort, but should not be used in the expectation of structural correction.
Will it get worse if I do not have surgery?
Hallux valgus is generally slowly progressive, but not at the same rate in everyone. In some people it stays at the same level for years. Follow-up is therefore recommended and the decision is based on symptoms.
Can I have surgery for appearance alone?
Surgery is not recommended for appearance alone. The decision rests on pain, inability to wear shoes and functional limitation; the recovery process and possible risks are discussed in detail.
When can I wear normal shoes after surgery?
The timeframe depends on the method used, bone healing and the settling of swelling, which can persist for months. Your physician determines the exact timing according to your recovery.
Can it come back?
The likelihood of recurrence depends on the method chosen, the degree of deformity, the structure of the foot and adherence during recovery. Maintaining suitable footwear habits is recommended.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of foot and ankle surgery and related areas. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any treatment or surgical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.