What is Hallux Valgus?
Hallux valgus, also known as bunion deformity, occurs when the joint of the big toe moves out of alignment. This often causes the joint to deviate towards the outside of the foot, and the toe to move on the opposite angle, towards the smaller toes. As a consequence, a bump forms at the joint.
The development of hallux valgus is thought to be multifactorial and may be due to environmental factors, which include poor fitting footwear, and structural factors (hereditary predisposition, excessive pronation), or a combination of the two (2).
What Are Symptoms of Bunions & Hallux Valgus?
HV affects each person individually, with a range of symptoms that may result in pain or discomfort or the presence of structural deformities absent of pain.
Early symptoms can include:
- Joint stiffness
- Joint swelling
- Joint pain
- Development of a bump over the big toe joint
Progressive manifestation of symptoms
- Joint pain
- Structural deformity of the big toe
- Structural deformity of the second toe; as the first toe deviates towards the second toe, it can cause it to cross over the first toe or result in a hammer toe deformity, corns, blisters, or other pain in the second toe
- Decreased balance—increased risk of falls (3)
- Slower walking speed
- Difficulty walking across uneven surfaces
- Muscle weakness
- Decreased joint range of motion
- Increased foot pressures under the ball of the first toe
- Difficulty ascending or descending stairs
In elderly patients, an unstable gait pattern may be associated with hallux valgus, including decreased walking speed and stride length over uneven surfaces (3).
Risk Factors of Hallux Valgus and How to Relieve Pain
Unfortunately, hallux valgus affects all factors of the population, but is found to be more prevalent with certain risk factors.
Risk factors include:
- Age: chance of developing hallux valgus increases with age
- Female: studies suggest hallux valgus is more prevalent in females; may be linked to excessive high heeled shoe use
- Joint injury: repetitive or traumatic injuries to the big toe joint may increase the development of hallux valgus
- Activities: exercise or occupations that increase the stress on the big toe joint can result in the manifestation of the deformity, including ballet dancers or gymnasts
Because it may manifest with a multifactorial onset, avoiding hallux valgus may be
difficult, especially if there is a family history. You can reduce symptoms by avoiding risk factors including:
- Ill-fitting footwear
- High impact exercise
- Ample rehab/physical therapy prior to returning to sport or activity post-injury
- Excessive weight gain
- Activities/actions that increase symptoms of pain
What are my options for treatment? Who else can help?
Treatment goals for individuals with hallux valgus include pain and symptom management, while allowing the individual to complete activities of daily living (ADLs) with greater function and mobility. Early treatment intervention is important as it may provide greater joint stability and slow the progression of the deformity and consequently improve or maintain your quality of life (3).
Conservative treatment options include:
- Custom foot orthotics
- Cushioning: off-the-shelf pads and toe sleeves
- Accommodative footwear
- Bunion night splint
- Physiotherapy and stretching
In severe cases, surgical interventions may be necessary. This type of intervention should only be discussed after conservative treatment options have been exhausted without significant pain relief or management.
There are several healthcare providers and other professionals that may help with symptom and exercise management. Other professionals may include:
- Occupational therapists
- Foot care nurses or chiropodists
Staying active with pain
Conservative treatments, which may include custom orthoses and/or changing your current footwear, play a key role in maintaining and staying active with hallux valgus.
While it is important to stay active, limiting your activity to movements that are not painful or less intensive will provide symptom relief.
Ensure that you have appropriate footwear for your activity needs. Your footwear choices may enhance your exercise or inhibit it without you even knowing it.
Always listen to your body, and allow for ample rest time when needed. Consult with your physician, physiotherapist, or kinesiologist before starting a new exercise program, or if you have any questions regarding your fitness plan.