What is Hallux Valgus?
Hallux valgus is a three-dimensional foot deformity characterized by lateral deviation of the great toe (hallux) combined with medial deviation of the first metatarsal bone (metatarsus primus varus), commonly known as a bunion 1, 2.
Clinical Characteristics
The deformity involves:
- Lateral deviation of the big toe at the first metatarsophalangeal (MTP-I) joint
- Medial deviation of the first metatarsal bone (varus position)
- Formation of a prominent medial bump at the MTP-I joint head that can cause pressure points and shoe conflict 2
- Potential restriction of mobility and pain 1
Epidemiology
The condition is highly prevalent:
- 23% prevalence in adults aged 18-65 years
- 36% prevalence in people over 65 years
- Typically begins between ages 30-60 years
- Women are affected 2.57 times more often than men 3, 2
Associated Risk Factors
The strongest independent risk factors (in descending order of association) include 3:
- Female sex (OR 2.57)
- Foot pain (OR 2.36)
- Narrow-toed shoes (OR 2.25) - poses greater risk than high heels
- Knee pain (OR 2.04)
- Scoliosis (OR 1.84)
- High-heeled shoes (OR 1.65)
- Osteoporosis (OR 1.50)
- Knee osteoarthritis (OR 1.47)
- Flatfoot (OR 1.19)
- Advancing age (OR 1.11)
Terminology Note
The term "hallux valgus" is anatomically correct, not "hallux abductus valgus" 4. The confusion stems from historical terminology, but movements of the toes should be described relative to the foot axis (through the second toe), not the body's midline. The muscle contributing to lateral deviation is the adductor hallucis, not the abductor hallucis 4.
Clinical Context in Diabetes
In persons with diabetes, hallux valgus is classified as a foot deformity that can alter foot shape and increase pressure at specific sites, contributing to ulcer risk 5. It requires accommodation through appropriate footwear modifications including custom-made insoles and extra-depth or custom-made medical grade footwear to prevent pressure-related complications 6, 5.