From the Guidelines
Military personnel are more likely to develop hallux valgus (bunions) due to their occupational demands, which involve prolonged standing, marching, and wearing restrictive footwear like combat boots for extended periods. The condition appears to be more prevalent among service members because these activities place repetitive stress on the forefoot and can contribute to the progressive deformity of the big toe joint. Military training often involves carrying heavy loads while walking long distances, which increases pressure on the feet and may accelerate bunion development in predisposed individuals. Although the provided studies do not directly address the prevalence of hallux valgus among military personnel, they highlight the high incidence of lower extremity overuse injuries, such as achilles tendinitis, patellar-femoral syndrome, plantar fasciitis, and stress fractures, which occur in 60%-80% of basic training injuries 1. Additionally, standard-issue military footwear may not always accommodate different foot shapes properly, potentially exacerbating the problem. For military personnel experiencing symptoms, interventions include properly fitted boots with adequate toe box width, orthotic inserts to correct foot mechanics, padding to reduce pressure on the bunion, and anti-inflammatory medications for pain relief. In severe cases that impact duty performance, surgical correction might be necessary, though this typically requires significant recovery time and temporary duty limitations.
Some key factors to consider in the development of hallux valgus among military personnel include:
- Prolonged standing and marching, which increase pressure on the forefoot
- Wearing restrictive footwear, such as combat boots, for extended periods
- Carrying heavy loads while walking long distances, which accelerates bunion development in predisposed individuals
- Inadequate accommodation of different foot shapes by standard-issue military footwear
- High incidence of lower extremity overuse injuries, which may be related to the development of hallux valgus. The study by 1 highlights the importance of considering sex as a risk factor for injury in military basic training, but it does not provide direct evidence for the development of hallux valgus.
From the Research
Hallux Valgus in Military Personnel
- The study 2 found that 28% of military servicemembers who underwent hallux valgus correction were able to return to full duty, including the ability to run 1.5 to 2 miles, 1 year after surgery.
- The same study 2 noted that the mean age of the patients was 40 ± 10 years, and the mean BMI was 28 ± 9 kg/m 2, which may be relevant to the development of hallux valgus.
- Another study 3 compared the outcomes of hallux rigidus surgical treatment between active duty and non-active duty populations, and found that active duty military personnel had a high rate of returning to their prior military activities after surgical treatment.
Risk Factors for Hallux Valgus
- A review of literature 4 suggested that several factors, including foot deformities, restrictive footwear, and pes planus, may contribute to the development of hallux valgus.
- The same review 4 noted that proper footwear, including shoes with an adequate length, wide toe box, cushioned sole, and lowered heel, may help to prevent or alleviate symptoms of hallux valgus.
- A guideline development study 5 recommended prevention and treatment strategies for hallux valgus, including foot conforming footwear, functional stabilization of the foot, and orthotic or insoles to improve functional stabilization.
Treatment Outcomes for Hallux Valgus
- A study 6 reviewed the treatment of hallux valgus and noted that non-operative treatment may alleviate symptoms but does not correct the deformity of the big toe.
- The same study 6 suggested that surgery is indicated if the pain persists, and that the correct operation must be selected from a wide variety of available techniques.
- The study 2 found that the type of surgical procedure used did not affect the likelihood of return to full duty, but noted that the analysis may have been underpowered to detect differences among factors that could be clinically important.