From the Guidelines
Hallux valgus treatment should prioritize conservative measures, including wearing wider shoes with a roomy toe box, using over-the-counter toe spacers or custom orthotic inserts, and pain management with acetaminophen or NSAIDs, before considering surgical correction. The condition, also known as a bunion, develops gradually due to inherited foot structure, arthritis, or wearing tight, narrow shoes that compress toes [ 1 ]. Women are more commonly affected than men, likely due to footwear choices.
Conservative Treatment
Conservative treatment options include:
- Wearing wider shoes with a roomy toe box to reduce pressure on the bunion
- Using over-the-counter toe spacers, bunion pads, or custom orthotic inserts to realign the toe and provide pain relief
- Pain management with acetaminophen or NSAIDs, such as ibuprofen (400-800mg three times daily)
- Ice application for 15-20 minutes several times daily to reduce inflammation
Surgical Correction
If conservative treatments fail after 6-12 months, surgical correction may be necessary, with options including bunionectomy, osteotomy, or joint fusion depending on deformity severity [ 1 ]. Early intervention with proper footwear and supportive devices can prevent progression and potentially avoid the need for surgery.
Footwear Recommendations
General footwear recommendations include a broad and square toe box, laces with three or four eyes per side, padded tongue, quality lightweight materials, and sufficient size to accommodate a cushioned insole [ 1 ]. Use of custom therapeutic footwear can help reduce the risk of future foot ulcers in high-risk patients.
From the Research
Definition and Prevalence of Hallux Valgus
- Hallux valgus is a common disorder of the forefoot that results from medial deviation of the first metatarsal and lateral deviation and/or rotation of the great toe (hallux) with or without medial soft-tissue enlargement of the first metatarsal head (bunion) 2.
- It is the most common pathologic condition affecting the great toe, with a known predilection in the female population (female-male ratio =9:1) 2.
- Hallux valgus affects about 23% of adults and 35.7% of people over 65 3.
Etiology and Risk Factors
- The exact etiology of hallux valgus is not fully understood, but several factors that deteriorate the integrality of the first ray, such as foot deformities, restrictive footwear, and pes planus, may be ascribed to the HV occurrence 3.
- Joint laxity/instability and shoe wear demands are also thought to contribute to the development of hallux valgus, particularly in women 2.
Treatment Options
- Conservative treatment should always be initiated first, and may include shoe modification, orthotics, and physical therapy 4, 3.
- Shoe modification should involve a shoe with an adequate length, wide toe box, cushioned sole, and a lowered heel to not increase the load on the metatarsal heads and cause pain 3.
- Orthotics, such as personalized 3D printed customized toe spreaders, may be applied in patients with HV, improving symptoms and bringing pain relief 3.
- Surgical treatment may be indicated in symptomatic hallux valgus, and should be oriented on the severity of the pathology and the postoperative mobilization possibilities of the patient and other patient-specific criteria 4.
Prevention and Management
- Prevention of hallux valgus may involve foot conforming footwear, functional stabilization of the foot by means of gymnastics or physiotherapy instructions, and orthotic and/or insoles to improve the functional stabilization 4.
- Management of hallux valgus should be based on the suffering of the patient, age, and presence of arthritis in the MTP-I-joint, as well as other patient-specific pathologies 4.