Can hallux valgus (bunion of the great toe) cause chest pain?

Hallux Valgus Does Not Cause Chest Pain

No, hallux valgus (bunion) cannot cause chest pain. Hallux valgus is a localized foot deformity characterized by lateral deviation of the great toe and medial deviation of the first metatarsal bone, affecting only the foot structure 1, 2. Chest pain requires immediate evaluation for life-threatening cardiac, pulmonary, or vascular causes that are completely unrelated to foot pathology 3.

Why This Question Arises: Anatomic and Physiologic Separation

• Hallux valgus affects the first metatarsophalangeal joint of the foot, causing local symptoms including pain at the bunion site, difficulty with shoe fitting, altered gait mechanics, and balance problems 2, 4.
• The condition has no anatomic connection to thoracic structures, no vascular supply that extends to the chest, and no neural pathways that could refer pain to the chest wall 1.
• Foot deformities like hallux valgus are recognized risk factors for foot ulceration in patients with peripheral artery disease and diabetes, but they do not generate chest symptoms 5.

Chest Pain Requires Urgent Cardiac Evaluation

• Any patient presenting with chest pain must have a 12-lead ECG obtained within 10 minutes and high-sensitivity cardiac troponin measured immediately to exclude acute coronary syndrome, regardless of any concurrent foot problems 3.
• Life-threatening causes that must be rapidly excluded include acute coronary syndrome (retrosternal pressure radiating to left arm/jaw/neck with diaphoresis), aortic dissection (sudden "ripping" pain with pulse differentials), pulmonary embolism (acute dyspnea with pleuritic pain and tachycardia >90% of cases), tension pneumothorax (unilateral absent breath sounds), and esophageal rupture 3.
• A completely normal physical examination does not exclude acute myocardial infarction; up to 30-40% of acute MIs present with normal findings 3.

Common Non-Cardiac Causes of Chest Pain

• After cardiac causes are excluded, costochondritis accounts for approximately 43% of chest pain presentations in primary care, characterized by reproducible tenderness at costochondral joints 3.
• Gastroesophageal reflux disease produces burning retrosternal pain related to meals and relieved by antacids, accounting for 10-20% of chest pain in outpatient settings 3.
• Pericarditis presents with sharp, pleuritic chest pain that worsens when supine and improves when leaning forward, often with a friction rub 3.

Critical Pitfall to Avoid

• Do not attribute chest pain to musculoskeletal causes (including any foot condition) without first obtaining ECG and troponin to exclude acute coronary syndrome 3. Even sharp or pleuritic chest pain can represent myocardial ischemia in approximately 13% of cases 3.
• Women, elderly patients, and those with diabetes frequently present with atypical chest pain symptoms and require full cardiac evaluation 3.
• The presence of hallux valgus or any other foot deformity is completely irrelevant to the evaluation of chest pain 5.