Hallux Valgus

A bump at the base of the big toe may be related to hallux valgus, often called a “bunion.” In this condition, the big toe deviates toward the other toes. An evaluation can determine the cause of the bump and any pain, if present.

A bunion may be present without causing pain.^{1, 2} For those who experience pain, non-surgical treatments, including physical therapy, can help relieve discomfort, especially for mild to moderate deformities.

Three key points for understanding treatments:

• Deformation does not always cause pain
• Surgery targets pain and problems related to the foot, not just its appearance. In a trial involving 209 people with painful hallux valgus, surgery reduced pain more significantly at one year than supportive insoles—known as orthotics—or a waiting list³.
• For mild to moderate hallux valgus, exercises can modestly reduce the angle of deviation. Combining them with a supportive tape or orthotic device can also reduce pain. A review of eleven trials reports these benefits, but the programs differ, and higher-quality trials are still needed⁴.

This guide will help you understand your hallux valgus, recognize when to seek professional advice, and discover treatment options. For an overview, consult our complete guide to physiotherapy.

What is Hallux Valgus (Bunion)?

Hallux valgus is a deviation of the big toe toward the second toe, accompanied by a shift of the bone at its base toward the inside of the foot. This misalignment forms the bump known as a “bunion.” It affectsthe forefoot, the part of the foot near the toes.

A meta-analysis of 76 studies estimated the prevalence of hallux valgus at 23% among adults aged 18 to 65 and at 35.7% among those over 65. The estimates varied depending on the population and the assessment method.⁵The metatarsophalangeal joint, located at the base of the big toe, connects the big toe to the long bone of the foot called the metatarsal.

The appearance of your toe alone does not determine your pain or your ability to walk. An asymptomatic bunion may not require any treatment.

What Causes Hallux Valgus?

Hallux valgus develops as a result of several factors, including foot shape and a family predisposition. Injuries, foot mechanics, and certain joint problems may also play a role. Tight shoes can particularly exacerbate discomfort; their exact role in the development of the deformity remains unclear.

The table distinguishes between factors associated with hallux valgus and habits that you can change. An association does not prove that a factor caused your deformity.

What are the Symptoms of Hallux Valgus?

The most common symptoms of hallux valgus are pain in the front of the foot, at the big toe joint; swelling around the bump; and redness or irritation around the bump.

Visible deformity may be present without causing any symptoms.

For those who develop symptoms:

Pain in the big toe joint: The pain may be dull or sharp, depending on the activity.

• Move the toe at the end of the movement
• Walk for long periods or go grocery shopping
• Run or exert yourself
• Wear shoes that are too tight

Swelling and irritation: The friction between the shoe and the bump can increase discomfort. A wider shoe may relieve this irritation. If the discomfort persists despite adjusting your activities, a physical therapy evaluation can help identify the cause.

Seek urgent medical attention if a painful joint becomes swollen and warm, or if the pain is accompanied by general malaise, fever, or sensations of heat, cold, or chills. Pain in the big toe isn’t always caused by a bunion. Warning signs of joint pain may indicate another problem that requires prompt treatment.

Go to the emergency room if you can no longer walk or put weight on your leg, or if a joint appears to be dislocated. After a fall or injury, severe pain, tingling, or loss of sensation around the joint also require emergency care.

How is a bunion (hallux valgus) diagnosed?

A healthcare professional can diagnose hallux valgus by examining the position of the big toe and discussing your symptoms. This foot examination also helps identify the causes of any pain that may accompany the condition.

Your healthcare professional will assess:

Examination of the foot: The healthcare professional examines the deviation of the toe and the bump at its base.

Range-of-motion examination: The healthcare professional checks how far the toe can move and which movements are painful.

Gait analysis: The professional observes how you place your foot and whether you adjust your weight distribution to avoid pain.

X-ray: This X-ray image of the bones allows for measuring the misalignment and evaluating the joint. Images taken while standing are particularly helpful in preparing for surgery.^{7, 2} The healthcare professional determines whether an X-ray is necessary based on your symptoms, the suspected diagnosis, and the planned treatment.

When should you see a physiotherapist for a bunion?

A physical therapy appointment is helpful when pain, stiffness, or difficulty walking interferes with your daily activities. The physical therapist can help you use your foot more effectively and refer you to a doctor if necessary.

In Quebec, you can see a physical therapist directly at a private clinic without first seeing a doctor.The Quebec Professional Order of Physical Therapy explains this direct access. However, warning signs require an urgent medical consultation.

You can also seek advice and exercises if you notice a loss of flexibility, even without pain.

• Pain limiting your daily activities
• Pain that persists despite rest
• Loss of toe mobility
• Difficulty walking normally
• Worry about it getting worse
• Hallux valgus accompanied by diabetes; consult a healthcare professional to monitor the health of your feet

How does physiotherapy treat bunions (hallux valgus)?

Foot and ankle physical therapy helps relieve the symptoms of hallux valgus through tailored exercises and advice. The program may include hand-guided toe movements, strengthening exercises, and adjustments to activities or footwear.

Your physical therapist will conduct a detailed evaluation to identify the factors contributing to your pain. The deformity alone does not explain all of your symptoms.

Non-surgical treatments aim to reduce pain and maintain the ability to walk and perform daily activities. Some programs have also modestly reduced the angle of deviation in clinical trials, though they do not guarantee that the bump will disappear permanently.

• Ability to move the toes and ankle
• Assessment of nerve function—nerves transmit messages related to sensation and movement—if your symptoms warrant it
• How to place your foot and control your movements
• Foot strength and balance

• Will guide your toe's movements with their hands to help you move with less pain
• It will provide you with specific exercises that target the muscles in the foot. Strengthening exercises can help improve the big toe's ability to push off and the toes' ability to spread apart.
• Will teach you how to control the movements of your foot—for example, how to spread your toes while keeping your heel on the ground
• It will guide you in balancing your activities so you can stay active without causing a lasting increase in pain—a principle of managing chronic pain
• Advise you on your posture and footwear

A trial involving 56 women with moderate, painful hallux valgus compared a combined program to a waiting list with no intervention. The program combined guided manual movements, foot strengthening, ankle stretches, and a toe spreader. After 36 sessions over three months, the treatment group experienced less pain and demonstrated improved foot function, greater strength, and increased ankle mobility. The angle of deviation had also decreased more significantly. These differences were still present one year later. This trial does not allow for isolating the effect of each component or establishing a standard treatment regimen for everyone.

What home exercises can you do for a bunion (hallux valgus)?

Home exercises for hallux valgus may include gentle movements of the big toe and exercises to strengthen the muscles that spread the toes apart. Work with your physical therapist to choose the exercises and determine the appropriate frequency, based on your pain level and foot mobility.

If you have symptoms, cut back on activities that cause too much pain and gradually resume them. The goal is to find the right balance—not to stop moving altogether. This principle also applies to other conditions, such as plantar fasciitis.

• Wear shoes that aren't too tight, with enough room in the front so your toes aren't cramped
• Gently move your big toe upward, as far as feels comfortable. Do not force a painful or stiff joint. Your physical therapist can adjust the stretch
• Gently spread your toes while keeping your foot on the floor, then relax. Work within a comfortable range, and adjust the movement if you have trouble controlling it.
• Avoid high heels if they make the pain worse
• Stay active with activities you can comfortably do, such as biking or swimming, if these activities are comfortable for you
• Orthotics support the foot, toe spreaders separate the toes, and splints maintain a specific position. These devices may provide relief for some people. A review of toe spreaders reports improvements in pain and, in some cases, in the angle of deviation, but the studies are small and use different devices. The best way to use them and their long-term effects remain uncertain⁹.

If your symptoms persist despite this at-home care, consult your physical therapist. An evaluation can help identify the underlying causes and develop a tailored plan.

When is surgery necessary for a bunion (hallux valgus)?

Surgery for hallux valgus may be considered if pain or difficulty walking remains significant despite appropriate non-surgical treatment. It is not automatically necessary and is not intended solely to improve the appearance of the foot.

If you have no symptoms: surgery performed solely for cosmetic reasons is not recommended. It can cause pain that did not exist before, as explained in the recommendations for bunion surgery.

If you have symptoms: non-surgical treatments include choosing appropriate footwear, support devices, and physical therapy. Their effectiveness should be reassessed based on your pain and your activities. The trial comparing surgery and orthotics did not test a comprehensive program of exercises and manually guided movements. In this trial involving people with painful hallux valgus, orthotics provided greater pain relief than the wait-and-see approach at six months. Surgery provided greater relief than orthotics or the wait-and-see approach at one year³.

The decision is made in consultation with an orthopedic surgeon, a doctor who specializes in bones and joints. The discussion covers treatments already tried, expected benefits, risks, and recovery time.

How to prevent bunions from getting worse?

Non-surgical treatments do not guarantee that hallux valgus will stop progressing. Proper footwear and exercises can improve comfort and, in some studies, reduce the angle of deviation. Follow-up visits are used to adjust treatment if there are changes in pain, walking ability, or the shape of the foot.

You cannot change your genetic makeup. However, you can reduce the pressure from your shoes on your toe and adjust the activities that trigger pain. These measures do not guarantee that all symptoms will be prevented or that the condition will not progress.

Choose the right shoes: make sure there is enough room in the front of the shoe to wiggle your toes. Avoid pointy-toed shoes. This recommendation also applies to other foot conditions.

Maintain mobility: Perform gentle stretches of the big toe as part of the therapeutic exercises tailored to your situation, according to the program agreed upon with your physical therapist.

Watch for changes: check quickly to see if the deformity is progressing or if symptoms appear. An evaluation will help adjust your care.

Adjust your activities: modify activities that cause pain or alternate them with activities that put less strain on your foot. This approach to active pain management can help you stay active.

Additional Guides on Joint Pain

Our supplementary guides explain neck and back pain, as well as osteoarthritis of the knee, hip, and neck. These topics pertain to other areas of the body and, on their own, do not explain hallux valgus.

• Knee osteoarthritis
• Hip osteoarthritis
• Neck Osteoarthritis
• Neck Pain
• Back Pain

References

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1. Badlissi F, Dunn JE, Link CL, Keysor JJ, McKinlay JB, Felson DT. Musculoskeletal disorders of the foot, pain, and foot-related functional limitations in older adults. J Am Geriatr Soc. 2005;53(6):1029-33. (Back to section: 1)
2. Wülker N, Mittag F. The treatment of hallux valgus. Dtsch Arztebl Int. 2012;109(49):857-67; quiz 868. (Back to sections: 1, 2, 3)
3. Torkki M, Malmivaara A, Seitsalo S, Hoikka V, Laippala P, Paavolainen P. Surgery vs. orthosis vs. watchful waiting for hallux valgus: a randomized controlled trial. JAMA. 2001;285(19):2474-80. (Back to sections: 1, 2, 3)
4. Zhu Z, Liu Y, Wang L, Liu H, Wang J. Effects of exercise combined with external support on hallux valgus angle and pain: A systematic review and network meta-analysis. Foot Ankle Surg. 2026;32(3):199-212. (Back to section: 1)
5. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res. 2010;3:21. (Back to section: 1)
6. ŞAYLI U, Çiğdem ALTUNOK E, GÜVEN M, AKMAN B, BİROS J, ŞAYLI A. Estimation of the prevalence and familial tendency of common forefoot deformities in Turkey: A survey of 2,662 adults. Acta Orthopaedica et Traumatologica Turcica. 2020;52(3):167-173. (Back to sections: 1, 2)
7. Perler A, Dixon M, Alvi F. Hallux Valgus. StatPearls. 2026. (Back to sections: 1, 2)
8. Nishimura A, Fukuda A, Nakazora S, Uchida A, Sudo A, Kato K, et al. Prevalence of hallux valgus and risk factors among Japanese community residents. J Orthop Sci. 2014;19(2):257-262. (Back to section: 1)
9. Krześniak H, Truszczyńska-Baszak A. Toe Separators as a Therapeutic Tool in Physical Therapy: A Systematic Review. J Clin Med. 2024;13(24). (Back to section: 1)
10. Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev. 2016;1(8):295-302.