Hallux Valgus

Have you noticed a bump at the base of your big toe? This deformity, called hallux valgus or "bunion," is one of the most common foot conditions. As specialized physical therapists, we regularly see patients who are concerned about this deformity.

Good news: most people with hallux valgus have no symptoms.¹ For those who do experience pain, conservative treatment is often very effective.

What science tells us:

^-Deformity does not always cause pain - Cosmetic surgery can create pain that did not exist before - Physical therapy offers excellent results without surgery

This guide will help you understand your bunion, recognize when to seek medical attention, and discover treatment options. For an overview, check out our comprehensive guide to physical therapy.

What is a bunion?

Hallux valgus is a deformity of the big toe that deviates toward the second toe. This deviation creates a bony protrusion at the base of the toe, known as a "bunion" in Quebec. It is the most common deformity of the forefoot, just asosteoarthritis of the knee is common in the lower limb.

This condition affects approximately 23% of adults aged 18 to 65 and up to 35% of older adults.³ The metatarsophalangeal joint (the joint at the base of the big toe) gradually becomes misaligned.

Having hallux valgus does not necessarily mean experiencing pain. The majority of people with this deformity live very well without symptoms, as with cervical osteoarthritis, where the presence of changes does not equate to the presence of pain.

What causes hallux valgus?

Hallux valgus results from several factors combined rather than a single cause, similar to other degenerative conditions such as hip osteoarthritis.

What are the symptoms of hallux valgus?

The majority of people with hallux valgus have no symptoms.¹ The visible deformity does not automatically translate into pain.

For those who develop symptoms:

Pain in the joint of the big toe This is the most common symptom. The pain can be dull or sharp depending on the activity. Pain often increases when you:

- Move your 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

Signs of inflammation After overexerting yourself, you may experience swelling, redness, and warmth at the base of your big toe. If the pain persists for several days despite rest, it may be a more serious inflammation requiring physical therapy assessment.

How is hallux valgus diagnosed?

The diagnosis is based on the history of symptoms andclinical examination. This condition is easily seen and felt.

Your healthcare provider will evaluate:

Visual observation : The angle of deviation and the protrusion are visible to the naked eye. Mobility assessment The professional moves your toe to assess the range of motion and identify painful movements, just as they would during a cervical pain assessment. Gait analysis Observing how you walk reveals compensations or biomechanical problems. Imaging X-rays are not always necessary. They can be used to measure the angle of deformity or plan surgery.¹ For conservative treatment, a clinical examination is sufficient, as for most musculoskeletal conditions.

When should you seek physiotherapy for hallux valgus?

Consult a physical therapist if you have symptoms or if your doctor has ruled out other causes. A physical therapist can reduce pain and improve your function.

In Quebec, physical therapists have direct access. You can make an appointment directly without seeing a doctor first. If your condition requires it, your physical therapist will refer you to the appropriate specialist.

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

Good reasons to consult:

- Pain that limits your daily activities - Pain that persists despite rest - Loss of toe mobility - Difficulty walking normally - Concern about progression

How does physical therapy treat hallux valgus?

Your physical therapist will perform a detailed assessment to determine the specific cause of your pain. Key point: the deformity is not necessarily what is causing your pain.

The evaluation includes:

- Joint mobility - Nerve gliding - Quality of movement - Strength and stability

Based on the results, your physical therapist will:

- Mobilize your toe to reduce pain and improve movement

- Will give you specific exercises targeting the intrinsic muscles of the foot (small deep muscles), similar to strengthening exercises for other areas.

- Will teach you motor control exercises to help you control your movements effectively

- Will guide you in balancing your activities to optimize healing, an important principle in managing any musculoskeletal pain

- Will advise you on your posture and shoes

What exercises can you do at home for hallux valgus?

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

Things that can help:

- Wear less narrow shoes with a wide toe box that fits the shape of your foot.

- Stretch your big toe upward several times a day without causing pain.

- Avoid high heels if they increase the pain.

- Practice low-impact activities such as cycling or swimming

If there is no improvement after 10 days, consult a physical therapist. An assessment will identify the specific causes and establish an appropriate plan.

When is surgery necessary for hallux valgus?

If you have no symptoms Surgery is strongly discouraged for cosmetic reasons. It can cause pain that did not exist before.² Doctors do not correct asymptomatic deformities. If you have symptoms Surgery should be a last resort. Start with several weeks of physical therapyConservative treatment works in most cases, as it does for most foot and ankle conditions.

The decision to undergo surgery must be made with an orthopedic surgeon after all conservative options have been exhausted.

How can you prevent hallux valgus from getting worse?

Even if you cannot change genetics, you can limit progression and prevent symptoms.

Choose suitable shoes : Choose shoes with a wide toe box that allow for free movement. Avoid pointed shoes. This recommendation also applies to other foot conditions. Maintain mobility : Gently stretch your big toe for a few minutes each day. Monitor changes : Check quickly to see if the deformity is progressing or if symptoms are appearing. The Early detection enables better management.. Adapt your activities : Modify painful activities or alternate with activities that are less stressful on the foot. This principle of active pain management promotes recovery.

References

1. Wulker N, Mittag F. The treatment of hallux valgus. Dtsch Arztebl Int. 2012;109(49):857-68.

2. Torkki M, Malmivaara A, Seitsalo S, et al. Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. JAMA. 2001;285(19):2474-80.

3. 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.

4. Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Reviews. 2016;1(8):295-302.

Internal Links Added:

- Total links: 18 (within target range of 15-25) - Related pathologies: 7 links (plantar fasciitis, ankle sprain, knee osteoarthritis, cervical osteoarthritis, hip osteoarthritis, neck pain, back pain) - Services: 7 links (physical therapy, physiotherapy) - Educational resources: 4 links (understanding chronic pain, physical therapy guide)

Link Distribution:

- Introduction: 2 links - Body sections: 14 links - Prevention: 2 links - Natural contextual placement throughout

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