A curved big toe, also known as hallux valgus, is a common foot deformity that causes the big toe to angle inward toward the other toes. This can cause pain, swelling, corns, calluses, and difficulty walking. While the exact causes are not fully understood, hallux valgus is often linked to genetics, foot structure, shoes, and certain health conditions.
What is hallux valgus?
Hallux valgus, commonly called a bunion, refers to the inward angulation of the big toe toward the second toe. This causes a bony protrusion, or bunion, to form on the inside of the foot near the big toe joint. As the big toe angles inward, the joint sticks out further on the side of the foot.
In a normal foot, the big toe points straight ahead in line with the bones in the forefoot. With hallux valgus, the big toe angles toward the other toes, sometimes overlapping or underlapping the second toe. This throws off the foot’s alignment and can cause pain and problems with mobility.
Signs and symptoms
Common signs and symptoms of hallux valgus include:
- Bunion or protrusion on the inside of the big toe joint
- Big toe angling inward toward the other toes
- Redness, swelling, corns, or calluses around the big toe joint
- Pain and discomfort along the inside of the foot
- Difficulty walking in shoes due to irritation
- Restricted motion of the big toe
As the deformity progresses, pain often increases, especially with increased activity. Shoes may start rubbing against the bunion, aggravating it further. In severe cases, the big toe can become immobile and rigid.
What causes hallux valgus?
Hallux valgus has many possible causes and risk factors. While the exact mechanisms are not fully understood, contributing factors include:
1. Genetics
Genetics play a role in the development of bunions. People with a family history of hallux valgus are more likely to have it themselves. Certain foot structures, like flat feet, high arches, and loose ligaments, can be inherited and increase the risk.
2. Foot mechanics
People whose first metatarsal bone is longer than the second metatarsal bone are more prone to developing hallux valgus. This causes the big toe to be pulled toward the second toe. Ligament laxity and muscle imbalance between the big toe flexors and extensors can also pull the big toe out of alignment.
3. Tight footwear
Wearing tight, narrow shoes with high heels forces the toes into an abnormal position and encourages hallux valgus formation. Pointy-toed shoes and shoes that squeeze the toes together are particularly problematic. The constant pressure pushes the big toe inward over time.
4. Injuries and arthritis
Injuries like broken bones, sprains, and turf toe can increase the risk if they damage the big toe joint. Forms of arthritis like osteoarthritis and rheumatoid arthritis that affect the foot can also play a role in the development of bunions.
5. Certain health conditions
Some health conditions are associated with increased risk of bunions, including:
- Rheumatoid arthritis
- Neurological conditions like cerebral palsy, Charcot-Marie-Tooth disease, and spina bifida
- Neuromuscular disorders like Marfan syndrome
- Down syndrome
- Dwarfism
The reasons for the connections are not always clear. Sometimes it relates to joint laxity problems caused by the conditions. In other cases, bunions develop due to reduced mobility and muscle weakness.
Risk factors
Certain factors can increase a person’s likelihood of developing bunions:
- Being female – women are about 10 times more likely to get bunions, possibly due to differences in foot anatomy and shoe choices.
- Family history – genetic inheritance plays a role.
- Age – older adults are more susceptible as cartilage weakens with age.
- Foot injuries or abnormalities present at birth.
- Rheumatoid arthritis.
- Wearing tight, narrow, or high-heeled shoes.
- Having a job that keeps you on your feet a lot like nursing or dancing.
How is hallux valgus diagnosed?
To diagnose a bunion, a doctor will examine the foot and ask about symptoms. They will look for redness, swelling, calluses, pain, and any bony protrusions around the big toe joint. They will also assess the big toe’s range of motion.
Diagnostic testing is sometimes done to evaluate the extent of the deformity, check joint alignment, look for arthritis, and rule out other potential causes of pain. Tests may include:
- X-rays – used to visualize the angle of the big toe and severity of osteoarthritis.
- CT scan – provides 3D views of bone alignment.
- MRI – used if a cartilage injury, ligament tear, or other soft tissue injury is suspected.
- Blood tests – helps diagnose inflammatory types of arthritis.
Based on the exam and test findings, the doctor will determine if hallux valgus is causing the symptoms and discuss treatment options.
What are the treatment options?
Milder cases of bunions that aren’t causing significant pain can be treated conservatively with:
- Wearing properly fitted shoes with a wide toe box – avoids pressure on the toe.
- Using bunion pads, sleeves, and spacers – decreases friction.
- Trying corrective orthotics – help realign the big toe.
- Doing bunion exercises – strengthen muscles and stabilize the joint.
- Taking anti-inflammatory medication – reduces pain and swelling.
- Getting bunion injections – corticosteroid injections can temporarily alleviate inflammation and pain.
For moderate to severe bunions, surgery is often necessary to realign the toe. Options include:
Bunionectomy
The most common procedure, a bunionectomy removes the bony bump and realigns the big toe joint. The surgeon may also fix tendons and ligaments around the joint to hold the toe in better position.
Lapidus bunionectomy
This reconstructive surgery realigns the metatarsal bone and fusion it with other bones using screws or pins. This provides stability but limits motion of the big toe joint.
Akin osteotomy
The Akin procedure involves cutting and shifting the big toe’s metatarsal to straighten the toe. Screws, pins, or staples hold it in place as it heals.
Keller arthroplasty
This removes the base of the toe’s proximal phalanx bone to allow the toe to bend outward if it’s rigid. Motion is preserved in the rest of the joint.
Arthrodesis
Arthrodesis fuses the joint bones together with plates, pins, screws or rods. This limits motion but provides stability and pain relief.
Recovering from bunion surgery takes several months. Physical therapy is needed to help regain strength and range of motion. Some stiffness and discomfort often remain.
| Treatment | Pros | Cons |
|---|---|---|
| Bunion pads and sleeves | – Relieve friction and pressure | – Don’t correct deformity |
| Orthotic devices | – Realign big toe position | – Can still cause discomfort |
| Anti-inflammatory medications | – Reduce swelling and pain | – Don’t fix deformity |
| Bunionectomy surgery | – Realigns big toe position | – Long, painful recovery |
| Arthrodesis surgery | – Provides stability | – Limited big toe motion |
Prevention
Although bunions can be hereditary, there are some preventative steps that can reduce the chances of developing them:
- Wear properly fitted, low-heeled shoes with a wide toe box.
- Avoid shoes that are tight-fitting, narrow, or pointy-toed.
- Use orthotics or spacers to keep toes aligned.
- Exercise toes and feet to strengthen muscles.
- Treat foot injuries right away to prevent deformities.
- Manage medical conditions like arthritis that affect foot health.
Treating bunions early when they first start developing can also help prevent progression of the deformity.
Conclusion
Hallux valgus, or bunions, occur when the big toe deviates inward toward the other toes. This common deformity has many causes including genetics, anatomy, joint damage, and wearing restrictive shoes. Diagnosis is made through physical exam and imaging like x-rays or MRI. Early treatment options include bunion pads, orthotics, medication, and exercises. Surgery to realign the toe may be necessary in severe cases. Prevention through proper footwear and early intervention can reduce the chances of bunions worsening over time. Left untreated, bunions can lead to painful arthritis and mobility problems. Consulting a podiatrist allows for tailored treatment to relieve discomfort and stop progression of the bunion deformity.