Bunions (Hallux Valgus): Causes, Symptoms & Treatment Options

A bunion (hallux valgus) is a progressive deformity: lateral deviation of the great toe with medial prominence of the first metatarsal head.

Etiology (Multifactorial)

• Genetics: Heritable foot structure (flatfoot, hypermobility, metatarsus primus varus).
• Footwear: Narrow toe box, high heels → mechanical exacerbation (not primary cause).
• Biomechanics: Overpronation, ligamentous laxity, gastrocnemius contracture.
• Inflammatory: RA, gout, psoriatic arthritis accelerate deformity.

Symptoms

• Medial forefoot prominence, pain with shoe wear
• 2nd toe crossover/hammertoe
• Bursitis over bunion (red, swollen)
• Transfer metatarsalgia (pain under lesser metatarsals)

Conservative Management

• Wide toe box shoes, soft uppers
• Orthotics (medial arch support, metatarsal pad)
• Toe spacers, splints (night) — symptomatic relief only
• NSAIDs, ice, activity modification
• PT: intrinsic foot strengthening, gastroc stretching

Surgical Indications

Persistent pain limiting function despite 3–6 months conservative care. Procedures: distal metatarsal osteotomy (Chevron), proximal osteotomy (Scarf, Crescentic), Lapidus (1st TMT fusion), Akin (phalanx osteotomy). Choice by deformity severity, arthritis, surgeon preference.

Prevention

Supportive footwear from youth; address biomechanics early; maintain healthy weight.