Hallux valgus — a painful bunion

Clinical context

What you should know

Anatomical and family predisposition play an important role. Tight footwear may aggravate symptoms but is not the only cause.

Treatment addresses pain and function rather than an isolated radiographic or cosmetic appearance. The type of correction depends on the joints, rotation, first-ray stability and associated deformities.

First step

Consultation and assessment

The foot is examined while standing and walking, including big-toe movement, calluses and adjacent joints. Weight-bearing radiographs are essential for measurements.

The footwear that can be tolerated, diabetes, circulation, smoking and the patient's goal are discussed. The correct technique cannot be selected from a photograph alone.

Prepare for your consultation

Stepwise treatment

Options are chosen according to the diagnosis and treatment goal

Conservative treatment

• wide toe-box shoes, soft materials and avoidance of direct pressure
• local padding and insoles when associated metatarsalgia is present
• activity modification and selected pain relief
• careful callus management without aggressive procedures in people with diabetes or poor circulation

Medication, injections and devices each have their own indications and contraindications. They are not recommended automatically and do not replace a diagnosis or monitoring of the response.

When surgery is considered

Surgery is considered when pain and difficulty wearing shoes persist. Osteotomies, soft-tissue procedures or a Lapidus fusion are selected according to the deformity; no single technique is best for every bunion.