Hallux valgus is the medical name for bunion.
It is where the big toe moves towards the smaller toes, creating an increased angle at big toe joint. The big toe joint then becomes more prominent.
Hallux valgus can be symptomatic or asymptomatic – not everyone who has hallux valgus has pain, and the condition can range from mild to severe.
It is a common condition which affects 23% of adults between the ages of 15 to 65, increasing to 36% for over 65’s. Women are more commonly affected than men.
Causes
There is no single reason for developing hallux valgus.
It is believed there are many contributing factors, which may include:
- Family history – others in your family may have the same condition.
- Foot shape – Long second toes or flat feet may contribute to this condition.
- Muscle strength – weak muscles within the foot may contribute to developing hallux valgus.
- Ligament laxity – some conditions such as hypermobility can allow joints to move out of line more easily.
- Footwear – narrow shoes which constrict the forefoot can push the toes together.
Symptoms
Not everyone who has hallux valgus has pain, and the condition can range from mild to severe.
Sometimes they can cause:
- Pain, stiffness or swelling at the big toe joint.
- Difficulty walking due to discomfort
- The forefoot may widen (splay), which can lead to problems finding comfortable footwear which are wide enough for your foot.
- Skin problems such as callous and corns can develop due to pressure and friction from your shoes rubbing against your joint.
- The joint may develop a soft fluid filled swelling, called a bursa.
- Pain under the ball of your foot, under the small toes.
How long will it take to get better?
Hallux valgus unfortunately does not go away. Mild cases of hallux valgus are not known to cause any impact on foot function. Once you have hallux valgus, it may gradually increase in size and angle over time in some cases.
Luckily, many people do not have pain with their hallux valgus and continue with all their normal daily living activities.
What can I do to help my hallux valgus?
Treatment options for hallux valgus can be surgical or non-surgical. It is recommended you try all non-surgical treatment for hallux valgus before considering any surgical interventions.
Treatment is aimed at reducing stress through your toe joint to help reduce inflammation and improve function. Changes in lifestyle can also be helpful in reducing pain and discomfort. The one person who can help you manage your symptoms is you.
Footwear
One of the most important changes you can make is to your footwear.
- Avoid narrow shoes
- Avoid high heeled shoes or shoes with a flexible sole as these place increased stress on the joints of the forefoot.
- Avoid shoes which have seams at the toe box that may irritate the toe joint.
Look for a shoe that has the following qualities;
- Heels should be broad and have a small heel, no more than 1.5 inches high.
- Soles should be firm and non-pliable.
- Wide fitting footwear to provide plenty of room for your toes and accommodate any potential toe deformity. You may want to consider shoes with an EE or EEE fitting, there are a number of specialist suppliers of footwear that provide wide fitting footwear.
- Lacing or velcro straps to hold the shoe firmly to the foot, for example running or walking shoe
- A rocker at the forefoot can limit bending of the joint during gait and therefore reduce pain- see picture below.
Padding and night splints
Bunion shields and toe separators can help to reduce symptoms of pain. Night splints may impact on shape positively and slow progression if your bunion is mild.
Strengthening and stretching exercises
Targeted strengthening and stretching exercises for the small muscles in and around your foot and ankle can help to improve your symptoms and delay the progression of hallux valgus.
Local NHS Ayrshire & Arran podiatrists have devised exercise videos to help with strengthening the correct muscles.
You can view a list of exercises below.
Activity modification
Avoiding high impact activities and replacing with low impact exercise (e.g. replace running with swimming) until pain settles.
Weight management
If you have a higher than average body mass index (BMI) you may be more at risk. Please click here for further support with managing weight.
Foot orthoses
Foot orthoses may be considered if self-management and exercises have not improved your symptoms. Your local MSK podiatrist may prescribe some foot orthoses to wear in your shoes to try and offload the joint. Relief can be felt from a firm insole or one which provides support at the painful joint.
Investigations and surgery
Do I need a scan?
Hallux valgus is usually diagnosed primarily via a physical examination and patient history. Your clinician will assess your foot and toe positions when seated and when standing and walking. X-rays and additional imaging tests such as diagnostic ultrasound are not usually indicated unless non-surgical treatment has failed to improve your symptoms.
Will I need surgery?
Surgical management is not usually considered unless you have tried all of the above measures and continue to have difficulty walking. If all non-surgical treatment has failed and you continue to have pain that is affecting your daily living then it may be appropriate for a referral to an orthopaedic surgeon to consider a surgical intervention. Surgery may be offered to reduce pain and correct your toe position. Recovery from this type of surgery usually takes between 3 to six months before getting back to normal activity, but everyone recovers differently. There are several surgical procedures for this condition, and the method used would depend on the size and severity of your hallux valgus.
Exercises
The exercises below have been provided to help with your ankle osteoarthritis. If there is any doubt about your fitness to do these exercises then please discuss this with your GP.
You may find that these exercises may slightly increase your symptoms initially. However you should find the exercises themselves will become easier to do and that you begin to move your foot and ankle more easily. The exercises can take up to 12 weeks for you to notice a great improvement.
If these exercises cause a large increase in your pain or after 12 weeks there are no noticeable changes in your day to day symptoms then please contact your GP or NHS inform for more advice.
Pain during exercise
Within the scale, aim to stay in the green or amber boxes. If you are in the red area then you can modify the exercises by:
- reducing the amount of movement during an exercise
- reducing the number of repetitions
- reducing the weights
- reducing your speed
- increasing rest time between sets
Pain after exercise
Your pain or other symptoms should return to your pre-exercise baseline within 30 minutes of exercising. On the morning after your exercises, you should not feel an increase in pain or stiffness that lasts longer than 60 minutes.
Disclaimer
Please note: These exercises should not be used without prior consultation with a medical professional as the use of the wrong exercise may cause additional health related issues and discomfort. NHS Ayrshire & Arran and MSK NHS Ayrshire & Arran are not liable or responsible for any harm, losses or damages whatsoever resulting from the use or misuse of the information contained in or implied by the provided information in each video. These are provided for information only.
If you have any concerns about your ability to perform exercise then please discuss your concerns with your doctor or healthcare provider prior to participating in any advice that is on the MSK NHS Ayrshire & Arran website.
It is recommended to use your ice pack (cryocuff) or cool pack after your exercises to reduce the pain and discomfort this may cause.
Please choose the most relevant exercise section for you.
1. Toe Spreading Exercise
In a seated position, with feet flat on the floor, try to lift your toes slightly and separate your toes (spread them apart). Do not allow the ball of your foot to come off the floor. Hold the position for 3 seconds.
As this becomes easier, you can try doing this exercise standing.
Aim to build to 3 sets of 15 reps.
2. Seated Toe Grip Strengthening With Towel Exercise
This is performed in seated position.
Use your toes to begin crunching the towel up with the aim of pulling the towel in towards you, do this in a slow controlled manner whilst maintaining your heel on the ground. When you have pulled the towel in as far as possible straighten it back out again.
Aim to build to 3 sets of 15 reps daily.
3. Seated Short Foot Exercises
Start in a seated position with your foot flat on the ground. Straighten your toes and press them gently into the ground whilst sliding the ball of your foot back towards your heel and lifting the arch of your foot. Be careful not to claw your toes whilst doing this exercise or lift the ball of the foot off the ground. Hold for 5 seconds.
Aim to build to 3 sets of 15 reps daily.
4. Standing Short Foot Exercise (progression)
Start in a standing position and straighten toes and press them gently into the ground whilst sliding the ball of your foot back towards your heel and lifting the arch of your foot. Be careful not to claw your toes whilst doing this exercise or lift the ball of the foot off the ground. Stand close to a wall or hand rail to aid with balance if required. Hold for 5 seconds.
Aim to build to 3 sets of 15 reps
5. Toe Spreading Exercise – Big Toe
This is performed in seated position. Try to move your big toe away from the other toes, it may be difficult at first. You can use your fingers to help. Try to hold the big toe in this position for 10 seconds, then release. This will help to strengthen your big toe muscles. Repeat 15 times.
Aim to build to 3 sets of 15 reps daily.
6. Toe Raises Exercise
This exercise is performed in a seated position. Place your feet flat on the ground.
Big Toe Raise – Start in a seated position, with feet flat on the floor. Keep your lesser toes touching the floor and lift the big toe. Relax the big toe back to floor. Repeat process 10 times and rest.
Lesser Toe Raises – Keep your big toe touching the floor and lift the other toes. Relax the toes back to floor. Repeat 10 times and rest.
7. Standing Ankle Forward Leans
Stand near to a wall or chair to aid with balance. Have your feet hip width apart. Spread your toes wide. Gently lean your body forward from your ankle joint, your toes should have to press down into the ground to help hold you up. Push down with your toes to return to the starting position.
Hold the forward lean for 5 seconds.
Repeat 15 times.
Do this exercise once per day.
8. Seated Towel Calf Stretch – Knee Straight
Place a towel around the ball of the affected foot and avoid bending your knee. Pull the towel toward you until you feel the stretch in the bottom of your foot and back of your calf muscle.
Hold the stretch for 30 seconds and repeat 3 times.
9. Seated Towel Calf Stretch – Knee Bent
Place a towel around the ball of the affected foot and bend your knee. Pull the towel toward you until you feel the stretch in the bottom of your foot and back of your calf muscle.
Hold the stretch for 30 seconds and repeat 3 times.
10. Standing Calf Stretch – Knee Straight
Place your hands on a wall for support and take a step back with the affected foot. Now begin to bend the knee of your front leg whilst moving your chest towards the wall until you feel a stretch in the back of you calf muscle.
Hold for 30 seconds and repeat 3 times.
11. Standing Calf Stretch – Knee Flexed
Adopt the same starting position as you did for the previous exercise. Slide the affected foot towards the front foot as demonstrated. This time when bending the front knee, also bend the knee of the back leg until you feel a stretch deeper in the calf muscle.
Hold this for 30 seconds and repeat 3 times.
