I have a hallux valgus deformity. Is there anything I can do?

I am an orthopedic physical therapist who works in a clinic that specializes in feet. I treat A LOT of feet. I don’t know how many times I have educated patients on the need to wear better shoes. Some of the patients that need to change up their shoe wear the most are those with a hallux valgus deformity. Hallux valgus deformities are primarily in women, although it does affect men as well. These women tend to wear narrow shoes and/or heels. Unfortunately, it is time for them to ditch the heels and put on some more supportive shoes. Read on to learn more about hallux valgus and how to treat it.

What is the hallux?

The hallux is the medical term for the big toe. The big toe is made up of two joints. The first one is the metatarsophalangeal joint (MTP). This is the larger of the two joints and is where the first metatarsal (long bone of the foot) meets the first phalanx (toe bone). The second joint of the big toe is the proximal interphalangeal joint (PIP). This joint is smaller and it is where the two bones (phalanges) of the big toe meet.

The big toe is very important in daily life. While walking, the big toe bears twice the load of the other toes and plays a key role in forward propulsion of the body. The big toe also is a vital component in balance. The MTP joint is the joint affected by hallux valgus. It has more movement than the PIP and plays a bigger role in walking, running, and balance.

“Palmer – Drawing Bones and joints of the foot – English labels” by Beckie Palmer, © StatPearls Publishing LLC, license: CC BY

What is hallux valgus deformity?

Hallux valgus occurs when the big toe deviates toward the 2^nd toe. This is considered one of the most common foot deformities. This deviation occurs because of a muscle imbalance. The first metatarsal is pushed away from the foot while the big toe is pushed toward the 2^nd toe. This will eventually cause the ligaments and the capsule surrounding the outside of the MTP joint to rupture.

“Blausen 0411 – Bones of the foot – English labels” by Blausen.com staff (2014), license: CC BY. Source: “Medical gallery of Blausen Medical 2014” https://en.wikiversity.org/wiki/WikiJournal_of_Medicine/Medical_gallery_of_Blausen_Medical_2014

What about the bunion?

A bunion is a bony bump that forms on the outside of the MTP joint. It is the end of the metatarsal bone as it deviates away from the foot. This area will get irritated and inflamed especially when wearing tight fitting shoes.

What are symptoms of hallux valgus?

There are several symptoms associated with hallux valgus. These include:

Pain, redness, and swelling at the MTP joint
- Becomes worse when walking
Pain when wearing tight fitting shoes
Gradually the bunion gets bigger and hardens
Abnormal walking to avoid putting weight through the big toe
Difficulty walking
Impaired balance

Who gets hallux valgus?

Hallux valgus is very common. It is estimated that is occurs in about 23% of adults aged 18 to 65 years old and 36% in adults above the age of 65. There are several risk factors associated with hallux valgus. These include:

Female – The prevalence is much higher in women than in men (15:1).
Hereditary – 70% of those with hallux valgus have a family history of the deformity.
Footwear – Tight, pointed shoes have not been found to cause hallux valgus but it can increase symptoms in those that are predisposed to getting it.
Congenital foot deformities
Severe flatfoot
Chronic Achilles tendon tightness
Hypermobility of the foot
Hip and knee osteoarthritis
High BMI

Who should I see?

Physical therapy – Physical therapy can help decrease the pain and swelling with techniques including manual therapy and dry needling. PT can evaluate and address abnormal joint mobility, gait, muscle weakness, and flexibility. Some PT’s or an orthotist can measure your foot for custom made orthotics. Orthotics might be needed to off-load the big toe and improve static and dynamic foot positioning while standing, walking, or running.
Orthopedic physician – An orthopedist that specializes in the foot and ankle will be necessary if your condition is not responding to physical therapy. Anti-inflammatories or an injection might help with inflammation and pain. Your orthopedist can order imagining to determine the extent of the damage to your toe. Depending on the stage of your deformity, your activity level, and your level of pain, you might be a candidate for surgery.

What can I do at home?

Relative rest – Avoiding activities that increase the pain and inflammation is the best to decrease the irritation in the big toe. Basically stay away from the activities that are causing pain. This might mean changing the way you exercise. If you are a runner you might think about switching from asphalt to trails. Swimming and biking would be good alternative activities that do not put much stress through the ankle and foot.
Ice – Ice can help decrease the pain and swelling at the foot. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or preventing you from participating in an activity. Ice immediately after activity.

Stretching – Stretching the calf muscles can help improve the motion at the ankle. This includes stretching the gastrocnemius and the soleus. See the video below.

Strengthening – It is important to strengthen the muscles of the foot, leg, calf muscles, knee, and hip. All of these muscles work together to stabilize the ankle and foot while running, walking, standing, and jumping. Using loop resistance bands , resistance bands and ankle weights can increase strength and difficulty of the exercises. See the videos below.

Balance – Working on balance is important in strengthening the foot and ankle but also improving proprioception.Improving proprioception will help improve the overall stability of the ankle. See the video below.

Toe separator – Using a toe separator can help alignment of the big toe and take pressure off of the bunion. The toe separator can go between your big toe and second toe while wearing shoes or socks. They can be worn all day or just during painful activities.

Shoe wear and orthotics – Changing shoe wear or using orthotics to off-load the big toe will help decrease your pain and improve your ability to walk and run. A rocker bottom or stiff soled shoe can help decreased the amount of extension needed from the big toe. Also you will want a shoe with a wide toe box to avoid rubbing and irritation to the bunion. Avoid shoes that have a heel and/or a narrow toe box. Most running stores can suggest appropriate shoe wear. Your PT can also evaluate your foot and help determine appropriate shoe wear.

In review

The hallux is the medical term for the big toe.
The big toe is made up of two joints.
- The first one is called the metatarsophalangeal joint (MTP). This is the larger of the two joints and is where the first metatarsal (long bone of the foot) meets the first phalanx (toe bone).
While walking the big toe bears twice the load of the other toes and plays a key role in forward propulsion of the body.
Hallux valgus occurs when the big toe deviates toward the 2^nd
A bunion is a bony bump that forms on the outside of the MTP joint.
Symptoms include pain and swelling at the MTP joint that increases with walking.
Physical therapy can help with toe pain, weakness, and abnormal walking.
Physical therapy or an orthotist would be needed for orthotics.
An orthopedist would be needed if other conservative measures are not helping.
There are things that you can do.
- Relative rest
- Ice
- Stretching
- Strengthening
- Balance
- Toe separator
- Shoe wear and orthotics