Foot / Ankle
Hallux Valgus (Bunion)
무지외반증
Deformity with lateral deviation of the great toe and medial prominence (bunion)
- How common
- Very common (23% of adult women)
- Typical age
- Women, 30+
What is it?
Genetic predisposition plus narrow shoes/heels cause the first metatarsal to deviate medially and the hallux laterally, progressing to joint deformity.
Commonly affected: First metatarsophalangeal joint (1st MTPJ)
How it develops
- Normal AlignmentHallux aligned straight forward
- Genetics + Shoe LoadNarrow shoes and heels push hallux laterally
- Capsular ImbalanceMedial capsule stretches, lateral tightens
- Bone/Tendon DriftMetatarsal drifts medially, tendons pull laterally
- Bunion FormationMedial prominence with overlying bursitis
Symptoms
- Shoe-Related PainPain with narrow shoe pressure on prominence
- Medial ProminenceBony bump on inner side of great toe
- Hallux Lateral DeviationGreat toe drifts toward 2nd toe
- Joint Pain1st MTPJ pain with walking
- Toe Overlap/CornsHallux overlaps 2nd toe, calluses develop
How it is examined
- Hallux Valgus AngleHVA >15° indicates hallux valgus (normal <15°)
- Intermetatarsal Angle1st–2nd metatarsal angle (normal <9°)
- MTPJ MobilityEvaluate joint stiffness
- Bunion InflammationMedial bursa inflammation over prominence
Imaging
Weight-bearing AP and lateral X-ray are standard.
- HVA >15°
- IMA >9°
- Metatarsus primus varus
- Possible 1st MTPJ OA
MRI rarely needed — only for concurrent pathology.
- MRI rarely required
- Co-existing tendinopathy or neuroma
Non-surgical care
- Shoe ModificationWide toe-box shoes, avoid heels
- Toe Spacer/OrthoticToe spacer between hallux and 2nd toe
- Arch Support InsolesArch support if flatfoot co-exists
- NSAIDs + IceShort-term for acute inflammation
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Conservative failure with severe deformity and functional limitation
Procedures that may be discussed
- Chevron osteotomy (mild)
- Scarf osteotomy (moderate)
- Lapidus (severe)
Outlook
Surgery gives >90% pain relief and cosmetic improvement.