Feet First : Hallux Valgus

Hallux valgus, or a bunion, is a commonly found deformity of the big toe. This deformity causes the 1st metatarsophalangeal joint to be more pronounced on the inside portion of your foot, and can be painful while wearing shoes or walking. It is often seen as a bony prominence at the base of your big toe. 

There are lots of considerations to managing or even preventing this potentially debilitating pathology.  


Footwear with a narrow toe box will keep pressure on your toes, usually pushing the big toe laterally. When worn for prolonged periods, not only will the bones in your feet adapt over time to this forced position, but your muscles, tendons, and ligaments will also change if not corrected for.  

This is especially significant when children grow up wearing shoes with a narrow toe box throughout their important development phases. As the human skeleton matures, the body adapts to the environment and stress it is exposed to.

When you reflect on your own childhood and adolescence, we often confined our feet to restrictive shoes, but no other part of the human body is restricted in that same way (unless there was a relevant medical correction to be made). 

Over time, the big toe will gradually misalign from its optimal position, and your foot/toe complex will start to compensate. In some cases, this is where the bony prominence begins to form. When the foot rolls off the ground while walking, the misalignment of the first toe could create a mechanical mistake in the gait pattern which would increase the pressure on the toe. This repeated pressure could cause the bunion to grow even more. 

How can you prevent bunions? 

One way to prevent bunions due to environmental factors, is to use footwear that is minimalistic in design. An important feature of any closed toe shoe should be an adequate toe box width. This will allow for your foot and toe to properly roll off the ground during your gait cycle, and allow your big toe to maintain proper alignment in a standing position. In the summer time, using sandals or flip flops that allows your toes to adequately spread is encouraged! The more comfortable you are walking barefoot, the better it is for your feet. 

If you already have a bunion developing and are not interested in going for surgery to remove it, there are some strategies that you can use to improve your situation : 

  1. Change your footwear to something with a wide toe box. This should provide some pain relief by decreasing the pressure on your toes. Walk barefoot as much as you can!
  2. Strengthen the muscles that align your big toe with recommended exercises, often involving the spreading of your toes. Consult your physiotherapist to learn more about these. 
  3. Depending on your tolerance, using a small spacer (orthotic) to put between your 1st and 2nd toe may help with your alignment as well. 

Tapings and manual therapy has been shown to help improve this condition, but are best used in combination with footwear modifications.  

What about surgery? 

Surgery is not always the best option! If you have already undergone one to remove the bunion or are thinking about doing it, know that in some cases the bunion will reform at the same place. It is just as important to actively prevent it from redeveloping, as the surgery is only dealing with the consequences of the problem, and not fixing the cause! 

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