Foot Conditions
Hallux valgus, commonly known as a bunion, is a progressive structural deformity of the first metatarsophalangeal (big toe) joint, and one of the most frequently presenting conditions in foot and ankle practice. Its severity, rate of progression, and appropriate management vary considerably between individuals, which makes accurate clinical assessment — rather than assumption based on appearance alone — central to determining the right course of treatment.
The medical term for a bunion, hallux valgus, describes a deformity in which the big toe (the hallux) drifts laterally toward the second toe, while the first metatarsal bone shifts in the opposite direction. The resulting prominence at the inside edge of the foot — the feature most people recognise as "the bunion" — is not itself the primary problem. It is the visible consequence of a change in the alignment of the first metatarsophalangeal joint, and often reflects deeper changes in the mechanics of the forefoot, including the position of the sesamoid bones beneath the joint and, over time, changes in the angle of the metatarsal bone itself.
This distinction matters clinically. Because the deformity involves the joint and the underlying bone rather than a simple soft-tissue lump, treatment aimed only at the visible prominence — without correcting the underlying angular relationship between the first and second metatarsals — does not address the deformity and is prone to recurrence.
Hallux valgus is understood to result from an interaction between inherited joint and ligamentous laxity and mechanical load. A family history of the condition is common, and is thought to reflect an inherited predisposition to instability at the first metatarsophalangeal joint and the joint immediately behind it. Once that instability is present, mechanical factors — including footwear with a narrow or tapered toe box, and biomechanical conditions such as flatfoot deformity that alter load distribution across the forefoot — can accelerate the rate of progression. Footwear is frequently assumed to be the primary cause; in practice, it is more accurately understood as a contributing factor that acts on an underlying structural predisposition, rather than a sole cause in isolation.
Clinical assessment begins with a detailed history — the duration and rate of progression of the deformity, the specific nature and location of any pain, and the degree to which footwear choice and daily activity are affected. Examination assesses the flexibility of the deformity, the range of motion at the first metatarsophalangeal joint, and the presence of any secondary lesser toe deformity or callus formation.
A weight-bearing X-ray is the standard imaging investigation, and is taken with the patient standing so that the deformity is assessed under normal load-bearing conditions rather than in a non-functional, non-weight-bearing position. Two specific angular measurements — the hallux valgus angle (the angle of deviation of the big toe) and the intermetatarsal angle (the angle between the first and second metatarsal bones) — are used to grade the deformity as mild, moderate, or severe. This grading is clinically significant: it is the principal factor determining whether non-surgical management remains appropriate, and if surgery is being considered, which surgical technique is best matched to the specific deformity.
Non-surgical measures are appropriate first-line management for mild to moderate deformity, and for patients whose symptoms are intermittent rather than persistent. These measures do not correct the underlying bony deformity, but they can meaningfully reduce load and friction over the joint and slow the rate of symptomatic progression:
These measures are managed as an ongoing strategy rather than a fixed course of treatment, and are reassessed if symptoms progress despite their use.
Surgical correction is considered when pain or functional limitation persists despite appropriate non-surgical management, or where radiographic assessment shows a deformity that is progressing at a rate likely to compromise the joint further. The decision is not based on the size of the visible prominence, but on the combination of the patient's symptoms, functional impact, and the hallux valgus and intermetatarsal angles measured on weight-bearing X-ray. This is also the point at which the specific surgical technique — matched to the grade of deformity — is determined, detailed on the corresponding procedure page.
Not every prominence at the base of the toes is hallux valgus.
A comparable deformity can develop at the base of the fifth toe — a Tailor's Bunion, or bunionette — involving the same mechanism of angular deformity but affecting the opposite side of the foot. It is assessed and, where indicated, treated as a distinct condition. If the prominence in question is on the lateral (outside) border of the foot, see Tailor's Bunion & Bunionette →
Hallux valgus arises from an inherited predisposition to instability at the first metatarsophalangeal joint, on which mechanical factors — including footwear and biomechanical conditions such as flatfoot deformity — then act to accelerate progression. Footwear alone is rarely the underlying cause.
None — the terms describe the same condition. "Bunion" is the common name for the visible prominence; hallux valgus is the clinical term describing the underlying joint deformity that produces it.
No. Deformity grade, symptom severity, and rate of progression — not the presence of a bunion alone — determine whether surgery is appropriate. Many cases are managed effectively with non-surgical measures, particularly where the deformity is mild and symptoms are intermittent.
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