tay.generalcomments@nhs.scot

Hallux Valgus

General information 

  • 33 per cent of people will develop hallux valgus at some stage in their lives - more common in females
  • Not all bunions are painful. Can have large bunions without significant pain.
  • Becomes symptomatic with ill-fitting shoes
  • Deviating great toe can cause pressure on the second toe, resulting in second hammer toe.

Symptoms and signs

  • Pain during walking and following activities
  • Restriction of movement in great toe joint
  • Can lead to mechanical function problem of the forefoot
  • Irritated skin around the bunion – may blister/ulcerate, sometimes can become infected
  • Joint redness and pain – secondary corns and callous

Primary Care management 

  • Provide with patient information leaflet for Hallux Valgus to support self-management
  • Footwear advice: avoid high heels, pointed or tight-fitting shoes. Encourage low heels, extra width shoes with laces or straps, as can be adjusted to the width of the foot. In-shoe orthosis and padding – Can be bought from any chemist / online
  • Weight loss if appropriate
  • Rest feet after periods of standing/walking.
  • Pain medication: Analgesia & NSAIDs as appropriate.
  • Intra-articular steroid injection by appropriately trained healthcare professional
  • If deciding to refer please request XR foot standing AP and oblique 

Useful resources

Hallux Valgus (NHS Tayside leaflet)
Patient information 'A Guide to Bunion Surgery'

Who to refer

  • If ulceration/ infection and wound dehisced - Urgent referral Foot and Ankle service
  • Daily pain should be primary reason for referral - either due to pressure effects or degenerate joint.
  • Failure of conservative treatment for 3 months, functional impairment.
  • Difficulty obtaining suitable shoes and deformity is deteriorating
  • If patient wishes to be considered for surgery
  • Surgical osteotomy/joint replacement/fusion may be necessary. Note that post op: unable to drive for 6 weeks, and will be off work 2 weeks for sedentary job

Who not to refer

  • Non-diabetic recurrent ulceration/ Infection - Urgent referral to Podiatry.
  • Diabetic Ulcer- Urgent referral to podiatry
  • Those with no pain- surgery will not be performed for cosmetic reasons

How to refer

SGI Gateway/Orthopaedics/Foot and Ankle Service.
Referral will be vetted by AHP and directed to most appropriate healthcare professional. 

Information to include when referring:
  • Duration and any cause of symptoms
  • Indicate site/spread of pain and if pain constant or intermittent, and/or waking at night
  • Indicate ROM, functional limitation
  • Include treatment to date
  • XR results