Hallux Valgus (HV), frequently referred to as bunions, is the most common forefoot deformity. It is characterized by abnormal angulation, rotation, and lateral deviation of the great toe at the first metatarsophalangeal joint.
Epidemiology studies indicate that across all age groups the prevalence of hallux valgus is greater in women (38%) compared with men (21%), with increasing prevalence as age increases. The higher prevalence among women may be due to footwear that is either poor or less forgiving, resulting in earlier and more frequent presentation.5,6
The often cited female prevalence can obscure the importance and the characteristic details of hallux valgus deformities in males,7 which are commonly hereditary in nature (mainly transmitted by the mother), with early onset and higher severity when compared to women.7
While studies show that sex and inheritance are important, other anatomical and biomechanical factors, such as anatomical metatarsal variants, including a long first metatarsal (probably most important in men), a rounded articulation, and metatarsus primus varus, play an important role. These variants increase the vulnerability to first-ray hypermobility, pes planus, and ligamentous laxity.8
HV also carries a noticeable impact on health related quality of life.9 Studies indicate that there are progressive reductions in both general health and foot -specific quality of life with increasing hallux valgus severity, leading to greater impairment on pain and functional assessment scales.9
Despite the high prevalence of foot problems and the significant impact foot impairment can have, foot problems often go unreported because many people, particularly older individuals, consider foot pain an inevitable consequence of ageing rather than a medical condition.10 Early, non-operative treatment can be useful in the management of hallux valgus symptoms. Options include nonsteroidal anti-inflammatory medications, steroid injections, activity modifications, shoe modifications, and orthotics or rocker bottom shoes. Prefabricated foot orthoses and rocker-sole footwear were similarly effective at reducing foot pain in people with first metatarsophalangeal joint osteoarthritis in a clinical study, although the prefabricated foot orthoses had greater adherence and fewer associated adverse events.9
If pain persists, however, a minimally invasive surgical intervention, like PROstep™ MICA™, is an option. Surgical interventions aimed at correcting or slowing the progression of HV deformity have a number of beneficial effects on localized pain relief. Surgical correction of hallux valgus allows improved ambulation and quality of life scores.5,9