The toe is deviated
The big toe points towards the other toes.
CONDITION / ARMS AND LEGS
Valgus deformity of the foot.
Hallux valgus of the foot is a condition in which the big toe deviates towards the other toes, and a painful "bump" protrudes on the side. Initially, pain is relieved with shoes and orthoses, and surgery is discussed when pain or limitations interfere with life.
CONCEPTUAL VISUALIZATION- What it is
- The big toe deviates towards the other toes, a bony "bump" is on the side of the foot.
- How often
- According to a meta-analysis of 45 studies — in about 19% of people, more often in women than in men.
- The first step
- Without surgery: wide comfortable shoes, orthoses, splints, pain relief.
- When surgery is performed
- When pain or limitations interfere with life and comfortable shoes do not help.
01 / WHAT IS ITWhat is
What is
Hallux valgus deformity.
The big toe rests on the first metatarsal bone. If this bone gradually moves inward, and the toe outward, toward the other toes, a bony "bump" appears at the side of the foot where they connect. Doctors call this hallux valgus.
The condition is common: in a meta-analysis of 45 studies, it was found on average in 19% of people — 23.74% of women and 11.43% of men; among people over 60 years old — 22.7%. The authors recommend interpreting these figures cautiously because the studies varied greatly.
It’s not just about appearance. According to a Cochrane review, the deformity disrupts balance and increases the risk of falls, complicates shoe selection, and causes pain.
It is not possible to get rid of a "bunion" on your own or stop its growth, but the pain can be relieved. Only surgery can remove the deformation itself, and it is done not for the appearance of the foot, but when the pain interferes with living.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
"bunion" presents.
The deformation increases gradually. It mainly causes pain in shoes and the fact that regular shoes become tight.
Bunion from the side
A hard bony bump at the base of the big toe; the skin over it may be thickened, swollen, and reddish.
Pain in shoes
Pain on the side or bottom of the foot, usually stronger in shoes and while walking.
Difficulty choosing shoes
Regular shoes press on the bunion, so it is necessary to look for wider ones.
Balance
According to the Cochrane review, deformity disrupts balance and increases the risk of falls.
It looks similar, but it’s not the same
Redness, warmth, and joint swelling that come and go occur more often with gout; morning stiffness and pain in multiple joints occur with arthritis. This is assessed by a doctor; if the skin over the joint is hot, painful, and swollen, see a doctor the same day.
03 / REASONSWhy does it occur?
Why does it occur?
deformation
The exact cause is not always known. This is a condition in which several factors combine.
Foot structure
In cross-sectional studies, the deformity was associated with the structure of the first metatarsal: a larger angle between it and the second, a longer bone, a rounded head.
Gender and age
In a meta-analysis of 23 studies, female sex and older age were associated with the deformity.
Tight shoes
In the same meta-analysis, narrow-toed shoes were more strongly associated with the deformity than high heels. No connection with body weight was found.
Other conditions
The deformity was also associated with flat feet, scoliosis, osteoporosis, and knee osteoarthritis. These are associations from observational studies, not proven causes.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
The "bunion" itself is a planned situation and does not require urgent care. Urgent signs may mainly appear after foot surgery: according to the NHS, such signs require 103.
103 immediately if:
- suddenly having difficulty breathing;
- pain in the chest or upper back;
- the heart beats very often;
- being unconscious or unresponsive;
- confusion of consciousness;
- very frequent breathing;
- cold, clammy, or pale skin;
- purple spots on the skin.
Do not delay:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after surgery the foot pain or swelling increases rather than decreases. On the same day: after surgery the calf or thigh of one leg is painful and swollen (may indicate a clot); the skin around the wound or above the "bunion" is painful, hot, and swollen; you are coughing up blood. In the coming weeks: if the pain does not go away after several weeks of comfortable shoes and home measures, interferes with usual activities, the "bunion" grows, or if you have diabetes — with diabetes foot problems can be more serious. Planned: If pain and tight shoes interfere with living, and comfortable shoes and orthoses no longer help, — make an appointment for a consultation about surgery.
05 / DIAGNOSTICSAs defined,
As defined,
what to do
- Conversation
Where and when it hurts, what shoes you wear, what you have already tried, whether the pain interferes with work, walking, sports.
- Foot examination
The doctor assesses the toe angle, joint mobility, the skin over the bunion, neighboring toes and the sole, as well as blood circulation and foot sensitivity.
- Foot X-ray
The images show the angle between metatarsal bones, toe deviation, and the condition of the joint. The deformity is classified as mild or moderate and severe.
- Other causes of pain
If there are signs of gout or arthritis, the doctor may prescribe additional tests.
- The solution
Whether conservative treatment is enough, whether surgery is necessary, and which operation is suitable specifically for your foot.
06 / TREATMENTHow we treat
How we treat
Hallux valgus deformity.
The first step is non-surgical treatment: it relieves pain but does not correct the deformity. Surgery is considered when pain and limitations interfere with life, and comfortable shoes do not help.
01
Without surgery
They relieve pain but do not correct the deformity.
- Shoes
- Wide, with low heels and a soft sole; without narrow toes and high heels. Cushion pads reduce friction against the bone.
- Orthotics and splints
- Insoles, toe separators, night and dynamic splints. In a review of 18 studies (mostly small), for orthotics, splints, manual therapy, and taping along with exercises, pain reduction was more likely than correction of the toe angle; the certainty of this data is low.
- Analgesia
- Cold for up to 5 minutes, over-the-counter painkillers, weight loss in case of excessive weight.
- What is known about the effect
- In a randomized study of 209 patients with painful bunions and a toe deviation angle up to 35°, improvement after a year was noted in 46% of those who wore orthoses, 83% of those who underwent surgery, and 24% of those who waited without treatment. Orthoses provided short-term relief.
02
Surgery
Osteotomy is cutting and repositioning the bone.
- What are they doing?
- The first metatarsal bone is cut, shifted into the correct position, and fixed with screws; the bunion prominence is reduced. Screws are often not removed.
- Open or minimally invasive
- Osteotomy is performed through a regular incision or through several incisions a few millimeters long. In some studies, pain in the first days after minimally invasive surgery was lower, but according to final results and complications, based on study reviews and the NICE guideline, the techniques are equivalent. NICE recommends that minimally invasive surgeries be performed by surgeons with specialized training.
- Benefit
- According to the Cochrane review, surgery can significantly reduce pain compared to no treatment or non-surgical treatment, but it has little effect on quality of life; the certainty of this data is low.
03
What to expect
- Recovery
- Most patients go home the same day. For at least the first 2 weeks, the leg is kept elevated, they do not drive for 6–8 weeks, return to work in 2–12 weeks, and return to sports in 3–6 months.
- Complications
- According to a meta-analysis in the 2025 review, the overall complication rate is 18.5%: pain under the metatarsal heads, recurrence of deformity, stiffness of the big toe joint, wound healing problems, excessive deviation of the toe in the opposite direction.
- Bunions recurrence
- In a meta-analysis of 23 studies (2914 people), the deformity recurred in 24.86% of operated patients; it was more frequent when the toe angle was larger before surgery or remained larger after it.
- After surgery
- The finger may be weaker or less mobile than before surgery, not completely straight, and the foot may still hurt.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Valgus deformity at the Valikhnovskyi Institute of Surgery is treated in the field of "Hand and Foot Restoration." Surgery is offered when pain or deformity interferes with walking, and orthopedic shoes no longer help; whether it is needed and which specific procedure is required is determined by examination and X-rays.
CLINIC SERVICE
Hand and foot rehabilitation
Grasping, sensitivity, support, and movement after injuries, wounds, and burns: fingers, tendons, nerves, and bones.
View service
What we do for this condition
- Osteotomy of the first metatarsal bone — the bone is cut and shifted so that the big toe becomes straight, and the "bunion" is reduced.
- Open or minimally invasive technique — through a regular incision or through incisions of a few millimeters using a micro burr; whether the method is suitable is determined by X-ray.
- Fixation with screws — holds the bone in the new position until it heals.
- Special footwear after surgery — load restriction for several weeks; after minimally invasive surgery, patients usually walk in special shoes without a cast.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photos and pictures onlineSend photos of the feet and X-ray, if available — the doctor will preliminarily assess the situation.
- ConsultationExamination of the foot, footwear, and toe mobility; X-ray if necessary.
- PlanWhether the footwear and orthoses are sufficient, whether surgery is needed, and by which technique.
- SurgeryOsteotomy of the first metatarsal with screw fixation — open or through micro-incisions.
- RecoverySpecial footwear and load restriction for several weeks, follow-up examinations and X-rays.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it possible to correct a "bunion" without surgery?
No: shoes, orthoses, and splints relieve pain, but they do not remove the deformity or stop its progression. Only surgery can remove it.
Do insoles and toe separators help?
They are more likely to reduce pain than to correct the toe angle, and the certainty of this data is low. In a randomized study, orthoses provided short-term relief.
When is surgery necessary?
When pain or deformity interferes with walking and daily life, and comfortable shoes and orthoses do not help. Surgery is not done just for the appearance of the foot.
Is minimally invasive surgery better than open surgery?
Based on final outcomes — no: according to study reviews and the NICE guideline, the techniques are equivalent. Which one suits you is determined by X-ray and the degree of deformity.
How long does recovery take?
For the first 2 weeks, the leg is kept elevated, driving is not allowed for 6–8 weeks, sports — after 3–6 months. Exact timing depends on the surgery.
Can a “bunion” come back?
Yes. In a meta-analysis of 23 studies, the deformity recurred in 24.86% of operated patients, more often when the toe angle was larger before or after the surgery.
Do the screws need to be removed?
Often they are not removed. Whether anything needs to be removed will be told by the doctor at the follow-up examination.
Sources
17 sources · Cochrane review, meta-analyses, randomized study, NICE and NHSshowCollapse
- Surgical interventions for treating hallux valgus and bunionsCochrane Database of Systematic Reviews, 2024doi:10.1002/14651858.CD013726.pub2 ↗
- Effectiveness of Nonsurgical Interventions for Hallux Valgus: A Systematic Review and Meta-AnalysisArthritis Care & Research, 2022doi:10.1002/acr.24603 ↗
- Hallux valgus orthosis characteristics and effectiveness: a systematic review with meta-analysisBMJ Open, 2021doi:10.1136/bmjopen-2020-047273 ↗
- Surgery vs Orthosis vs Watchful Waiting for Hallux Valgus: a randomized controlled trialJAMA, 2001doi:10.1001/jama.285.19.2474 ↗
- Global prevalence and incidence of hallux valgus: a systematic review and meta-analysisJournal of Foot and Ankle Research, 2023doi:10.1186/s13047-023-00661-9 ↗
- Determinants and associated factors for hallux valgus: a systematic review and meta-analysisBMC Musculoskeletal Disorders, 2026doi:10.1186/s12891-026-10054-1 ↗
- Characteristics of foot structure and footwear associated with hallux valgus: a systematic reviewOsteoarthritis and Cartilage, 2012doi:10.1016/j.joca.2012.06.007 ↗
- Hallux Valgus: Prevalence and Treatment OptionsDeutsches Ärzteblatt International, 2025doi:10.3238/arztebl.m2025.0068 ↗
- Prevalence and Predisposing Factors for Recurrence after Hallux Valgus Surgery: A Systematic Review and Meta-AnalysisJournal of Clinical Medicine, 2021doi:10.3390/jcm10245753 ↗
- Does Minimally Invasive Surgery Provide Better Clinical or Radiographic Outcomes Than Open Surgery in the Treatment of Hallux Valgus Deformity? A Systematic Review and Meta-analysisClinical Orthopaedics and Related Research, 2023doi:10.1097/CORR.0000000000002471 ↗
- Minimally invasive chevron osteotomy provides comparable outcomes to open surgery for hallux valgus: A systematic review and meta-analysisFoot and Ankle Surgery, 2026doi:10.1016/j.fas.2025.11.010 ↗
- Minimally Invasive vs. Open Surgery for Hallux Valgus: A Meta-AnalysisFrontiers in Surgery, 2022doi:10.3389/fsurg.2022.843410 ↗
- Minimally invasive percutaneous surgical techniques with internal fixation for correcting hallux valgus (HTG723)NICE, 2024nice.org.uk/guidance/htg723/chapter/1-Recommendations ↗
- BunionsNHS, 2023nhs.uk/conditions/bunions ↗
- DVT (deep vein thrombosis)NHS, 2026nhs.uk/conditions/deep-vein-thrombosis-dvt ↗
- Pulmonary embolismNHS, 2026nhs.uk/conditions/pulmonary-embolism ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
The figures on the page are from these sources.
"Bunion"
does it interfere with walking?
Send a photo of the feet and X-ray, if available. The doctor will say whether comfortable shoes and orthoses are enough or if surgery should be considered.