The following patient information sheet is meant to help patients and family better understand a specific pediatric orthopaedic condition. It is not meant to be comprehensive, and only reflects one viewpoint. This page does not replace a medical evaluation by a pediatric orthopaedic surgeon, and your own surgeon may have a different approach to your condition.

 

What is hallux valgus?

Hallux valgus is caused by curvature the bones leading up to and including the big toe. A joint in the big toe called the metatarsal-phalangeal joint has to curve to compensate for this, and when it does so a portion of the foot becomes prominent. This prominent portion is called a bunion.


Why does my child have hallux valgus?

Hallux valgus occurs more often in girls, and more often with a family history of the disease. In children it is usually caused by metatarsus primus varus, which is an angulation between two bones in the foot. It is thought to be related to flatfeet.


How is the diagnosis of hallux valgus made?

Hallux valgus is generally easily seen on examination. The diagnosis is confirmed and the severity determined with x-rays.


What non-surgical treatments are available for hallux valgus?

Pain is generally located over the prominent part of the inner foot, and can often be treated with appropriate shoewear. Ideally, shoes should have good arch support and a widened toe box to accommodate the toe.

A nighttime splint is a reasonable treatment option. It holds the toe in a corrected position at night, which theoretically encourages the toe to grow into a straighter position, although studies on this have shown mixed results (some studies show improvement with treatment, some studies show do not show benefit).


What surgical treatments are available for hallux valgus?

Surgical treatment is considered only with the presence of persistent pain despite shoewear modifications. In these cases, it is important to determine whether the foot is still growing.

If the foot has essentially finished growing, then it can be straightened with osteotomies. Please see my separate section on foot osteotomy. It is important to note that osteotomy is only an option if growth is either complete or nearly complete. Otherwise, the hallux valgus can come back as the foot continues to grow.

If the foot has not finished growing, then the options are to wait until growth is complete and then proceed with osteotomy, or attempt guided growth of the foot. Please see my separate section on guided growth. For hallux valgus, this is performed in a permanent fashion by placing a drill hole through one or two bones in the foot. This is an attractive option because it is a very minimal surgery. The incision is minimal, and the child can go home the same day even if both feet are treated. The downside is that this approach is relatively new, and thus its results are not well known. If the treatment does not fully correct the foot by the time the child is full grown, then an osteotomy in the future may still be necessary. If the treatment corrects the foot too fast, then an additional (but also minimal) surgery would be necessary to fully stop the growth of the bones treated.


What can I expect in the future for my child with hallux valgus?

As it is very difficult to follow children until late adulthood, the long term outcome for hallux valgus in children is not fully understood. However, the data available suggests that children without pain have a reasonable chance of not having significant pain as adults. Because of this, osteotomy for hallux valgus is not recommended in children for the deformity alone; rather, surgery is based on pain and functional issues.