GPAtlas🧭 When to Suspect
Suspect hallux valgus (a bunion) in any patient with a bony prominence at the base of the big toe, where the hallux deviates laterally towards the lesser toes and the first metatarsal head drifts medially to become prominent. It is common – present in roughly a quarter of adults over 40 and rising with age – and is considerably more prevalent in women. Most cases are familial; narrow or high-heeled footwear tends to provoke symptoms and accelerate an existing deformity rather than cause it outright.
Typical complaints are deep joint pain on walking, friction pain or a red, inflamed bursa over the prominence, difficulty fitting shoes, and forefoot pain (metatarsalgia) as load shifts laterally. Note that the size of the deformity correlates poorly with pain – a modest bunion can be very symptomatic, and a large one painless.
Distinguish from hallux rigidus (osteoarthritis of the first MTP joint – a stiff, dorsally prominent joint with pain on dorsiflexion but no lateral deviation), acute gout (a hot, red, exquisitely tender first MTP – podagra), and septic arthritis. A bunionette (tailor's bunion) is the equivalent prominence over the fifth metatarsal head.
Source: NICE; Royal College of Surgeons / British Orthopaedic Association.
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