How does hallux valgus develop?

The most common causes of hallux valgus are:

  • Sex – women develop this condition much more often than men (9:1), which is related to the weaker ligamentous structures of the female foot.
  • Footwear – hallux valgus was already described in the early eighteenth century, when higher heels became fashionable. Heels overload the front of the foot, widening the forefoot and lowering the transverse arch. Narrow toe boxes additionally increase pressure on the big toe, worsening the deformity and promoting local inflammation.
  • Genetic factors – estimates suggest this applies to 58–88% of patients. Hallux valgus is mainly inherited through the maternal line.
  • Hypermobility of the first metatarsal bone. This accounts for approximately 5% of cases.
  • Flatfoot
  • Contracture of the Achilles tendon
  • Pathology of the tibialis posterior muscle
  • Injury, laxity or excessive length of the big toe
  • Rheumatic diseases: rheumatoid arthritis, psoriatic arthritis, systemic lupus, gout, Down syndrome and Marfan syndrome
  • Amputation of the second toe
  • Removal of the medial sesamoid bone
  • Other factors

The development and progression of hallux valgus are influenced by the simultaneous presence of several of these adverse factors.