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1 · SNAPSHOT

Hallux Valgus (Bunion) body chart — Illustrative, not diagnostic. Canva body chart for Hallux Valgus (Bunion).

Who: Often a family history. Very narrow toe boxes and high heels in your 20s are associated with it (Matsuoka et al. 2026) [21] — whether shoes cause it or just irritate it isn't settled.
What: A three-dimensional first-ray deformity — lateral deviation of the hallux with a medial prominence.
How it behaves: Pain and swelling at the medial first MTP. Worse in narrow shoes and on prolonged walking. Eased by wide shoes and rest.

The one thing to take from this page:

Treat what limits comfort and function. Alignment is a finding, not the target — and saying so up front is what keeps the patient with you.

What conservative care actually moves

Moves well	Moves modestly
Pain	Alignment
Function and footwear tolerance	Hallux valgus angle
Pressure distribution	—

Non-surgical care can improve pain and some alignment measures, with realistic expectations required, and intervention matched to tolerance and goals [1]. Orthoses may help, and design, wear time, comfort and adherence strongly shape the result [2].

Promise the pain and the function. Don't promise the angle.

⚠️ No Australian guideline exists. Anchored to a NICE-based management update [3] and the Cochrane review of surgery [4].

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Five stages, in your course's order.

MAIN PROBLEM

"The bump rubs in every shoe I own."
"It aches after I've been on my feet all day."
"My toe's pushing into the second one now."

Note which of those three it is. Rubbing, aching, and deformity progression are different complaints with different treatments.

BODY CHART

Mark the medial eminence — and separately, the dorsal joint line (that's the hallux rigidus question) and the plantar first MTP (sesamoids).
Mark callus and skin irritation, including under the second and third metatarsal heads. Transfer load is part of this pattern.
Note second toe position — drift, overriding, or a hammer deformity.

BEHAVIOUR

	Fits hallux valgus	Points elsewhere
Aggs	Narrow shoes, prolonged walking	Push-off, hills, sprinting → hallux rigidus
Eases	Wide shoes, rest, going barefoot	Stiff-soled or rocker shoes → hallux rigidus
Severity	VAS 0–10 at best / at worst / right now	—
Pain site	Medial prominence	Dorsal, with jamming → hallux rigidus. Plantar → sesamoiditis
Onset	Gradual, progressive	Acute, red, hot → gout

HISTORY

Footwear, in detail — work, exercise, and what they'd wear if pain weren't a factor.
Family history. Common, and worth naming because it reframes blame.
Rate of progression, and whether the second toe has started to change.
What matters to them. Comfort in shoes? Walking distance? Running? The goal decides the plan.

SPECIAL / SCREENING QUESTIONS

Acute red hot swollen joint — gout, and it is ruled out before loading.
Morning stiffness >30 min (In), multiple joints, systemic features — inflammatory arthropathy.
Numbness, burning into the toes — neuroma or nerve.
Diabetes or neuropathy — changes the risk of a pressure lesion entirely.

Assessing this region? Download the Ankle & Foot assessment template →

3 · HYPOTHESIS RANKING

Competing pattern	The one discriminating feature
Hallux rigidus (1st MTP OA)	Dorsal pain and stiffness with reduced dorsiflexion, often under 40°, rather than medial eminence pain and lateral toe deviation.
Gout	Acute red, hot, swollen first MTP. Rule it out before loading anything.
Sesamoiditis	Plantar rather than medial pain, worse on push-off.

And the ones that come with it

Transfer metatarsalgia and lesser toe deformity. Hallux valgus alters medial forefoot loading and shifts pressure centrally (Wong et al. 2025), which is why the second and third metatarsal heads start to hurt and the second toe starts to change. Treating only the bunion in a foot that has already transferred its load is treating half the problem.

4 · RED FLAGS — DON'T MISS THIS

This section is free, on every pattern, forever. Safety is never gated.

Finding	What it suggests	What you do
Acute red, hot, swollen 1st MTP	Gout, or septic arthritis	Same-day medical review. Do not load it
Fever, systemically unwell with a hot joint	Septic arthritis	🚑 Emergency
Hot, swollen first MTP — check passive range	Painful loss of active and passive range points into the joint; preserved passive range points periarticular (bursitis, tendinitis)	Hot is same-day medical review either way — septic arthritis is the one that can't wait (Swisher et al. 2025) [22]
Morning stiffness >30 min (In), multiple joints, systemic features	Inflammatory arthropathy	GP referral
Skin breakdown or ulceration over the eminence	Pressure lesion	Offload urgently; medical review if diabetic
Diabetes or neuropathy with any callus or skin change	Neuropathic ulcer risk	🚑 See the infection page
Rapidly progressive deformity, or sudden change	Structural failure or inflammatory	Medical or orthopaedic referral
Focal bony tenderness with a load spike	Stress fracture	Offload and image

The rule: a gradually deforming, shoe-sensitive, non-inflamed joint is yours. Hot, red, systemically unwell, ulcerated, or neuropathic is not.

Cross-links: Hallux rigidus · Metatarsalgia · Infection / osteomyelitis / ulcer

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Guideline anchor

No Australian guideline covers hallux valgus.

Anchored to the NICE-based management update (Imran et al. 2025, PMID 41393558) for the pathway, the systematic review and meta-analysis of non-surgical interventions (Hurn et al. 2022, PMID 33768721) for conservative care, and the Cochrane review of surgery (Dias et al. 2024, PMID 39051477) for the operative side.

PubMed Source

The NICE-based anchor is a UK pathway summary, not an Australian one, and the Cochrane review is a synthesis rather than a guideline. Neither is written for a physiotherapist deciding how hard to push an alignment device. The conservative reasoning on this page comes from the primary evidence and is labelled as such.

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The evidence summary is for members

Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.

Sources · 20

Show

Every source on this page resolves and title-verifies against PubMed. Newest first.

2022Hurn et al. (2022). Effectiveness of Nonsurgical Interventions for Hallux Valgus: A Systematic Review and Meta-Analysis. Arthritis care & research, 74(10), 1676-1688. https://doi.org/10.1002/acr.24603
2021Kwan et al. (2021). Hallux valgus orthosis characteristics and effectiveness: a systematic review with meta-analysis. BMJ open, 11(8), e047273. https://doi.org/10.1136/bmjopen-2020-047273
2025Imran et al. (2025). Hallux Valgus Management: An Update Based on National Institute for Health and Care Excellence (NICE) Guidelines. Cureus, 17(11), e96642. https://doi.org/10.7759/cureus.96642
2024Dias et al. (2024). Surgical interventions for treating hallux valgus and bunions. The Cochrane database of systematic reviews, 7(7), CD013726. https://doi.org/10.1002/14651858.CD013726.pub2
2013Nix et al. (2013). Gait parameters associated with hallux valgus: a systematic review. Journal of foot and ankle research, 6(1), 9. https://doi.org/10.1186/1757-1146-6-9
2015Kim et al. (2015). Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus. Journal of physical therapy science, 27(4), 1019-22. https://doi.org/10.1589/jpts.27.1019
2015Mortka & Lisiński (2015). Hallux valgus-a case for a physiotherapist or only for a surgeon? Literature review. Journal of physical therapy science, 27(10), 3303-7. https://doi.org/10.1589/jpts.27.3303
2016Fraissler et al. (2016). Treatment of hallux valgus deformity. EFORT open reviews, 1(8), 295-302. https://doi.org/10.1302/2058-5241.1.000005
2018Nishimura et al. (2018). Does hallux valgus impair physical function?. BMC musculoskeletal disorders, 19(1), 174. https://doi.org/10.1186/s12891-018-2100-0
2021Ying et al. (2021). Adjusted Indirect and Mixed Comparisons of Conservative Treatments for Hallux Valgus: A Systematic Review and Network Meta-Analysis. International journal of environmental research and public health, 18(7). https://doi.org/10.3390/ijerph18073841
2021Ezzatvar et al. (2021). Prevalence and Predisposing Factors for Recurrence after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis. Journal of clinical medicine, 10(24). https://doi.org/10.3390/jcm10245753
2023Oztarsu & Oksuz (2023). Comparison of the effects of progressive supervised and home program exercise therapy in mild-moderate hallux valgus. Journal of comparative effectiveness research, 12(3), e220091. https://doi.org/10.2217/cer-2022-0091
2024Khan & Patil (2024). The Effect of Therapeutic Approaches on Hallux Valgus Deformity. Cureus, 16(4), e58750. https://doi.org/10.7759/cureus.58750
2024Krześniak & Truszczyńska-Baszak (2024). Toe Separators as a Therapeutic Tool in Physiotherapy-A Systematic Review. Journal of clinical medicine, 13(24). https://doi.org/10.3390/jcm13247771
2025Bajraszewski et al. (2025). Footwear Toe-Box Shape and Medial Forefoot Pressures in Women With Hallux Valgus. Journal of foot and ankle research, 18(2), e70041. https://doi.org/10.1002/jfa2.70041
2025Jankowicz-Szymańska et al. (2025). The impact of corrective exercises, kinesiology taping, and mechanical correction on pain and foot shape in women with hallux valgus. Frontiers in physiology, 16, 1473278. https://doi.org/10.3389/fphys.2025.1473278
2025Ettinger et al. (2025). Hallux Valgus: Prevalence and Treatment Options. Deutsches Arzteblatt international, 122(11), 308-314. https://doi.org/10.3238/arztebl.m2025.0068
2025Cho et al. (2025). Current Concepts of Radiographic Evaluation and Surgical Treatment for Hallux Valgus Deformity. Journal of clinical medicine, 14(14). https://doi.org/10.3390/jcm14145072
2025Wong et al. (2025). Does Hallux Valgus Impair Medial Forefoot Loading? A Meta-Analysis of Plantar Pressure Distribution. Journal of foot and ankle research, 18(3), e70073. https://doi.org/10.1002/jfa2.70073
2025Gumuskaya et al. (2025). Preoperative and Postoperative Physical and Mechanical Rehabilitation Interventions in Hallux Valgus: A Systematic Review. Journal of foot and ankle research, 18(3), e70083. https://doi.org/10.1002/jfa2.70083

Mapped to this pattern

FHSQ
Foot Health Status Questionnaire
foot health and general health · 6 min

Generic measures that also apply

Related: hallux rigidus · metatarsalgia · sesamoiditis

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