Hallux Valgus (Bunion): Symptoms, Causes and Treatment Options

Hallux valgus is a progressive foot deformity characterized by lateral deviation of the great toe at the first metatarsophalangeal joint and medial displacement of the first metatarsal bone. It commonly results in bunion formation, pain, and difficulty with footwear.

Hallux valgus causes and risk factors include genetic predisposition, ligamentous laxity, pes planus, and prolonged use of narrow or high-heeled shoes. Biomechanical imbalance leads to joint instability, gradually worsening deformity, and secondary soft tissue irritation.

Hallux valgus symptoms and clinical presentation involve medial eminence prominence, localized pain, swelling, and callus formation. Advanced cases may show restricted joint motion, overlapping toes, and altered gait mechanics that negatively impact functional mobility.

Hallux valgus diagnosis and treatment options rely on physical examination and weight-bearing radiographs to assess angular deformities. Management ranges from conservative approaches such as orthotics and footwear modification to surgical correction including osteotomy procedures.

What is Hallux Valgus and Why Does It Occur?

Hallux Valgus is, in the simplest terms, the disruption of the anatomical alignment of the big toe. In a normal, healthy foot, the big toe points forward in parallel with the other toes. However, when this deformity develops, the big toe (hallux) starts to lean outward toward the smaller toes. In response to this motion, the first metatarsal bone opens inward toward the inner part of the foot.

This opposite-direction movement causes the well-known swelling at the joint—namely, the bunion. This swelling is not a newly formed bone tissue but a result of the joint angle deformity, where the head of the bone protrudes outward.

Factors contributing to the development of this structural disorder include:

• Genetic predisposition
• Flatfoot (Pes Planus)
• Wearing high-heeled shoes
• Narrow, pointed-toe shoes
• Rheumatic joint diseases
• Achilles tendon tightness
• Excess weight
• Occupations that require prolonged standing

My patients often ask, “Doctor, I’ve never worn high heels, so why do I have this?” The answer usually lies in your genetic inheritance. If your mother or father has this protrusion, your foot structure may be predisposed to this deformity—even if you wear the most comfortable sneakers. Poor footwear choices can certainly accelerate the process and worsen the pain, but shoes are not always the sole culprit.

What Are the Symptoms of Hallux Valgus?

The condition usually begins silently. Initially, you may only notice mild redness when wearing shoes. Over time, this mechanical imbalance affects surrounding tissues and turns into a cluster of symptoms.

Common complaints include:

• Swelling at the base of the big toe
• Redness over the joint
• Throbbing pain
• Difficulty wearing shoes
• Hammertoe deformity in the second toe
• Callus formation on the sole
• Sensation of imbalance while walking
• Pain that wakes you at night
• Numbness between the toes

In advanced stages—especially when the big toe goes under or over the second toe—gait mechanics are completely disrupted. The skin in the affected area becomes so sensitive that even the softest shoes feel like sandpaper. At this stage, the patient’s social life begins to be restricted; taking a walk, shopping, or attending a simple event can become a torment.

How Is Hallux Valgus Evaluated Radiographically?

As a physician, I begin observing my patients as they walk in. Their gait, foot placement, and shoe choice offer my first clues. However, the gold standard for diagnosing Hallux Valgus and assessing its severity is radiological imaging.

Here’s a critical detail: X-rays must be taken while the patient is standing—under weight-bearing conditions. X-rays taken while lying down won’t show the true extent of the deformity, because the foot flattens and the angles of the bones change under body weight, revealing the actual problem.

In weight-bearing X-rays, we evaluate:

• Hallux Valgus angle
• Intermetatarsal angle
• Sesamoid bone positioning
• Joint congruency
• Presence of arthritis

Particularly, the displacement of the tiny sesame-shaped sesamoid bones beneath the big toe joint is a key indicator of disease progression and the necessity for surgery. However, as an Interventional Radiologist, I focus not only on bone angles but also on the soft tissue damage and nerve entrapments caused by those angles.

Is Hallux Valgus Pain Only Bone-Related?

This is the most common misconception. Patients usually believe that the pain stems from the bony protrusion. However, clinical experience shows that in Hallux Valgus, the disabling pain often comes from “secondary” sources. The deformity creates a domino effect, and the actual damage occurs in neighboring regions.

Secondary pain sources include:

• Bursitis
• Capsulitis
• Synovitis
• Metatarsalgia
• Morton’s Neuroma
• Calluses
• Tendon injuries

The protrusion at the big toe joint constantly rubs against footwear, causing inflammation of protective fluid sacs under the skin called bursae (bursitis). This leads to intense tenderness even upon touch. More importantly, since the big toe can’t bear its load, pressure is transferred to the other toes, resulting in severe pain in different parts of the foot—especially the sole and between the toes.

What Is Morton’s Neuroma, a Secondary Issue?

The most frequent and possibly most distressing complication in Hallux Valgus patients is Morton’s Neuroma. When the foot structure collapses and metatarsal bones move closer together, the nerves responsible for toe sensation get compressed. The nerve between the 3rd and 4th toes, in particular, thickens and develops an edema sheath under this pressure.

Symptoms of Morton’s Neuroma include:

• Electric shock sensation
• Burning pain
• Tingling
• Numbness in the toes
• Sensation of a pebble inside the shoe

Patients often say, “Doctor, my bone aches, but what really kills me are the cramps and burning between my toes.” That’s a classic neuroma picture. Hallux Valgus is a mechanical problem, yes—but the resulting pain is neuropathic (nerve-related). The good news is that you don’t need bone surgery to treat this nerve pain. That’s where interventional radiology comes in.

What Causes Metatarsalgia—Pain in the Sole?

In a normal walking cycle, the main push-off point is the big toe. It bears most of the body’s weight. But in a foot with Hallux Valgus, the big toe deviates and can no longer perform its role.

So where does the load go? Unfortunately, it shifts to the second and third metatarsal heads—which aren’t designed to carry it. This is called “load transfer metatarsalgia.”

Symptoms of metatarsalgia include:

• Burning sensation in the sole
• Painful calluses
• Inability to stand for long periods
• Pain when walking barefoot
• Joint capsule damage

Patients describe it as “It feels like a fireball under my foot” or “It’s like walking on gravel.” This pain is the result of chronic inflammation caused by mechanical imbalance. While callus removal offers temporary relief, the pain returns unless load distribution and nerve irritation are corrected.

How Is Interventional Radiology Used in These Problems?

Interventional Radiology is one of the most technologically advanced fields in medicine. Our philosophy is: “Treat without cutting, under visualization, and with precision.” In Hallux Valgus patients with mild-to-moderate bone deformities or those who decline surgery, we focus on pain management.

Our goal is not to correct the bone (which is the domain of orthopedic surgery), but to eliminate pain, edema, and nerve compression that reduce quality of life. With treatments especially for Morton’s neuroma and stubborn bursitis, we can relieve patients without surgery.

Advantages of these treatments include:

• No scalpel used
• No stitches required
• No general anesthesia
• No hospital stay
• Patients walk home the same day
• Very low infection risk

What is Image-Guided Injection and Why Is It Important?

In the past—before advanced imaging technologies—injections into joints or nerves were done “blindly.” Doctors relied on their anatomical knowledge and hoped for accuracy. But the foot is a small and complex structure. A millimetric deviation can send the drug to the wrong place, rendering the treatment ineffective.

As Interventional Radiologists, we never perform blind procedures. Ultrasonography (USG) is our eyes. With high-resolution ultrasound machines, we can clearly see nerves, vessels, tendons, and inflamed bursae beneath the skin.

Benefits of ultrasound-guided procedures:

• Accurate targeting
• Maximum drug efficacy
• Minimal side effects
• Protection of surrounding tissues
• Less pain
• Safe application

We follow the needle tip on-screen and reach directly into the Morton neuroma or inflamed bursa. Thus, we achieve a higher therapeutic effect with a lower drug dose. These injections, composed of corticosteroids and local anesthetics, act like firefighters during acute pain flares.

What Is Radiofrequency Ablation (RFA) Treatment?

If a patient’s pain has become chronic and injections only provide temporary relief, we use the advanced Radiofrequency Ablation (RFA) method—one of the most recent advancements in pain management.

The RFA device sends radio waves through a special needle to the tissue. We choose between two modes depending on the patient’s condition:

• Thermal Radiofrequency (Classic)
• Pulsed Radiofrequency (PRF)

Thermal Radiofrequency: A controlled heat (usually 60–80°C) is generated at the needle tip, permanently desensitizing pain-carrying nerve fibers—effectively “shutting down pain pathways.”

Pulsed Radiofrequency (PRF): This is my preferred, “nerve-friendly” method. It doesn’t burn or damage the nerve. The device sends high-voltage energy pulses intermittently while keeping the tissue temperature near body heat (42°C). This energy modulates the nerve’s molecular structure—commanding it to stop sending pain signals. The nerve stays alive, no sensation is lost, but the chronic pain disappears. Using this method instead of surgical neurectomy in Morton’s neuroma both relieves pain and preserves sensation.

Is Hallux Valgus Treatment Painful and How Long Does It Take?

Patients often fear the procedure will be painful. But modern medicine prioritizes patient comfort. When you arrive at our clinic, we place you in a special procedure room and administer sedatives via IV to create a relaxed, semi-sleep state. This is not general anesthesia—you breathe on your own, can talk to us, and feel no pain or anxiety.

We also completely numb the target foot area with local anesthesia. The whole process—including preparation—consists of:

• Preparation and sterilization
• Local anesthesia
• Target identification via ultrasound
• Needle placement
• Sensory testing
• Treatment application (RFA or Injection)

The entire procedure usually takes 20 to 40 minutes. A small bandage is applied to the needle entry point. Since no incisions are made, there is no need for stitches or dressings.

What Is the Recovery Process After Treatment?

After the procedure, we monitor the patient in the recovery room for about half an hour. Once blood pressure and pulse are stable and the patient feels well, we discharge them.

The biggest advantage of interventional treatments over surgery is the rapid recovery. You can walk immediately after the procedure. No crutches, no casts, and no special orthopedic boots are needed.

Post-procedure care includes:

• Rest for the first 24 hours
• Ice application
• Elevating the foot
• Wearing loose, comfortable shoes
• Performing simple doctor-recommended exercises

Most patients return to work and social activities the next day. A mild ache during the first few days is expected and easily controlled with simple painkillers. It may take 2–3 weeks for the full effect of radiofrequency treatment to be felt and for pain relief to become permanent.

Embolization for Big Toe Osteoarthritis

A micro-particle injection is administered via the ankle. The procedure takes 15 minutes, and you can walk out after 2 hours. This is the longest-lasting pain-relief method. We are the team that introduced and published this method on an international platform.

Frequently Asked Questions

Prof. Dr. Özgür KILIÇKESMEZ

Prof. Dr. Özgür Kılıçkesmez is one of Türkiye’s leading interventional radiology and neuroradiology specialists, focusing on minimally invasive endovascular treatments. His primary areas of expertise include aneurysm and stroke treatments, embolization procedures, non-surgical treatments of thyroid and parathyroid diseases, interventional oncology, and peripheral vascular interventions. He currently serves as the Head of the Interventional Radiology and Neuroradiology Department at Istanbul Memorial Göztepe Hospital.
Graduating from Istanbul University Cerrahpaşa Faculty of Medicine in 1997, Prof. Dr. Kılıçkesmez received advanced training in interventional radiology and oncology as a Clinical Fellow at London Guy’s & St Thomas’ and King’s College Hospital between 2012 and 2013. He earned the title of Professor in 2020 and, in the same year, became the Founding Interventional Radiologist at SBÜ Çam and Sakura City Hospital. He also holds the EBIR (European Board of Interventional Radiology) certification.
Prof. Dr. Kılıçkesmez has 94 international and 40 national publications and over 2500 citations. He serves as a reviewer for prestigious journals such as the American Journal of Roentgenology (AJR) and Diagnostic & Interventional Radiology. With his clinical and academic expertise, he is a nationally and internationally recognized authority in stroke treatment, brain aneurysm, embolization, tumor ablation, and minimally invasive treatments of thyroid/parathyroid diseases.