Aetiology of hallux valgus

The aetiology of hallux valgus (HV) is complex and multi-factorial: (1,2)

• footwear - exacerbating factor; may enhance the progression of the deformity
  • HV occurs in unshod communities as well as shoe wearing ones. However evidence from one study in China revealed that HV was 70 times more common among shoe-wearers than unshod members of the community
• familial incidence - this ranges from 65-85%
  • appears to be an autosomal dominant trait with incomplete penetrance - this means that successive generations won't always have the deformity
  • generalised joint laxity is more common in patients with HV e.g. Marfan's syndrome and Ehlers-Danlos syndrome may cause joint laxity and also have in marked HV
• in the elderly there may be weak intrinsic muscles of the foot which results in a 'splay foot' type deformity and possible HV; this may also occur in rheumatoid disease
• rock climbing (3)

Reference:

1. Perera AM, Mason L, Stephens MM; The pathogenesis of hallux valgus. J Bone Joint Surg Am. 2011 Sep 7;93(17)
2. Barnish MS, Barnish J; High-heeled shoes and musculoskeletal injuries: a narrative systematic review. BMJ Open. 2016 Jan 13;6(1)
3. Schoffl V, Kupper T; Feet injuries in rock climbers. World J Orthop. 2013 Oct 18;4(4):218-228.