What is Hallux Varus?

Hallux varus is a deformity of the big toe in which the toe drifts inward toward the midline of the body, away from the other toes. This is the opposite of a bunion (hallux valgus), where the big toe angles outward. The condition can be congenital (present at birth) or acquired later in life, most often as a complication of bunion surgery.

While mild cases may cause little or no discomfort, more severe deformities can lead to pain, difficulty wearing shoes, and progressive joint problems.

Causes

Hallux varus can develop from several factors:

  • Surgical overcorrection – the most common cause, often after bunion (hallux valgus) surgery

  • Congenital deformity – abnormal development of the toe structures present from birth

  • Trauma – injury to the big toe joint or surrounding soft tissues

  • Inflammatory arthritis – such as rheumatoid arthritis or ankylosing spondylitis

  • Neurological conditions – e.g., Charcot‑Marie‑Tooth disease, post‑polio syndrome

  • Tendon imbalance – over‑tightening of the medial capsule or over‑pull of the abductor hallucis muscle

Symptoms

Patients with hallux varus may notice:

  • A visible inward deviation of the big toe

  • Pain or irritation when wearing shoes (especially narrow or stiff shoes)

  • Decreased range of motion in the big toe joint

  • Instability or weakness when pushing off during walking

  • Corns, calluses, or blisters due to abnormal pressure points

  • Cosmetic concerns about the appearance of the toe

Diagnosis

Diagnosis is usually straightforward:

  • Physical exam – the inward angulation of the big toe is visible

  • Range of motion testing – to determine if the deformity is flexible or fixed

  • X‑rays – weight‑bearing images to measure the angle of deviation, assess joint health, and identify prior surgical changes

  • Medical history – especially prior bunion surgery or trauma

Nonsurgical Treatment

Mild or flexible cases may be managed without surgery:

  • Shoe modifications – wide toe boxes, soft uppers, or custom shoes to reduce irritation

  • Orthotics or insoles – to support the foot and redistribute pressure

  • Toe splints or taping – especially in early post‑surgical cases, to guide the toe back into alignment

  • Padding – to protect bony prominences from rubbing

  • Physical therapy – stretching and strengthening to improve balance and reduce discomfort

  • Medications – NSAIDs for pain and inflammation

When is Surgery Needed?

Surgery may be recommended when:

  • The deformity is fixed and painful

  • Conservative measures fail to relieve symptoms

  • There is progressive arthritis or joint degeneration

  • Shoe wear becomes very difficult

Surgical options include:

  • Soft tissue procedures – tendon transfers (e.g., abductor hallucis or extensor hallucis longus transfer), ligament reconstruction, or capsular release

  • Osteotomy – bone realignment procedures to restore proper toe position

  • Arthrodesis (fusion) – fusing the big toe joint in severe, rigid, or arthritic cases; reliably relieves pain but eliminates motion

  • Revision bunion surgery – if hallux varus developed after overcorrection of a bunion