Incidence and Progression of Hallux Valgus: a Prospective Cohort Study.

OBJECTIVE Hallux valgus is a common and disabling condition. The objective of this study was to identify factors associated with hallux valgus incidence and progression. METHODS Participants were from a population-based prospective cohort study, the Clinical Assessment Study of the Foot. All adults aged ≥50 years registered with four general practices in North Staffordshire, UK were invited to take part in a postal survey at baseline and at 7-year follow-up which included health questionnaires and self-assessment of hallux valgus using line drawings. RESULTS Complete baseline and follow-up data were available for 1,482 participants (739 women and 743 men, mean [standard deviation] age 62.9 [8.1] years), of whom 450 (30.4%) had hallux valgus in at least one foot at baseline. Incident hallux valgus was identified in 207 (20.1%) participants (349 [15.4%] feet) and was associated with baseline age, poorer physical health, foot pain and wearing shoes with a very narrow toe-box shape between the age of 20 and 29 years. Hallux valgus progression was identified in 497 (33.6%) participants (719 [24.3%] feet) but was not associated with any baseline factors. CONCLUSION Incident hallux valgus develops in one in five adults aged ≥50 years over a 7-year period and is related to age, poorer physical health, foot pain and previous use of constrictive footwear. Progression occurs in one in three adults. These findings suggest that changes in first metatarsophalangeal joint alignment may still occur beyond the age of 50 years.