Juvenile Hallux Valgus: Evaluation and Treatment

Juvenile hallux valgus (the "bunion") occurs when the big toe deviates toward the other toes while the first metatarsal shifts in the opposite direction, creating the characteristic medial prominence. Unlike the adult form — which is almost always degenerative — the juvenile form is typically linked to ligamentous laxity, family history or association with pronated flatfoot.

It usually appears in late childhood or adolescence, more often in girls, and is almost always bilateral. The initial complaint is rarely pain: families more often notice the cosmetic deformity and difficulty wearing certain shoes. True pain tends to appear later, after long hours on the feet or during sport.

The approach in adolescents is radically different from the adult one: during growth the deformity can still be influenced by the biomechanical context, and surgery is deferred until sufficient skeletal maturity (generally after 13–14 years of age) to reduce the risk of recurrence. In the meantime we optimise footwear, prescribe insoles for the associated flatfoot and work on muscle strengthening. Surgery is reserved for symptomatic cases that do not respond to conservative management.