Risk Factors for Hallux Valgus: The Framingham Foot Study

Purpose: Hallux valgus is a common foot deformity in older adults, but its risk factors and relation with foot pain are poorly understood. The purpose of this study was to identify risk factors associated with hallux valgus and foot pain in a large population based study. Methods: A cross-sectional study of 3415 ambulatory adults from the population-based Framingham Study was undertaken. A validated foot examination performed by trained examiners assessed for risk factors in subjects identified to have hallux valgus including age, gender, body mass index, pes planus (defined by computerized pressure mats), and past high heel use. Foot pain (y/n) was queried: “on most days, do you have pain, aching or stiffness in either foot?” Multivariate logistic regression models were performed to examine the effect of the above risk factors on hallux valgus. Results: 20% of men and 41% of women had hallux valgus. Foot pain and older age increased the odds of having hallux valgus in both women and men (all p<0.03). Pes planus and wearing high heels as main shoe during ages 20-64y increased the odds of hallux valgus by 70% (p=0.001) and 22% (p=0.01), respectively in women only. Conclusions: We saw strong associations between hallux valgus, foot pain and increased age in both men and women. Additional risk factors in women were wearing high heels during ages 20-64y and having pes planus. Future public health efforts should focus on targeting modifiable risk factors that are associated with this common foot deformity.