Dawaa Reference

Clinical reference

Hallux valgus (bunion)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Hallux Valgus - StatPearls - NCBI Bookshelf (NBK553092) - https://www.ncbi.nlm.nih.gov/books/NBK553092/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class LD71.01 - condition scope only, no dose · MSF Essential Drugs 2024 (ibuprofen oral monograph)

Verified against1 document
  • MSF Essential Drugs 2024 (ibuprofen oral monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Patients typically describe gradual forefoot widening along with pain, swelling, and redness over the inner side of the big toe joint [redness]
  • Sharp or deep pain at the big-toe joint is worsened by walking and by tight-fitting shoes
  • Some patients also feel pain under the second metatarsal head due to overload from first-ray instability
  • Tingling, numbness, or burning along the top-inner side of the big toe suggests compression of a nearby sensory nerve [numbness · tingling]

Signs — what you find (4)

  • The classic bunion forms as the great toe drifts and rotates outward while the first metatarsal head shifts inward
  • Friction over the bunion prominence leads to skin and nerve irritation and bursitis underneath
  • Pressure shifted onto the lesser metatarsals, especially the second, can lead to metatarsalgia and eventual hammer toe deformity [visible deformity]
  • Normal big-toe joint motion is about 15 degrees of upward bend and 65 to 75 degrees of downward bend; check for pain or crepitus [crepitus]

Tests (4)

  • Diagnosis is mainly clinical, but weight-bearing x-rays are the gold-standard imaging to measure the deformity
  • Blood tests aren't routinely needed unless something points to a metabolic, inflammatory, or systemic cause
  • The AP x-ray view measures the hallux valgus angle and the intermetatarsal angle and shows sesamoid positioning
  • If deep infection or bone infection is suspected, such as with an ulcer or a prior failed operation, MRI or a bone scan may be used

If not this — what else fits (3)

  • Hallux rigidus/limitus is on the differential for hallux valgus
  • Turf toe, gout, and septic arthritis are also on the differential
  • Peripheral neuropathy and peripheral vascular disease are on the differential

SourceStatPearls "Hallux Valgus" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Pain | Main treatment

PAIN

1

IBUPROFEN

Pain

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

200 to 400 mg 3 to 4 times daily as required, to a maximum of 1,200 mg in 24 hours. Take it with food and keep doses at least 4 hours apart. - Short courses when the bunion flares, not a standing prescription - the article's own wording is short courses.

Paediatric dose

5-10 mg/kg/dose [child max 400 mg]

(Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, to a maximum of 30 mg/kg in 24 hours. Nothing under 3 months of age. A single dose is capped at 400 mg, which is the adult single-dose maximum in the same MSF entry.)

Dose by weight
3kg15-30 mg/dose
4kg20-40 mg/dose
5kg25-50 mg/dose
6kg30-60 mg/dose
7kg35-70 mg/dose
8kg40-80 mg/dose
9kg45-90 mg/dose
10kg50-100 mg/dose
11kg55-110 mg/dose
12kg60-120 mg/dose
13kg65-130 mg/dose
14kg70-140 mg/dose
15kg75-150 mg/dose
16kg80-160 mg/dose
17kg85-170 mg/dose
18kg90-180 mg/dose
19kg95-190 mg/dose
20kg100-200 mg/dose
21kg105-210 mg/dose
22kg110-220 mg/dose
23kg115-230 mg/dose
24kg120-240 mg/dose
25kg125-250 mg/dose
26kg130-260 mg/dose
27kg135-270 mg/dose
28kg140-280 mg/dose
29kg145-290 mg/dose
30kg150-300 mg/dose
31kg155-310 mg/dose
32kg160-320 mg/dose
33kg165-330 mg/dose
34kg170-340 mg/dose
35kg175-350 mg/dose
36kg180-360 mg/dose
37kg185-370 mg/dose
38kg190-380 mg/dose
39kg195-390 mg/dose
40kg200-400 mg/dose
41kg205-400 mg/dose (upper capped)
42kg210-400 mg/dose (upper capped)
43kg215-400 mg/dose (upper capped)
44kg220-400 mg/dose (upper capped)
45kg225-400 mg/dose (upper capped)
46kg230-400 mg/dose (upper capped)
47kg235-400 mg/dose (upper capped)
48kg240-400 mg/dose (upper capped)
49kg245-400 mg/dose (upper capped)
50kg250-400 mg/dose (upper capped)
Dose source

MSF Essential Drugs 2024 (ibuprofen oral monograph)

Why

Hallux valgus is managed conservatively first, with footwear that takes the pressure off the joint; the article's pharmacological measures are short courses of non-steroidal anti-inflammatory drugs, topical analgesics and anti-inflammatories, or cryotherapy, to settle the inflammation, bursitis and capsulitis that accompany the deformity. It names no drug and no amount, so the amount is MSF's.

Cautions
  • The medicine settles the inflammation; it does not straighten the toe. Severe or refractory deformity is a surgical referral.
  • Skin breakdown, ulceration or infection over the bunion matters far more in a patient with diabetes, and an anti-inflammatory that masks the discomfort can delay it being seen.
  • The article also names topical analgesics and anti-inflammatories as an option but names no product, strength or quantity, so none is printed.
  • Not for a child under 3 months. MSF also contra-indicates ibuprofen in allergy to any NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery carrying a risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, and severe infection.
  • Avoid in pregnancy. MSF contra-indicates it outright from the beginning of the sixth month and names paracetamol as the substitute. Short-term use while breast-feeding carries no contra-indication.
  • Give with caution to an older or an asthmatic patient. Do not combine it with methotrexate, with an anticoagulant, or with another NSAID, and watch the combination with a diuretic or an ACE inhibitor - MSF's instruction there is to drink plenty of fluids to avoid renal failure.
  • It may cause allergic reactions, epigastric pain, peptic ulcer, haemorrhage and renal impairment.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

MAIN TREATMENT

2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

Lateral deviation of the great toe with bunion formation; managed conservatively with footwear advice and analgesia, with surgical referral for severe or refractory deformity. - Refer, with advice

Paediatric dose

A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Lateral deviation of the great toe with bunion formation; managed conservatively with footwear advice and analgesia, with surgical referral for severe or refractory deformity.

Cautions
  • Skin breakdown, ulceration, or infection over the bunion, especially important in patients with diabetes.
  • The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.