# Hallux valgus (bunion) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - MSF Essential Drugs 2024 (ibuprofen oral monograph) ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text HALLUX VALGUS (BUNION) 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) Review status: REVIEWED against the source listed above (2026-08) 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 Source StatPearls "Hallux Valgus" - disease-level clinical article Status traced to the source above Rx: Pain | Main treatment PAIN 1. IBUPROFEN [1st line] Adult 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. Peds 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.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) 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. Caution 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. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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 Peds A child is dosed from the drug rows above, by weight. The referral threshold and the safety-netting are the same at any age. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)