Determinants and associated factors for hallux valgus: a systematic review and meta-analysis

BACKGROUND: Hallux valgus (HV) is a prevalent deformity with inconsistent evidence regarding its etiology. The objective of this review is to systematically synthesize the associated factors of HV. METHODS: Following PRISMA guidelines, five databases (PubMed, Web of Science, Cochrane, Embase, CNKI) were searched up to November 2025. We included observational studies (including cross-sectional, case-control, and prospective cohort designs) assessing factors associated with HV. Meta-analysis was performed and expressed as odds ratios (OR) if two or more articles assessed the same factor. RESULTS: Twenty-three studies were included. We identified eleven factors independently associated with increased odds of sustaining hallux valgus (HV) (in order of highest to lowest OR): (1) female sex (OR 2.57, 95% CI 1.83-3.52); (2) foot pain (OR 2.36, 95% CI 1.61-3.46); (3) narrow-toed shoes (OR 2.25, 95% CI 1.64-3.07); (4) knee pain (OR 2.04, 95% CI 1.55-2.68); (5) scoliosis (OR 1.84, 95% CI 1.14-2.98); (6) high-heeled shoes (OR 1.65, 95% CI 1.27-2.15); (7) osteoporosis (OR 1.50, 95% CI 1.13-1.99); (8) knee osteoarthritis (OR 1.47, 95% CI 1.05-2.07); (9) history of stroke (OR 1.26, 95% CI 1.04-1.53); (10) flatfoot (OR 1.19, 95% CI 1.07-1.33); and (11) age (OR 1.11, 95% CI 1.03-1.20). No significant associations were found for BMI or heart problems. CONCLUSION: HV is a multifactorial condition primarily associated with female sex, aging, and mechanical constriction from narrow footwear, which poses a greater risk than high heels. Systemic conditions like scoliosis and osteoarthritis also contribute significantly. Interventions should be multifactorial, with a strong emphasis on footwear modification. TRIAL REGISTRATION: PROSPERO CRD420251218756.