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

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. 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. 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. 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. PROSPERO CRD420251218756.