# Factors Related to the Etiology of Hallux Abducto Valgus: A Systematic Review

## TL;DR

This review explores the causes of hallux abducto valgus, finding that it results from a mix of genetic, biomechanical, and lifestyle factors.

## Contribution

The study provides a systematic review of etiological factors for hallux abducto valgus, highlighting a multifactorial model with hereditary and biomechanical components.

## Key findings

- Genetic factors, including collagen-related genes, show strong familial aggregation in HAV development.
- Biomechanical factors like first-ray hypermobility and reduced abductor hallucis muscle activity are consistently linked to HAV.
- Female sex, older age, and narrow footwear are recurring risk factors for HAV.

## Abstract

Background: The origin of hallux abducto valgus (HAV) is considered to be multifactorial; however, evidence regarding the factors involved in its development is scattered and often contradictory. Understanding the factors that contribute to the onset of HAV is crucial for informing both prevention and clinical management strategies. This review aims to explore the etiological factors associated with the development of HAV. Methods: A literature search was conducted in PubMed, Embase, Web of Science and Scopus. The search included observational studies that investigated etiological or risk factors related to the development of HAV. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklists, and the level of evidence was classified according to the Oxford Centre for Evidence-Based Medicine (OCEBM). Results: A total of 36 observational studies (20 cross-sectional and 16 case–control) were included, involving 14,500 participants, predominantly females. Genetic evidence indicated strong familial aggregation and variants in collagen- and extracellular matrix-related genes as potential hereditary determinants. The most consistent biomechanical factors were first-ray hypermobility, abnormal foot pronation and reduced activity of the abductor hallucis muscle. Additionally, female sex, older age and prolonged use of narrow or inadequate footwear were identified as recurring predictive variables. Overall, the findings support a complex etiological model based on the interaction of intrinsic and extrinsic factors. Conclusions: The development of HAV appears to be determined by the interaction of genetic, structural and biomechanical factors that alter first-ray stability and forefoot function. Current evidence supports a multifactorial etiological model with a strong hereditary component and higher susceptibility in women. Longitudinal studies employing standardized methods are needed to establish causal relationships and quantify the relative contribution of each factor.