Metatarsus Primus Varus

Metatarsus primus varus is a foot deformity that affects the angle of the bones of the big toe. The deformity usually develops during adulthood as a result of wearing tight shoes that place pressure on the bones of the big toe, and it can cause pain and swelling. It's also associated with a bunion, which is a bump on the side of the big toe.

Close up of woman's feet with red toenail polish
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Bones Affected In Metatarsus Primus Varus

This condition involves the metatarsals and phalanx bones of the foot.

  • Metatarsals are long bones in the foot that connect to the toes
  • Proximal phalanges are the bone in each toe that's closet to the foot
  • Distal phalanges are the bone in each toe that's closest to the tip of the toe

In metatarsus primus varus, the first metatarsal bone, which connects to the proximal phalanx bone of the big toe, is rotated and angled away from the second metatarsal bone. The rotation of the first metatarsal bone causes the head of the bone to push outward, creating a bump on the side of the foot.


When pressure is applied to the angled first metatarsal in a foot with metatarsus primus varus, forcing the big toe inward, it can cause an angular position above or below the adjacent toe. It may also cause swelling, tenderness, skin irritation, blisters, and pain.


This condition is related to the condition that's called hallux valgus or hallux abducto valgus, which is commonly known as a bunion. A bunion is the painful swelling of the first joint of the big toe, which is called the metatarsophalangeal joint.

There is a misconception that a bunion is an enlargement of the bone, but this is not usually the case. An inflamed bursal sac may develop, but that's a result of a bunion—not a cause.

In rare cases, a bone anomaly in the metatarsophalangeal joint may contribute to the issue.

Causes of Metatarsus Primus Varus

Metatarsus primus varus is most often found in populations where shoes are regularly worn.

Bunion symptoms occur most often in people who wear shoes with a tight or pointed toe box, such as with high heels. Women are affected more often than men, and for these reasons, shoes are often considered a contributor to metatarsus primus varus, hallux valgus and bunions. However, genetics are also considered as a possible cause.

Problems related to metatarsus primus varus and bunions develop over time and do not generally get better without treatment.

Treatment for Metatarsus Primus Varus and Bunions

Initial treatment is generally aimed at reducing the pain and swelling of bunions. These conservative treatments do not, however, correct the metatarsus primus varus or hallux valgus problems.

Initial treatments can include

  • Changing shoes: Because bunions are aggravated by shoes and shoes are considered a contributor to the deformities, Changing to a shoe that's recommended for bunions can help relieve symptoms. This includes shoes with a wider toe box and a soft expansive material in the toe box. It's also important to avoid high heels and other pointed-toe shoes.
  • Applying ice: Ice applied several times a day will help reduce pain and swelling.
  • Padding: Bunion pain can be eased with padding, which can be found in retail stores or prescribed by a healthcare provider.
  • Adjusting activities: Avoid standing for long periods and other activities that cause bunion pain.
  • Medication: Anti-inflammatory medications, such as ibuprofen, can help reduce the pain and swelling of a bunion.
  • Orthotics: A healthcare provider may suggest custom orthotics to help with bunions.

If the nonsurgical treatments for bunions are insufficient and bunions are interfering with normal activity, surgery is an option. A surgeon will examine the angle between the first and second metatarsal bones, called the first intermetatarsal angle, to determine which surgical procedure is needed.

Procedures can include the removal of some of the bone that produces the bump in a bunion, adjusting the bone structure of the foot contributing to the condition, and addressing structural changes to tissues in the area that may have been affected.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Orthopedic Surgeons. Bunion.

  2. Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev. 2016;1(8):295-302. doi:10.1302/2058-5241.1.000005

  3. Wu DY, Lam EKF. Can the Syndesmosis Procedure Prevent Metatarsus Primus Varus and Hallux Valgus Deformity Recurrence? A 5-Year Prospective Study. J Foot Ankle Surg. 2018;57(2):316-324. doi:10.1053/j.jfas.2017.10.012

Additional Reading

By Terence Vanderheiden, DPM
Terence Vanderheiden, DPM, is a podiatrist in Massachusetts with a subspecialty in the area of podiatric sports medicine.