Epidemiology and risk factors of hallux valgus in Japanese population: HAPPI study

Hallux valgus (HV) is a common foot deformity characterized by lateral deviation of the great toe. Despite known associations with gender, age, and footwear, the prevalence of HV and its associated risk factors in Japan remain unclear. We conducted the first-ever prospective population-based cohort study (HAPPI study) in Japan to elucidate the prevalence of HV and identify its associated risk factors.

HAPPI study is a prospective, population-based cohort conducted in Japan from 2020 to 2023. A total of 1499 participants aged 20 and older were included across seven geographic regions in this analysis. HV was objectively assessed using self-photographs, with a hallux valgus angle ≥15° defining the condition. Demographic, clinical, and footwear-related data were collected via questionnaires. Logistic regression analysis identified risk factors, calculating odds ratio (OR) and 95 % confidence interval (CI).

The prevalence of HV was 23.5 %, with higher rates in women (31.6 %) than men (13.3 %). Age-specific prevalence rates among women increased from 20.0 % in their 20s to 48.0 % in those aged 80 years or older. Bilateral HV was observed in 12.4 % of participants (5.7 % in men, 17.7 % in women), while unilateral HV was observed in 11.1 % (7.5 % in men, 13.9 % in women). Logistic regression identified significant risk factors, including female gender (OR: 3.2, 95 % CI: 2.4-4.4) and age ≥60 years. High-heeled shoe use in the 20s (OR: 3.3, 95 % CI: 1.2-9.5) and very narrow toe-box shapes (OR: 2.5, 95 % CI: 0.98-6.5) were associated with HV.

HAPPI study demonstrated that HV is prevalent in Japan, affecting nearly one in four individuals, with significantly higher rates in women and older adults. Early footwear choices, particularly the use of high-heeled and very narrow toe-box shoes, were strongly associated with HV.