Effectiveness of Nonsurgical Interventions for Hallux Valgus: A Systematic Review and Meta‐Analysis

Abstract

Objective To conduct a systematic review and meta‐analysis investigating the effectiveness of nonsurgical interventions for hallux valgus (HV). Methods Medline, CINAHL, Embase, and the Cochrane Library were searched to April 2020, including parallel‐group and crossover studies investigating nonsurgical interventions for HV. Two reviewers independently screened articles for inclusion, extracted data, determined risk of bias, and made assessments using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. Risk of bias was assessed using version 2 of the Cochrane risk‐of‐bias tool. Effect sizes (mean differences or risk ratios, and 95% confidence intervals) were calculated and pooled where possible for the primary outcomes, foot pain, and HV angle. Results Eighteen included studies investigated a wide range of nonsurgical interventions for HV. Most studies had small sample sizes and concerns regarding risk of bias. Five separate meta‐analyses for foot orthoses, splints, manual therapy, and taping added to foot exercises showed no significant effects on primary outcomes. However, results from 8 studies showed a significant pain reduction with the use of foot orthoses, night splints, dynamic splints, manual therapy, taping added to foot exercises, a multifaceted physical therapy program, and Botox injections. Four studies reported a clinically significant reduction in HV angle with night splints, foot exercises, multifaceted physical therapy, and Botox injections. Conclusion There is a low level of certainty surrounding the effectiveness of nonsurgical interventions for HV, but a reduction in pain appears more likely than improvement in HV angle.

Insights Into Patients Questions Over Bunion Treatments: A Google Study

“…This could be attributed to the lack of consensus among foot and ankle experts on the best intervention for HV, as evident from the current literature. 3,11,12,18,23,27,31 Moreover, it is possible our findings reflect the high rate of dissatisfaction that persists despite attempts at both nonsurgical and surgical treatments for HV. 3,32,41 Finally, the high rate of searches being conducted over evaluation of treatment may be in part to differing expectations.…”

“…However, no intervention is superior. 3,[10][11][12]18,23,27,31 Patients searching the Internet and more specifically Google for health-related and orthopaedic information is now a well-documented occurrence. 7,14,19 Considering the high prevalence of HV along with the wide variety of nonsurgical and surgical treatment options for HV, we suspect patients have been searching the Internet for information regarding treatment options for HV.…”

Custom-Made Foot Orthotics for People With Lower Limb Conditions

“…4 Foot orthotics fall under the broader category of conservative, nonsurgical offloading interventions. 5,6 These are external devices specifically designed to offload local stress, thus relieving mechanical pressure from specific regions of the foot. Foot orthotics vary across different parameters, including materials, design and construction, and customization.…”

Investigation on the site of coronal deformities in Hallux valgus

“…Patients with HV suffer from pain due to inflammation and deformity-related problems such as difficulty fitting in shoes and pressure ulcerations 2 . Conservative treatment may contribute to pain alleviation, but its power for deformity correction is limited 3 . A previous review found surgery was more beneficial than conservative interventions, especially in moderate to severe deformities 4 .…”