Common non-surgical treatments for hallux valgus
In June 2022 (1) researcher announced the start of a study that will explore the use of non-surgical treatments for hallux valgus. The authors write: “Non-surgical management of hallux valgus may involve footwear advice or modification, foot orthoses, night splints, and physical therapies (manual therapy, taping or foot exercises). In podiatric clinical practice, these interventions are often combined in a multifaceted approach. However, there is limited evidence for the effectiveness of any of these interventions. . . . The available evidence provides preliminary support for the use of footwear, foot orthoses and foot exercises for the treatment of hallux valgus, but these three promising approaches are yet to be evaluated in combination.”
Common non-surgical treatments:
- Toe spreaders
- Toe and bunion wraps, tapes and cushions to help keep the toes in anatomical correct position.
- Footwear changes – getting a wider shoe.
- Shoe inserts or insoles
- Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs).
- Orthoses (hallux splints)
- Physical therapy and ball rollers
- Ultrasound therapy
- Cortisone injections
There is widespread variation in the optimal procedure for correction of severe hallux valgus deformity
A June 2022 study (2) examined minimally invasive surgery for severe hallux valgus in 106 feet. The researchers write: “There is widespread variation in the optimal procedure for correction of severe hallux valgus deformity . . . There is limited evidence investigating the clinical or radiological outcomes following treatment of severe hallux valgus deformity with third-generation minimally invasive chevron and Akin osteotomies (MICA).” To add to the medical knowledge on the subject, the research team conducted a prospective observational single surgeon series of consecutive patients who underwent primary third-generation MICA with screw fixation for severe hallux valgus.
- 106 consecutive feet (78 patients; 73 female, 5 male) met the inclusion criteria.
- At two years following surgery, patient reported scale scoring reported significantly improvement for the pain, walking and standing
- Conclusion: “This study has demonstrated third-generation MICA for the treatment of severe hallux valgus deformity enables substantial deformity correction and is associated with significant improvements in clinical patient reported outcomes 2 years following surgery.
Patients’ experiences of their post-operative outcomes following forefoot surgery
A June 2022 study (3) tried to understand patients’ experiences of their post-operative outcomes following forefoot surgery
“Hallux valgus and hallux rigidus are two common forefoot conditions causing deformity, pain, functional limitations, disability and deteriorating health status resulting in the requirement for surgery. Even when surgery is performed by an experienced surgeon, there remains a potential for patients to experience dissatisfaction and unfavorable outcomes. Adverse results are moderated by psychosocial variables; however, there is a paucity of qualitative research providing insight into how patients perceive their outcomes and the factors affecting their recovery.”
The researchers of this study aimed to explore patients’ experiences of their surgical outcomes following forefoot surgery and factors associated with their recovery. Semi-structured interviews with 15 patients who received surgery for hallux valgus and/or hallux rigidus were conducted.
The patients had common themes:
- physical limitations,
- the psychosocial impact of surgical recovery,
- regaining normality,
- patients’ expectations for physical recovery and
- an altered body-image.
“Patients experiencing problematic outcomes were functionally limited, had low mood and were unable to return to a normal life post-surgery. The women (in this study) reported weight related issues and were limited in their footwear and clothing choices, negatively impacting on their self-esteem.
Conclusion: “A forefoot condition is multifaceted, with patients experiencing a range of physical and psychological factors that may influence their outcomes and recovery from surgery. Patients need to be supported holistically with the use of a biopsychosocial model. A multidisciplinary approach to care and treatment within the forefoot surgical pathway with the inclusion of allied health professionals will enable to better support patients to enhance their outcomes. ”
1 Menz HB, Lim PQ, Hurn SE, Mickle KJ, Buldt AK, Cotchett MP, Roddy E, Wluka AE, Erbas B, Munteanu SE. Footwear, foot orthoses and strengthening exercises for the non-surgical management of hallux valgus: protocol for a randomised pilot and feasibility trial. Journal of Foot and Ankle Research. 2022 Dec;15(1):1-0.
2 Lewis TL, Ray R, Gordon DJ. Minimally invasive surgery for severe hallux valgus in 106 feet. Foot and Ankle Surgery. 2022 Jan 31.
3 Dismore LL, van Wersch A, Critchley R, Murty A, Swainston K. A qualitative study to understand patients’ experiences of their post-operative outcomes following forefoot surgery. British Journal of Pain. 2022 Jun:20494637211060278.