E Arvanitakis*, C Formosa and A Gatt

University of Malta, Podiatry Department, Faculty of Health Sciences, Malta

*Corresponding Author: E Arvanitakis, University of Malta, Podiatry Department, Faculty of Health Sciences, Malta.

Received: September 29, 2022; Published: October 10, 2022

Abstract

Background: Hallux Abducto Valgus (HAV) is a very common, multifactorial, painful foot condition associated with a deformation of the big toe. Dysfunctions in the biomechanics of the first ray such as hypomobility or hypermobility have been suggested to play a key role in several foot conditions. Surgical interventions should be considered as a last option for patients presenting with hallux valgus. Many conservative, non-surgical treatments have proved inefficient, therefore there is scope for an innovative, non- surgical solution to reduce HV development and support proper foot function.

Research Question: The purpose of this study is to determine the availability and efficacy of the current non- surgical treatment modalities through a systematic review and to perform a systematic literature search to identify studies which have analyzed the effect of non-surgical foot appliances on hallux valgus, the effect of hallux valgus appliances on foot function, including muscle action, 1st ray biomechanics, hallux valgus angle and plantar pressure distribution, the effect of hallux valgus applications on pain, deformity and disability, to perform a quality assessment to identify the rigor of the identified studies.

Methods: The systematic review was conducted in PubMed in order to determine the availability and efficacy of present non-surgical treatment modalities for the control of the hallux valgus progression and for this investigation we used relevant search terms. We followed the Effective Public Health Practice Project Quality Assessment Tool recommendations for the assessment of risk of bias and the report was performed following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results: Eight studies were eligible for selection. Hallux Abducto Valgus was the pathology to be evaluated with the use of soft and semi-rigid orthoses, taping, custom-made foot orthoses, static and dynamic orthoses. In most studies the reduction of the level of pain and the prevention of HAV progression was the effect of the non-surgical treatment.

Significance: It has been shown that the use of non-surgical treatment decreased the pain caused by HAV in most cases and in some it was shown that progression of the HAV deformity was prevented.

Keywords: Hallux valgus, medical devices for Hallux valgus, conservative treatment for HAV

References

1. J Ferrari., et al. “Interventions for treating hallux valgus (abductovalgus) and bunions”. Cochrane Library: Cochrane Reviews 1 (2004): CD000964.
2. MH Kim., et al. “Comparison of muscle activities of abductor hallucis and adductor hallucis between the short foot and toe-spread-out exercises in subjects with mild hallux valgus”. Journal of Back and Musculoskeletal Rehabilitation 26 (2013): 163-168.
3. D Tarantino., et al. “Hallux valgus deformity: Treatment options, postoperative management, and return to sport”. Journal of Human Sport and Exercise 4proc (2021): S1674-S1687.
4. JF Sarwark. “Essentials of Musculoskeletal Medicine fourth edition”., American Academy of Orthopaedic Surgeons, Chicago (2010).
5. H Martin., et al. “Investigation of first ray mobility during gait by kinematic fluoroscopic imaging--a novel method”. BMC Musculoskeletal Disorders 13 (2012): 14.
6. PJ Mansfield and DA Neumann. Chapter 11 - Structure and Function of the Ankle and Foot. In P. J. Mansfield and D. A. Neumann (Eds.), “Essentials of Kinesiology for the Physical Therapist Assistant, third edition”., St. Louis (MO): Mosby (2019): 311-350.
7. FD Ross. “The relationship of abnormal foot pronation to hallux abducto valgus--a pilot study”. Prosthetics and Orthotics International 10 (1986): 72-78.
8. M Cornwall., et al. “The Influence of First Ray Mobility on Forefoot Plantar Pressure and Hindfoot Kinematics During Walking”. Foot and ankle International 27 (2006): 539-547.
9. G Slullitel., et al. “Effect of First Ray Insufficiency and Metatarsal Index on Metatarsalgia in Hallux Valgus”. Foot and Ankle International 37 (2015): 300-306.
10. C Van Beek and J Greisberg. “Mobility of the first ray: review article”. Foot and Ankle International 32 (2011): 917-922.
11. JF Doty and MJ Coughlin. “Hallux valgus and hypermobility of the first ray: facts and fiction”. International Orthopaedics 37 (2013): 1655-1660.
12. D Morton. “Significant characteristics of the Neanderthal foot”. Natural History 26 (1926): 310-314.
13. DJ Morton. “Hypermobility of the first metatarsal bone: the interlinking factor between metatarsalgia and longitudinal arch strains”. JBJS 10 (1928): 187-196.
14. D Morton. “The human foot; its evolution, physiology and functional disorders”. Columbia University Press, New York (1935).
15. MH Kim., et al. “Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus”. The Journal of Physical Therapy Science 27 (2015): 1019-1022.
16. SE Hurn., et al. “Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists”. Journal of Foot and Ankle Research 9 (2016): 16.
17. N Kadel. “Foot and ankle problems in dancers”. Physical Medicine and Rehabilitation Clinics of North America 4 (2014): 829-844.
18. AM Perera., et al. “The Pathogenesis of Hallux Valgus”. Journal of Bone and Joint Surgery 93 (2011): 1650-1661.
19. HB Menz., et al. “Epidemiology of Shoe Wearing Patterns Over Time in Older Women: Associations with Foot Pain and Hallux Valgus”. The Journals of Gerontology Series A Biological Sciences and Medical Sciences 71 (2016): 1682-1687.
20. I Arias-Martín., et al. “Effectiveness of custom-made foot orthoses for treating forefoot pain: a systematic review”. International Orthopaedics 42 (2018): 1865-1875.
21. Effective Public Healthcare Panacea Project, Quality Assessment Tool for Quantitative Studies.
22. D Moher., et al. “PRISMA Group, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement”. BMJ 339 (2009): b2535.
23. S Armijo-Olivo., et al. “Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research”. Journal of Evaluation in Clinical Practice 18 (2012): 12-18.
24. MY Jeon., et al. “Effects of Taping Therapy on the Deformed Angle of the Foot and Pain in Hallux Valgus Patients”. Journal of Korean Academy of Nursing 34 (2004): 685-692.
25. TE Kilmartin., et al. “A controlled prospective trial of a foot orthosis for juvenile hallux valgus”. The Journal of Bone and Joint Surgery British 76 (1994): 210-214.
26. JA Groiso. “ Juvenile hallux valgus. A conservative approach to treatment”. The Journal of Bone and Joint Surgery America 74 (1992): 1367-1374.
27. A Tehraninasr., et al. “Effects of insole with toe-separator and night splint on patients with painful hallux valgus: a comparative study”. Prosthetics and Orthotics International 32 (2008): 79-83.
28. N Chadchavalpanichaya., et al. “Effectiveness of the custom-mold room temperature vulcanizing silicone toe separator on hallux valgus: A prospective, randomized single-blinded controlled trial”. Prosthetics and Orthotics International 42 (2018): 163-170.
29. SA Abdalbary. “Foot Mobilization and Exercise Program Combined with Toe Separator Improves Outcomes in Women with Moderate Hallux Valgus at 1-Year Follow-up a Randomized Clinical Trial”. Journal of the American Podiatric Medical Association 108 (2018): 478-486.
30. N Moulodi., et al. “A comparison of the hallux valgus angle, range of motion, and patient satisfaction after use of dynamic and static orthoses”. Foot (Edinb) 41 (2019): 6-11.
31. SM Lee and JH Lee. “Effects of balance taping using kinesiology tape in a patient with moderate hallux valgus: A case report”. Medicine (Baltimore) 95 (2016): e5357.
32. SF Tang., et al. “The effects of a new foot-toe orthosis in treating painful hallux valgus”. Archives of Physical Medicine and Rehabilitation 83 (2002): 1792-1795.
33. MP Formosa., et al. “Evaluating Quality of Life in Patients with Hallux Abducto Valgus Deformity After a Taping Technique”. Journal of the American Podiatric Medical Association 107 (2017): 287-291.
34. GO Karabicak., et al. “Short-Term Effects of Kinesiotaping on Pain and Joint Alignment in Conservative Treatment of Hallux Valgus”. Journal of Manipulative and Physiological Therapeutics 38 (2015): 564-71.
35. J Higgins and S Green. “Cochrane Handbook for Systematic Reviews of Interventions”. West Sussex, England: Wiley, John and Sons, Incorporated (2008).
36.  

Citation

Citation: E Arvanitakis.,et al. “Hallux Abducto Valgus: A Systematic Review on the Effectiveness of Conservative and Non-Operative Treatments of the 1st Ray and Hallux Abducto Valgus Progression". Acta Scientific Orthopaedics 5.11 (2022): 54-64.

Copyright

Copyright: © 2022 E Arvanitakis., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.