Interventions for Treating Hallux Valgus (Bunion)

Ferrari J., Williams R.L. Dept. of Podiatry, University College London, England.

Introduction: Hallux valgus is one of the most common foot pathologies. It can develop at any age and affects up to 48% of the population, predominantly women. Over the past century, 150 surgical procedures have been developed to treat the deformity.
Objectives: To identify and summarise all trials which evaluate the treatments used in the correction of deformity of the great toe (hallux valgus) and to establish the effectiveness of treatments.
Methods: Randomised or quasi-randomised studies on surgical and conservative treatments were included. Electronic searches and hand searching of podiatry journals were used to identify trials. Outcome measurements included reduction in degree of deformity (hallux valgus angle and intermatatarsal angle), range of movement, post-operative complications, pain, satisfaction, footwear problems and limitation in walking.
Results: Only 12 trials were located. Trial size and methodological quality tended to be poor. Two trials considered conservative treatment and found no difference in outcome between treatment and no treatment. The remaining 10 trials were considered in subgroups. The Keller's arthroplasty appears to be a poor choice of operation when improved range of motion and intermetatarsal angle were considered. The Chevron's osteotomy appeared to be a less favourable technique to any other technique compared with it. An adaptation made by a surgeon to an original operation appeared to have no advantage over the original operation. The use of a new rehabilitation technique seemed to have benefit in improving range of motion following surgery.
Discussion: Although around 150 operations have been recorded for treatment of hallux valgus, only 12 trials were located which evaluated a small number of these procedures. There appeared to be no optimal treatment for the condition and numbers of patients remaining dissatisfied after treatment in all trials was consistently high. The review highlighted the limited evidence available to assess the usefulness of treatments for hallux valgus. The need for larger trials with improved methodological quality was shown. For any treatment, the high levels of dissatisfaction suggested a greater need to consider the patients' hopes on outcome prior to undertaking a procedure.

Rome 1999 PB31