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Updated: Jul 15, 2026
An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery
Published on: February 17, 2018
Interventions for treating hallux valgus (abductovalgus) and bunions
J Ferrari1, J P Higgins, R L Williams
1Department of Podiatry, University College London, 33 Fitzroy Square, London, UK, W1P 6AY. jillferrari@ucl.ac.uk
Insights
Evidence from randomized trials on hallux valgus treatments is insufficient. Current interventions, both conservative and surgical, show no clear advantage, with high patient dissatisfaction rates persisting even after symptom improvement.
Area of Science:
- Orthopedics
- Podiatry
- Evidence-Based Medicine
Background:
- Hallux valgus, a deviation of the great toe, requires effective treatment strategies.
- Evaluating current interventions for hallux valgus is crucial for improving patient outcomes.
Purpose of the Study:
- To systematically review and assess the evidence from randomized controlled trials (RCTs) on interventions for hallux valgus correction.
- To identify the most effective conservative and surgical treatments for hallux valgus.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Medline, Embase, Cinahl, Amed, Cochrane registers) up to October 1998.
- Included were randomized or quasi-randomized trials of conservative and surgical hallux valgus treatments, excluding studies on non-specific surgical aspects.
- Methodological quality assessment and data extraction were performed independently by two reviewers.
Main Results:
- Twelve trials of poor methodological quality and small sample sizes were included.
- Conservative treatments showed no difference compared to no treatment.
- Surgical techniques, including Keller's arthroplasty and chevron osteotomy, demonstrated no significant advantages over other methods.
- Post-operative continuous passive motion may improve range of motion and recovery, while early weight-bearing was not detrimental.
Conclusions:
- Insufficient evidence exists to recommend specific conservative, operative, or post-operative treatments for hallux valgus.
- High rates of patient dissatisfaction (25-33%) were observed, even with improved clinical outcomes.
- Future research should focus on standardized interventions, patient-centered outcomes, and longer follow-up periods for hallux valgus treatment evaluation.
Background:
Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot.
Objectives:
To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus.
Search Strategy:
Medline (1966-October 1998), Embase (1980-1998), Cinahl (1982-1998), Amed (1993-1998), the Cochrane Controlled Trials Register, the Cochrane Musculoskeletal Injuries Trials Register and bibliographies of identified trials were searched. Hand searching of podiatry journals was undertaken. Date of the most recent search: October 1998.
Selection Criteria:
Randomised or quasi-randomised trials of both conservative and surgical treatments of hallux valgus. Excluded were studies comparing areas of surgery not specific to the control of the deformity such as use of anaesthetics or tourniquet placement.
Data Collection And Analysis:
Methodological quality of trials which met the inclusion criteria was independently assessed by two reviewers. Data extraction was undertaken by one reviewer and confirmed by another. The trials were grouped according to the interventions being compared, but the dissimilarity in the comparisons prevented pooling of results.
Main Results:
The methodological quality of the 12 included trials was poor and trial sizes were small. Two trials involving 150 patients evaluated conservative treatments. There was no difference in outcomes between treatment and no treatment. Two trials involving 133 patients compared Keller's arthroplasty with other surgical techniques. In general, there was no advantage in using Keller's over the other techniques, particularly in terms of range of motion and intermetatarsal angle. Three trials involving 205 patients compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Three trials involving 157 patients compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations. Two trials involving 95 patients evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery; early weightbearing was not found to be detrimental to final outcome.
Reviewer'S Conclusions:
There is insufficient evidence from randomised trials to determine which methods of either conservative, operative or post-operative treatment are the most appropriate for the hallux valgus. It is notable that the numbers of patients remaining dissatisfied at follow-up were consistently high (25 to 33%), even when the hallux valgus angle and pain had improved. Assessment of future research should focus on evaluating basic intervention types in eligible patients with similar degrees of deformity. Future research should include patient-focused outcomes, standardised assessment criteria and longer surveillance periods.
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