From the Research
Hallux valgus interphalangeus (HVI) diagnosis and treatment should prioritize conservative management, including proper footwear, toe spacers, and orthotics, before considering surgical intervention, as supported by the most recent study 1.
Diagnosis and Treatment Overview
The diagnosis of HVI involves identifying the angulation at the interphalangeal joint of the big toe, which can be caused by various factors such as restrictive footwear, pes planus, and biomechanical alterations. Treatment should focus on alleviating symptoms and preventing progression of the deformity.
Conservative Management
Conservative management is the first line of treatment for HVI and includes:
- Wearing wide-toed shoes with a cushioned sole and a lowered heel to reduce pressure on the metatarsal heads 1
- Using toe spacers or personalized 3D printed customized toe spreaders to improve symptoms and bring pain relief 1
- Performing stretching exercises for the toe to maintain flexibility and range of motion
- Using custom orthotics to redistribute pressure away from the affected joint and compensate for subtalar joint hyperpronation 1
Surgical Intervention
If conservative measures fail to provide relief after 3-6 months, surgical intervention may be considered. The most common procedure for HVI is an interphalangeal osteotomy, which involves cutting and realigning the bone to correct the deformity, as reported in a case study 2. Post-surgery, patients typically need to wear a special shoe for 4-6 weeks and undergo physical therapy to regain mobility and strength.
Importance of Early Intervention and Proper Footwear
Early intervention and proper footwear choices can help prevent progression of the deformity and reduce the likelihood of needing surgery. A thorough evaluation by a podiatrist or orthopedic surgeon is crucial for proper diagnosis and treatment planning, especially since HVI can sometimes be associated with underlying conditions like rheumatoid arthritis or certain neuromuscular disorders 3.
Additional Considerations
Other studies have highlighted the importance of footwear, foot orthoses, and strengthening exercises in the non-surgical management of hallux valgus, although the focus was not specifically on HVI 4. The use of dynamic foot orthoses with a 3/4-length design has been suggested to be less likely to negatively affect dorsal or medial pressures 1. However, the primary approach should always prioritize the most recent and highest quality evidence available, which in this case supports conservative management as the initial treatment strategy for HVI 1.