What is the treatment for hallux valgus?

Treatment for Hallux Valgus

Conservative management with appropriate footwear modification should be the first-line treatment for hallux valgus, as these measures can alleviate symptoms but will not correct the deformity; surgery is indicated only when conservative treatment fails to control pain. 1, 2

Conservative Treatment Approach

Footwear Modifications

• Patients should be referred for specialized footwear if standard shoes cannot accommodate the deformity or if there are signs of abnormal loading. 1
• Shoes must accommodate the deformity and avoid tight fitting at the metatarsophalangeal joints. 1
• Wider shoes with adequate cushioning and support are essential, avoiding tight shoes or those with rough edges and uneven seams. 3

Orthotic Devices and Splints

• Insoles, orthoses, and toe alignment splints cannot improve the forefoot deformity itself but can alleviate symptoms due to increased local pressure. 2
• Nocturnal splints may be used as part of conservative management. 4
• These devices provide symptomatic relief only and should not be expected to correct the structural deformity. 2

When Conservative Treatment Fails

• If pain persists despite 2-4 weeks of appropriate conservative treatment with footwear modification and orthotic devices, surgical intervention should be considered. 3, 5

Surgical Management

Indications for Surgery

• Surgery is indicated when pain persists despite adequate conservative treatment. 5
• The goal is to correct the deformity and alleviate symptoms that cannot be managed conservatively. 6

Surgical Technique Selection

• Mild deformities are best treated with distal first metatarsal osteotomies, such as the Chevron (V-shaped) osteotomy. 5
• Severe deformities require a soft-tissue procedure at the first metatarsophalangeal joint combined with a proximal first metatarsal osteotomy. 5
• In cases of osteoarthritis and in elderly patients, resection arthroplasty is preferred. 5
• Arthrodesis is performed in physically active patients with osteoarthritis. 5

Surgical Outcomes

• Proper surgical treatment results in a good or very good outcome in 85% of patients and a satisfactory result in a further 10%. 5
• Recurrent deformity occurs in approximately 29% of patients in some series, highlighting the importance of careful patient selection and surgical technique. 1
• Complex osteotomies may increase reoperation rates compared to simple osteotomies, with little difference in pain outcomes between the two approaches. 6

Post-Operative Management

• After correction of hallux valgus, patients can usually bear their full weight on the treated foot while wearing a flat surgical shoe. 5
• Functional support with bracing is preferred over immobilization in post-operative management. 1
• Splints are helpful after surgery to retain joint congruency and assure proper toe position during soft tissue healing. 2

Important Clinical Considerations

Evidence for Conservative vs. Surgical Treatment

• Surgery may result in a clinically important reduction in pain (18-point reduction on 0-100 scale) compared to no treatment at 12 months. 6
• Surgery may result in only a slight increase in function (9-point improvement on AOFAS scale) and little to no difference in quality of life compared to no treatment. 6
• The modest functional improvements and quality of life benefits should be weighed against surgical risks when counseling patients. 6

Common Pitfalls

• Do not promise patients that conservative measures will correct the deformity—they only provide symptomatic relief. 2
• Avoid selecting complex osteotomies when simple osteotomies would suffice, as complex procedures may increase reoperation rates without improving pain outcomes. 6
• Ensure proper patient selection for surgery, as recurrence rates can be substantial. 1