For an adult with mild‑to‑moderate hallux valgus, which of these modalities—ultrasound therapy, short‑wave diathermy, transcutaneous electrical nerve stimulation (TENS), manipulation, multiple exercises, manual and skin traction—are supported by current clinical‑practice guidelines?

Guideline-Supported Modalities for Hallux Valgus

For mild-to-moderate hallux valgus, only "multiple exercises" aligns with current clinical practice guidelines; ultrasound therapy, short-wave diathermy, TENS, manipulation, and manual/skin traction are either not recommended or lack evidence for this condition. 1, 2

Evidence-Based Analysis by Modality

Multiple Exercises: SUPPORTED

• Supervised exercise programs are strongly recommended for musculoskeletal conditions analogous to hallux valgus, achieving superior outcomes compared with unsupervised home programs for symptom control and functional improvement 2
• Exercise therapy (including range of motion, progressive resistance training, and proprioceptive training) demonstrates beneficial effects with reductions in pain and improvements in function 3
• Functional stabilization through gymnastics or physiotherapy instructions is recommended for secondary prevention 4

Ultrasound Therapy: NOT SUPPORTED

• Ultrasound is conditionally recommended only for osteoarthritis of the knee, hip, and hand—not for hallux valgus 5
• The heterogeneity of ultrasound delivery methods and short duration of benefit led to only conditional recommendations even in OA, where evidence exists 5
• No guideline evidence supports ultrasound for hallux valgus specifically 1, 2

Short-Wave Diathermy: NOT SUPPORTED

• Short-wave therapy is explicitly listed among therapies to AVOID as it has no proven benefit 6
• While diathermy studies in OA were more likely to be sham-controlled than other heat modalities, this evidence applies only to OA—not hallux valgus 5

TENS (Transcutaneous Electrical Nerve Stimulation): STRONGLY RECOMMENDED AGAINST

• TENS is strongly recommended against for knee and hip OA based on low-quality studies with small sample sizes, variable controls, and lack of demonstrated benefit 5
• Studies examining TENS have been of low quality and demonstrate lack of benefit even in conditions where it has been studied 5
• No evidence supports TENS for hallux valgus 1, 2

Manipulation: NOT SUPPORTED FOR HALLUX VALGUS

• Manual therapy with manipulation is conditionally recommended against when added to exercise alone in knee/hip OA, showing little additional benefit over exercise alone 5
• While one exploratory trial (N=30) tested manual and manipulative therapy for hallux valgus and found it equivalent to night splints in the short term, this single small study is insufficient to establish guideline-level recommendations 7
• Manual mobilization combined with exercise shows benefit in ankle sprains but this evidence does not transfer to hallux valgus 5

Manual & Skin Traction: NOT SUPPORTED

• Manual traction is mentioned only as part of manual therapy techniques for OA (which are conditionally recommended against over exercise alone) 5
• No guideline evidence supports traction for hallux valgus 1, 2

Clinical Algorithm for Hallux Valgus Conservative Management

First-line approach:

1. Therapeutic footwear that accommodates the bunion deformity with sufficient width, adequate length, and adjustable features 2
2. Custom or prefabricated orthoses to redistribute pressure 2
3. Supervised exercise program focusing on functional stabilization 2, 4

Avoid these modalities:

• Ultrasound therapy (no evidence for hallux valgus)
• Short-wave diathermy (no proven benefit) 6
• TENS (strongly recommended against even in OA) 5
• Manipulation as standalone therapy (insufficient evidence)
• Traction (no evidence for hallux valgus)

Critical Pitfall

The most important caveat: Conservative measures including exercise cannot correct the hallux valgus deformity itself—they can only control symptoms and potentially slow progression 4, 8. Surgery remains the only option for actual deformity correction when conservative management fails and the patient has significant pain and disability 9, 8.