Effectiveness of Nonsurgical Interventions for Hallux Valgus: A Systematic Review and Meta-Analysis.

Abstract

To conduct a systematic review and meta-analysis investigating the effectiveness of nonsurgical interventions for hallux valgus (HV). Medline, CINAHL, Embase, and the Cochrane Library were searched to April 2020, including parallel-group and crossover studies investigating nonsurgical interventions for HV. Two reviewers independently screened articles for inclusion, extracted data, determined risk of bias, and made assessments using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. Risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool. Effect sizes (mean differences or risk ratios, and 95% confidence intervals) were calculated and pooled where possible for the primary outcomes, foot pain, and HV angle. Eighteen included studies investigated a wide range of nonsurgical interventions for HV. Most studies had small sample sizes and concerns regarding risk of bias. Five separate meta-analyses for foot orthoses, splints, manual therapy, and taping added to foot exercises showed no significant effects on primary outcomes. However, results from 8 studies showed a significant pain reduction with the use of foot orthoses, night splints, dynamic splints, manual therapy, taping added to foot exercises, a multifaceted physical therapy program, and Botox injections. Four studies reported a clinically significant reduction in HV angle with night splints, foot exercises, multifaceted physical therapy, and Botox injections. There is a low level of certainty surrounding the effectiveness of nonsurgical interventions for HV, but a reduction in pain appears more likely than improvement in HV angle.