Conservative Management of Hallux Valgus: Difference between revisions
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==== Shoes ==== | ==== Shoes ==== | ||
Ask the patient to bring along all their shoes to a consultation and assess shoes. Considerations with shoes are: | |||
* The shoes that work for the patient | |||
* The shoes that help the patient | |||
* The shoes that are easiest to walk in | |||
* The most problematic shoe | |||
* What shoes the patient likes to wear | |||
* What shoes the patient has to wear<br /> | |||
== Sub Heading 3 == | == Sub Heading 3 == | ||
Revision as of 11:10, 4 August 2023
Original Editor - User Name
Top Contributors - Wanda van Niekerk and Jess Bell
Introduction[edit | edit source]
Hallux valgus is a common foot disorder. It is a painful deformity at the first metatarsophalangeal joint and characterised by progressive lateral deviation of the hallux (great toe) and medial deviation of the first metatarsal bone.[1] Its causes are multifactorial and it can disrupt the function of the foot during gait and balance.[1] It negatively influences quality of life in persons with this disorder.[1] This page will focus specifically on the conservative management of Hallux Valgus.
Read more: Clinically Relevant Anatomy; Clinical Presentation of Hallux Valgus
Some causes of Hallux valgus include:
- biomechanics
- age
- time
- shoes
Read more detail on the Epidemiology and Aetiology of Hallux Valgus here.
Predisposing Factors[edit | edit source]
Look at the bigger picture and evaluate the whole kinetic chain!
- Midfoot instability
- Hindfoot instability
- Tight calf muscles
- Ankle injury
- Loss of talocrural joint range of motion (ROM)
- Out-toeing
- Genetics
- Medical conditions
- Type II Diabetes
- Reactive arthritic conditions (eg. gout)
- Generalised low tone/ hypermobility
- Peripheral neuropathy
- Medications
- Shoes
Conservative Management[edit | edit source]
Aims of Management[edit | edit source]
This is a progressive condition and it is not a condition that can be fixed with conservative management. The aims of conservative management are:
- patient education
- pain management
- management of the deformity
- stop or slow down the progression of the deformity
- delay surgical intervention
- manage cases for which surgery is not an option
Patient Education[edit | edit source]
- Establish what the patient's understanding is of hallux valgus and explain the condition to the patient
- Do they understand the underlying mechanisms?
- Do they understand the condition?
Patient education is an important part of any healthcare setting. It is a way for rehabilitation professionals to communicate key information, it improves patient self-efficacy and self-management skills. It is also been shown to improve clinical outcomes such as pain and function.[2]
Pain Management[edit | edit source]
- Transcutaneous electrical nerve stimulation (TENS) - protocols for chronic pain management (different currents, different application times) may be beneficial in providing symptomatic pain relief. Johnson et al.[3], reported "moderate - certainty" evidence that pain is reduced with TENS. It is also an affordable treatment.
- Investigate underlying medical causes and refer to rheumatologist when necessary
- Non-steroidal anti-inflammatories (NSAIDs) may help with pain relieve[7]
- Over the counter orthotic devices may reduce pain in the intermediate term as reported by Hurn et al.[8]
Shoes[edit | edit source]
Ask the patient to bring along all their shoes to a consultation and assess shoes. Considerations with shoes are:
- The shoes that work for the patient
- The shoes that help the patient
- The shoes that are easiest to walk in
- The most problematic shoe
- What shoes the patient likes to wear
- What shoes the patient has to wear
Sub Heading 3[edit | edit source]
Resources[edit | edit source]
- bulleted list
- x
or
- numbered list
- x
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Menz HB, Marshall M, Thomas MJ, Rathod‐Mistry T, Peat GM, Roddy E. Incidence and progression of hallux valgus: a prospective cohort study. Arthritis Care & Research. 2023 Jan;75(1):166-73.
- ↑ Forbes R, Mandrusiak A, Smith M, Russell T. A comparison of patient education practices and perceptions of novice and experienced physiotherapists in Australian physiotherapy settings. Musculoskeletal Science and Practice. 2017 Apr 1;28:46-53.
- ↑ Johnson MI, Paley CA, Jones G, Mulvey MR, Wittkopf PG. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: A systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ open. 2022 Feb 1;12(2):e051073.
- ↑ Esther CL, Belen OA, Aranzazu RM, Gabriel GN. Foot deformities in patients with diabetic mellitus (with and without peripheral neuropathy). Journal of Tissue Viability. 2021 Aug 1;30(3):346-51.
- ↑ Cohen-Rosenblum AR, Somogyi JR, Hynes KK, Guevara ME. Orthopaedic Management of Gout. JAAOS Global Research & Reviews. 2022 Nov 1;6(11):e22.
- ↑ 6.0 6.1 Ulus SA, Özkul E, Atiç R, Yiğit Ş, Akar MS, Durgut F, Dönmez S, Yazar C, Adıyaman E, Beştaş FO. Hallux valgus: A narrative review. Unico's Review. 2023 Apr 13;2(1):1-6.
- ↑ Andrews NA, Ray J, Dib A, Harrelson WM, Khurana A, Singh MS, Shah A. Diagnosis and conservative management of great toe pathologies: a review. Postgraduate Medicine. 2021 May 19;133(4):409-20.
- ↑ Hurn SE, Matthews BG, Munteanu SE, Menz HB. Effectiveness of Nonsurgical Interventions for Hallux Valgus: A Systematic Review and Meta‐Analysis. Arthritis care & research. 2022 Oct;74(10):1676-88.
