Conservative Management of Hallux Valgus: Difference between revisions

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* There is still research needed on the effect of corrective taping on balance. Corrective taping of hallux valgus in middle-aged adults showed a negative effect on balance when walking or climbing stairs.<ref name=":5">Gur G, Ozkal O, Dilek B, Aksoy S, Bek N, Yakut Y. Effects of corrective taping on balance and gait in patients with hallux valgus. Foot & Ankle International. 2017 May;38(5):532-40.</ref> This may thus increase fall risk.<ref name=":5" />
* There is still research needed on the effect of corrective taping on balance. Corrective taping of hallux valgus in middle-aged adults showed a negative effect on balance when walking or climbing stairs.<ref name=":5">Gur G, Ozkal O, Dilek B, Aksoy S, Bek N, Yakut Y. Effects of corrective taping on balance and gait in patients with hallux valgus. Foot & Ankle International. 2017 May;38(5):532-40.</ref> This may thus increase fall risk.<ref name=":5" />
* Jeon et al reported an improvement in hallux valgus angle and pain in with 15 taping treatments in 15 participants during a four-week period.<ref>Jeon MY, Jeong HC, Jeong MS, Lee YJ, Kim JO, Lee ST, Lim NY. Effects of taping therapy on the deformed angle of the foot and pain in hallux valgus patients. Journal of Korean Academy of Nursing. 2004 Aug 1;34(5):685-92.</ref>
* Jeon et al.<ref>Jeon MY, Jeong HC, Jeong MS, Lee YJ, Kim JO, Lee ST, Lim NY. Effects of taping therapy on the deformed angle of the foot and pain in hallux valgus patients. Journal of Korean Academy of Nursing. 2004 Aug 1;34(5):685-92.</ref>, reported an improvement in hallux valgus angle and pain in with 15 taping treatments in 15 participants during a four-week period.
* Akaras et al.<ref name=":7">Akaras E, Guzel NA, Kafa N, Özdemir YA. [https://www.researchgate.net/publication/331277254_The_acute_effects_of_two_different_rigid_taping_methods_in_patients_with_hallux_valgus_deformity The acute effects of two different rigid taping methods in patients with hallux valgus deformity.] Journal of Back and Musculoskeletal Rehabilitation. 2020 Jan 1;33(1):91-8.</ref>, concluded that Mulligan taping methods could be alternative treatments for hallux valgus management. Twenty two participants were included in the study and the acute effects of two different rigid tape methods (Mulligan taping and athletic taping) were investigated in participants with hallux valgus deformities.<ref name=":7" /> Read the full article here with the taping methods also being described and images shown:  [https://www.researchgate.net/publication/331277254_The_acute_effects_of_two_different_rigid_taping_methods_in_patients_with_hallux_valgus_deformity The acute effects of two different rigid taping methods in patients with hallux valgus deformity.]<ref name=":7" />
* Akaras et al.<ref name=":7">Akaras E, Guzel NA, Kafa N, Özdemir YA. [https://www.researchgate.net/publication/331277254_The_acute_effects_of_two_different_rigid_taping_methods_in_patients_with_hallux_valgus_deformity The acute effects of two different rigid taping methods in patients with hallux valgus deformity.] Journal of Back and Musculoskeletal Rehabilitation. 2020 Jan 1;33(1):91-8.</ref>, concluded that Mulligan taping methods could be alternative treatments for hallux valgus management. Twenty two participants were included in the study and the acute effects of two different rigid tape methods (Mulligan taping and athletic taping) were investigated in participants with hallux valgus deformities.<ref name=":7" /> Read the full article here with the taping methods also being described and images shown:  [https://www.researchgate.net/publication/331277254_The_acute_effects_of_two_different_rigid_taping_methods_in_patients_with_hallux_valgus_deformity The acute effects of two different rigid taping methods in patients with hallux valgus deformity.]<ref name=":7" />


Revision as of 08:25, 7 August 2023

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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
    • Consider condition such as psoriatic arthritis, cholesterol, diabetes[4], gout[5], rheumatoid arthritis[6], connective tissue disorders[6]
    • Bilateral issues, uncontrollable pain, symptoms not resolving with rest or treatment should be referred to the relevant healthcare professional
  • 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
Shoe Advice[edit | edit source]

Research has highlighted that certain design features ( i.e. elevated heel and a restrictive toe box) in shoes may be a cause of foot pain. Biomechanical studies have found that heel elevation in shoes can:

  • increase pressure under the metatarsal heads
  • limit first metatarsophalangeal joint motion
  • increase Achilles tendon stiffness

Shoes with a restrictive or narrow toe box can:

  • increase pressure on medial side of the foot and between the toes

These changes may add to foot pain overtime. There are also research showing relationships between wearing shoes with elevated heels and hallux valgus as well as shoes with a narrow toe box and hallux valgus. Menz et al.[9] found no association between hallux valgus and heel height of footwear worn, but did find a significant association between the wearing of shoes with a restrictive or narrow toe box between the ages of 20 to 39 years and hallux valgus development later on.[9]

Shoes that generally will be better to wear may include[7]:

  • Shoes that prevent big toe hyperextension
  • Wedges with a wide toe box
  • Running shoe or trainer with strong midfoot and wide toe box

Taping[edit | edit source]

Kinesio taping[edit | edit source]

Kinesiology taping may reduce pain in people with hallux valgus. A positive effect with the correction of the big toe position on function of the foot has been reported.[10] Using kinesiology tape can also influence dynamic parameters of the foot such as increased support surface under the head of the first metatarsal and the lateral surface of the heel during gait.[11] Therefore this may help patients who are not yet ready to consider surgery or who are unable to have surgery.[11]Please watch the taping technique shown in the course video.

Taping[edit | edit source]
  • Bayer et al.,[12] investigated the effects of taping and foot exercises on patients with hallux valgus. Participants were divided into two groups (study group - received taping and foot exercises; control group - only foot exercises). Hallux valgus angle, pain and walking ability was measured. After the eight week treatment programme, both groups had a significant decrease in hallux valgus angle and pain. Walking ability improved in the study group. Between group comparison showed that the study group had significantly better results in hallux valgus angle, pain and walking ability.[12] Taping technique used in this study[12]:
    • Non allergenic, non elastic white tape used
    • Anchor around the distal toe at the base of the toenail
    • Anchor strip around instep and arch of foot
    • A 2 cm wide strip placed parallel to the midline of the medial aspect of the foot, from distal to proximal
    • Hallux sustained in a midline position
    • Anchors again over the original anchors

[13]

  • There is still research needed on the effect of corrective taping on balance. Corrective taping of hallux valgus in middle-aged adults showed a negative effect on balance when walking or climbing stairs.[14] This may thus increase fall risk.[14]
  • Jeon et al.[15], reported an improvement in hallux valgus angle and pain in with 15 taping treatments in 15 participants during a four-week period.
  • Akaras et al.[16], concluded that Mulligan taping methods could be alternative treatments for hallux valgus management. Twenty two participants were included in the study and the acute effects of two different rigid tape methods (Mulligan taping and athletic taping) were investigated in participants with hallux valgus deformities.[16] Read the full article here with the taping methods also being described and images shown: The acute effects of two different rigid taping methods in patients with hallux valgus deformity.[16]

Sub Heading 3[edit | edit source]

Resources[edit | edit source]

  • bulleted list
  • x

or

  1. numbered list
  2. x

References[edit | edit source]

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Cohen-Rosenblum AR, Somogyi JR, Hynes KK, Guevara ME. Orthopaedic Management of Gout. JAAOS Global Research & Reviews. 2022 Nov 1;6(11):e22.
  6. ↑ 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.
  7. ↑ 7.0 7.1 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.
  8. ↑ 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.
  9. ↑ 9.0 9.1 Menz HB, Roddy E, Marshall M, Thomas MJ, Rathod T, Peat GM, Croft PR. Epidemiology of shoe wearing patterns over time in older women: associations with foot pain and hallux valgus. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2016 Dec 14;71(12):1682-7.
  10. ↑ Żłobiński T, Stolecka-Warzecha A, Hartman-Petrycka M, Błońska-Fajfrowska B. The Influence of Short-Term Kinesiology Taping on Foot Anthropometry and Pain in Patients Suffering from Hallux Valgus. Medicina. 2021 Mar 26;57(4):313.
  11. ↑ 11.0 11.1 Żłobiński T, Stolecka-Warzecha A, Hartman-Petrycka M, Błońska-Fajfrowska B. The short-term effectiveness of Kinesiology Taping on foot biomechanics in patients with hallux valgus. Journal of back and musculoskeletal rehabilitation. 2021 Jan 1;34(4):715-21.
  12. ↑ 12.0 12.1 12.2 Bayar B, Erel S, Şimşek İE, Sümer E, Bayar K. The effects of taping and foot exercises on patients with hallux valgus: a preliminary study. Turkish Journal of Medical Sciences. 2011;41(3):403-9.
  13. ↑ Sandringham Sports Physio. Bunion Taping Big Toe for Pain Relief. Available from: https://www.youtube.com/watch?v=BLlGETd_BWk[last accessed 7 August 2023]
  14. ↑ 14.0 14.1 Gur G, Ozkal O, Dilek B, Aksoy S, Bek N, Yakut Y. Effects of corrective taping on balance and gait in patients with hallux valgus. Foot & Ankle International. 2017 May;38(5):532-40.
  15. ↑ Jeon MY, Jeong HC, Jeong MS, Lee YJ, Kim JO, Lee ST, Lim NY. Effects of taping therapy on the deformed angle of the foot and pain in hallux valgus patients. Journal of Korean Academy of Nursing. 2004 Aug 1;34(5):685-92.
  16. ↑ 16.0 16.1 16.2 Akaras E, Guzel NA, Kafa N, Özdemir YA. The acute effects of two different rigid taping methods in patients with hallux valgus deformity. Journal of Back and Musculoskeletal Rehabilitation. 2020 Jan 1;33(1):91-8.
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