Hallux abducto valgus : a systematic review on the effectiveness of conservative and non-operative treatments of the 1st ray and hallux abducto valgus progression

Background: Hallux Abducto Valgus (HAV) is a very common, multifactorial, painful foot condition associated with a deformation of the big toe. Dysfunctions in the biomechanics of the first ray such as hypomobility or hypermobility have been suggested to play a key role in several foot conditions. Surgical interventions should be considered as a last option for patients presenting with hallux valgus. Many conservative, non-surgical treatments have proved inefficient, therefore there is scope for an innovative, non- surgical solution to reduce HV development and support proper foot function. Research Question: The purpose of this study is to determine the availability and efficacy of the current non- surgical treatment modalities through a systematic review and to perform a systematic literature search to identify studies which have analyzed the effect of non-surgical foot appliances on hallux valgus, the effect of hallux valgus appliances on foot function, including muscle action, 1st ray biomechanics, hallux valgus angle and plantar pressure distribution, the effect of hallux valgus applications on pain, deformity and disability, to perform a quality assessment to identify the rigor of the identified studies. Methods: The systematic review was conducted in PubMed in order to determine the availability and efficacy of present non-surgical treatment modalities for the control of the hallux valgus progression and for this investigation we used relevant search terms. We followed the Effective Public Health Practice Project Quality Assessment Tool recommendations for the assessment of risk of bias and the report was performed following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Eight studies were eligible for selection. Hallux Abducto Valgus was the pathology to be evaluated with the use of soft and semi-rigid orthoses, taping, custom-made foot orthoses, static and dynamic orthoses. In most studies the reduction of the level of pain and the prevention of HAV progression was the effect of the non-surgical treatment.peer-reviewe