Hallux valgus deformity: Treatment options, post-operative management, and return to sport
DOI:
https://doi.org/10.14198/jhse.2021.16.Proc4.14Keywords:
Hallux valgus deformity, Hallux valgus treatment, Hallux valgus surgery, Hallux valgus post-operative management, Hallux valgus return to sportAbstract
Hallux valgus is the commonest forefoot deformity, consisting in a deviation of the great toe. The pathophysiology is complex and multifactorial, with women being more affected than men. Hallux valgus causes symptoms in three ways: pain in the bunion, lack of space for the other toes, and metatarsalgia. Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique variant of turf toe. Patients in whom conservative measures fail to relieve symptoms may be considered for surgery, since none of the non-surgical treatment options can permanently correct the hallux valgus deformity. Concern exists on the correct treatment approach and the most appropriate surgical technique, especially in athletes. Newest minimally invasive procedures allow to achieve good clinical and radiographic outcomes and they are associated with decreased recovery and rehabilitation times. Post-operative rehabilitation is aimed to restore physiological gait and foot function, encouraging both plantar pressure on the first ray and joint mobility, with walking immediately permitted. Further studies of higher levels of evidence should be performed to identify the correct indications for this disease. The aim of this narrative review is to give an insight about the treatment options, related post-operative rehabilitation, and return to sport.
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References
Aicale, R., Tarantino, D., Giai Via, A., Oliva, F., & Maffulli, N. (2017). Z Shortening of Healed Achilles Tendon Rupture (pp. 125-128). https://doi.org/10.1007/978-3-662-54074-9_21
Aicale, R., Tarantino, D., & Maffulli, N. (2017). Basic Science of Tendons. In A. Gobbi, J. Espregueira-Mendes, J. G. Lane, & M. Karahan (Eds.), Bio-orthopaedics: A New Approach (pp. 249-273). Springer. https://doi.org/10.1007/978-3-662-54181-4_21
Aicale, R., Tarantino, D., & Maffulli, N. (2018). Surgery in Tendinopathies. Sports Medicine and Arthroscopy Review, 26(4), 200-202. https://doi.org/10.1097/JSA.0000000000000214
Aicale, R., Tarantino, D., & Maffulli, N. (2019). Non-insertional Achilles Tendinopathy: State of the Art (pp. 359-367). https://doi.org/10.1007/978-3-662-58704-1_32
Baxter, D. E. (1994). Treatment of bunion deformity in the athlete. The Orthopedic Clinics of North America, 25(1), 33-39. https://doi.org/10.1016/S0030-5898(20)31864-2
Baxter's The Foot and Ankle in Sport-2nd Edition. (n.d.). Retrieved 5 November 2017, from https://www.elsevier.com/books/baxters-the-foot-and-ankle-in-sport/marymont/978-0-323-02358-0
Bisaccia, D. R., Aicale, R., Tarantino, D., Peretti, G. M., & Maffulli, N. (2019). Biological and chemical changes in fluoroquinolone-associated tendinopathies: A systematic review. British Medical Bulletin, 130(1), 39-49. https://doi.org/10.1093/bmb/ldz006
Bösch, P., Wanke, S., & Legenstein, R. (2000). Hallux valgus correction by the method of Bösch: A new technique with a seven-to-ten-year follow-up. Foot and Ankle Clinics, 5(3), 485-498, v-vi.
Chang, J. T. (2001). Distal metaphyseal osteotomies in hallux abducto valgus surgery. McGlamry's Comprehensive Textbook of Foot and Ankle Surgery, 505-527.
Chiang, C.-C., Lin, C.-F. J., Tzeng, Y.-H., Huang, C.-K., Chen, W.-M., & Liu, C.-L. (2012). Distal linear osteotomy compared to oblique diaphyseal osteotomy in moderate to severe hallux valgus. Foot & Ankle International, 33(6), 479-486. https://doi.org/10.3113/FAI.2012.0479
Ciechanowicz, D., Kozłowski, J., Kołodziej, Ł., & Kromuszczyńska, J. (2020). Return to Physical Activities after Scarf Osteotomy for Hallux Valgus. Ortopedia, Traumatologia, Rehabilitacja, 22(2), 95-106. https://doi.org/10.5604/01.3001.0014.1166
de Prado, M., Ripoll, P. L., Vaquero, J., & Golanó, P. (n.d.). Tratamiento quirúrgico percutáneo del hallux valgus mediante osteotomías múltiples. Revista Española de Cirugía Ortopédica y Traumatología, 406-416. https://doi.org/10.1016/S1888-4415(03)76145-1
Facfas, A. S. B., Dpm, & Miller, R. (2001). McGlamry's Comprehensive Textbook of Foot and Ankle Surgery. Lippincott Williams & Wilkins.
Ferrari, J., Higgins, J. P., & Prior, T. D. (2009). WITHDRAWN: Interventions for treating hallux valgus (abductovalgus) and bunions. The Cochrane Database of Systematic Reviews, 2, CD000964. https://doi.org/10.1002/14651858.CD000964.pub3
Ferrari, J., Higgins, J. P. T., & Prior, T. D. (2004). Interventions for treating hallux valgus (abductovalgus) and bunions. The Cochrane Database of Systematic Reviews, 1, CD000964. https://doi.org/10.1002/14651858.CD000964.pub2
Fournier, M., Saxena, A., & Maffulli, N. (2019). Hallux Valgus Surgery in the Athlete: Current Evidence. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons, 58(4), 641-643. https://doi.org/10.1053/j.jfas.2018.04.003
Fraissler, L., Konrads, C., Hoberg, M., Rudert, M., & Walcher, M. (2016). Treatment of hallux valgus deformity. EFORT Open Reviews, 1(8), 295-302. https://doi.org/10.1302/2058-5241.1.000005
Giotis, D., Paschos, N. K., Zampeli, F., Giannoulis, D., Gantsos, A., & Mantellos, G. (2016). Modified Chevron osteotomy for hallux valgus deformity in female athletes. A 2-year follow-up study. Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons, 22(3), 181-185. https://doi.org/10.1016/j.fas.2015.07.004
Hallux Valgus Treatment & Management: Approach Considerations, Medical Therapy, Surgical Options. 2017 Jun 22 [cited 2021 Jul 16]; Available from: https://emedicine.medscape.com/article/1232902-treatment#d9
Hallux Valgus Workup: Laboratory Studies, Imaging Studies, Staging. [cited 2021 Jul 16]. Available from: https://emedicine.medscape.com/article/1232902-workup#c5
Hawke, F., Burns, J., Radford, J. A., & du Toit, V. (2008). Custom-made foot orthoses for the treatment of foot pain. The Cochrane Database of Systematic Reviews, 3, CD006801. https://doi.org/10.1002/14651858.CD006801.pub2
Hester, W. A., & Pedowitz, D. I. (2020). Postoperative Considerations in the Management of Hallux Valgus. Foot and Ankle Clinics, 25(1), 141-150. https://doi.org/10.1016/j.fcl.2019.11.002
Kadakia, A. R., Smerek, J. P., & Myerson, M. S. (2007). Radiographic results after percutaneous distal metatarsal osteotomy for correction of hallux valgus deformity. Foot & Ankle International, 28(3), 355-360. https://doi.org/10.3113/FAI.2007.0355
Karabicak, G. O., Bek, N., & Tiftikci, U. (2015). Short-Term Effects of Kinesiotaping on Pain and Joint Alignment in Conservative Treatment of Hallux Valgus. Journal of Manipulative and Physiological Therapeutics, 38(8), 564-571. https://doi.org/10.1016/j.jmpt.2015.09.001
Klosok, J. K., Pring, D. J., Jessop, J. H., & Maffulli, N. (1993). Chevron or Wilson metatarsal osteotomy for hallux valgus. A prospective randomised trial. The Journal of Bone and Joint Surgery. British Volume, 75(5), 825-829. https://doi.org/10.1302/0301-620X.75B5.8376450
Leemrijse, T., Valtin, B., & Besse, J.-L. (2008). [Hallux valgus surgery in 2005. Conventional, mini-invasive or percutaneous surgery? Uni- or bilateral? Hospitalisation or one-day surgery?]. Revue De Chirurgie Orthopedique Et Reparatrice De L'appareil Moteur, 94(2), 111-127. https://doi.org/10.1016/j.rco.2007.04.006
Ling, S. K. K., Wu, Y.-M., Li, C., Lui, T. H., & Yung, P. S.-H. (2020). Randomised control trial on the optimal duration of non-weight-bearing walking after hallux valgus surgery. Journal of Orthopaedic Translation, 23, 61-66. https://doi.org/10.1016/j.jot.2020.04.009
Lui, T. H. (2007). Arthroscopy and endoscopy of the foot and ankle: Indications for new techniques. Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 23(8), 889-902. https://doi.org/10.1016/j.arthro.2007.03.003
Lui, T. H. (2008). First metatarsophalangeal joint arthroscopy in patients with hallux valgus. Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 24(10), 1122-1129. https://doi.org/10.1016/j.arthro.2008.05.006
Lui, T. H., Chan, K. B., Chow, H. T., Ma, C. M., Chan, P. K., & Ngai, W. K. (2008). Arthroscopy-assisted correction of hallux valgus deformity. Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 24(8), 875-880. https://doi.org/10.1016/j.arthro.2008.03.001
Lui, T. H., Ng, S., & Chan, K.-B. (2005). Endoscopic distal soft tissue procedure in hallux valgus surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 21(11), 1403. https://doi.org/10.1016/j.arthro.2005.08.015
MacMahon, A., Karbassi, J., Burket, J. C., Elliott, A. J., Levine, D. S., Roberts, M. M., Deland, J. T., O'Malley, M. J., Yu, J., Mancuso, C. A., & Ellis, S. J. (2016). Return to Sports and Physical Activities After the Modified Lapidus Procedure for Hallux Valgus in Young Patients. Foot & Ankle International, 37(4), 378-385. https://doi.org/10.1177/1071100715617750
Maffulli, N., Aicale, R., & Tarantino, D. (2017). Autograft Reconstruction for Chronic Achilles Tendon Disorders. Techniques in Foot & Ankle Surgery, 16(3), 117-123. https://doi.org/10.1097/BTF.0000000000000154
Maffulli, N., Aicale, R., & Tarantino, D. (2020). Tendinopathy of the Achilles Tendon (pp. 227-237). https://doi.org/10.1007/978-3-030-29231-7_31
Maffulli, N., Longo, U. G., Marinozzi, A., & Denaro, V. (2011). Hallux valgus: Effectiveness and safety of minimally invasive surgery. A systematic review. British Medical Bulletin, 97, 149-167. https://doi.org/10.1093/bmb/ldq027
Maffulli, N., Longo, U. G., Oliva, F., Denaro, V., & Coppola, C. (2009). Bosch osteotomy and scarf osteotomy for hallux valgus correction. The Orthopedic Clinics of North America, 40(4), 515-524, ix-x. https://doi.org/10.1016/j.ocl.2009.06.003
Maffulli, N., Loppini, M., & Denaro, V. (2013). Role of percutaneous distal metatarsal osteotomy for the management of hallux valgus deformity. Archives of Orthopaedic and Trauma Surgery, 133(8), 1181-1182. https://doi.org/10.1007/s00402-013-1778-6
Maffulli, N., Oliva, F., Coppola, C., & Miller, D. (2005). Minimally invasive hallux valgus correction: A technical note and a feasibility study. Journal of Surgical Orthopaedic Advances, 14(4), 193-198.
Magnan, B., Bortolazzi, R., Samaila, E., Pezzè, L., Rossi, N., & Bartolozzi, P. (2006). Percutaneous distal metatarsal osteotomy for correction of hallux valgus. Surgical technique. The Journal of Bone and Joint Surgery. American Volume, 88 Suppl 1 Pt 1, 135-148. https://doi.org/10.2106/JBJS.E.00897
Mann, R. A., & Coughlin, M. J. (1981). Hallux valgus-Etiology, anatomy, treatment and surgical considerations. Clinical Orthopaedics and Related Research, 157, 31-41. https://doi.org/10.1097/00003086-198106000-00008
McInnes, B. D., & Bouché, R. T. (2001). Critical evaluation of the modified Lapidus procedure. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons, 40(2), 71-90. https://doi.org/10.1016/S1067-2516(01)80048-X
Mizuno, K., Hashimura, M., Kimura, M., & Hirohata, K. (1992). Treatment of hallux valgus by oblique osteotomy of the first metatarsal. Foot & Ankle, 13(8), 447-452. https://doi.org/10.1177/107110079201300803
Nguyen, U.-S. D. T., Hillstrom, H. J., Li, W., Dufour, A. B., Kiel, D. P., Procter-Gray, E., Gagnon, M. M., & Hannan, M. T. (2010). Factors associated with hallux valgus in a population-based study of older women and men: The MOBILIZE Boston Study. Osteoarthritis and Cartilage, 18(1), 41-46. https://doi.org/10.1016/j.joca.2009.07.008
Nix, S., Smith, M., & Vicenzino, B. (2010). Prevalence of hallux valgus in the general population: A systematic review and meta-analysis. Journal of Foot and Ankle Research, 3, 21. https://doi.org/10.1186/1757-1146-3-21
Park, C. H., & Lee, W.-C. (2017). Recurrence of Hallux Valgus Can Be Predicted from Immediate Postoperative Non-Weight-Bearing Radiographs. The Journal of Bone and Joint Surgery. American Volume, 99(14), 1190-1197. https://doi.org/10.2106/JBJS.16.00980
Perera, A. M., Mason, L., & Stephens, M. M. (2011). The pathogenesis of hallux valgus. The Journal of Bone and Joint Surgery. American Volume, 93(17), 1650-1661. https://doi.org/10.2106/JBJS.H.01630
Piqué-Vidal, C., Maled-García, I., Arabi-Moreno, J., & Vila, J. (2006). Radiographic angles in hallux valgus: Differences between measurements made manually and with a computerized program. Foot & Ankle International, 27(3), 175-180. https://doi.org/10.1177/107110070602700304
Portaluri, M. (2000). Hallux valgus correction by the method of Bösch: A clinical evaluation. Foot and Ankle Clinics, 5(3), 499-511, vi.
Polastri, M. (2011). Postoperative Rehabilitation after Hallux Valgus Surgery: A literature review. The Foot and Ankle Online Journal. https://doi.org/10.3827/faoj.2011.0406.0004
Roukis, T. S. (2005a). Central metatarsal head-neck osteotomies: Indications and operative techniques. Clinics in Podiatric Medicine and Surgery, 22(2), 197-222, vi. https://doi.org/10.1016/j.cpm.2004.10.003
Roukis, T. S. (2005b). The tailor's bunionette deformity: A field guide to surgical correction. Clinics in Podiatric Medicine and Surgery, 22(2), 223-245, vi. https://doi.org/10.1016/j.cpm.2004.10.004
Roukis, T. S. (2009). Percutaneous and minimum incision metatarsal osteotomies: A systematic review. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons, 48(3), 380-387. https://doi.org/10.1053/j.jfas.2009.01.007
Roukis, T. S., & Schade, V. L. (2008). Minimum-incision metatarsal osteotomies. Clinics in Podiatric Medicine and Surgery, 25(4), 587-607, viii. https://doi.org/10.1016/j.cpm.2008.05.007
Saro, C., Andrén, B., Wildemyr, Z., & Felländer-Tsai, L. (2007). Outcome after distal metatarsal osteotomy for hallux valgus: A prospective randomized controlled trial of two methods. Foot & Ankle International, 28(7), 778-787. https://doi.org/10.3113/FAI.2007.0778
Saxena, A. (2000). Return to athletic activity after foot and ankle surgery: A preliminary report on select procedures. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons, 39(2), 114-119. https://doi.org/10.1016/S1067-2516(00)80035-6
Saxena, A., & Louis, M. S. (2013). Medial Locking Plate Versus Screw Fixation for Fixation of the Ludloff Osteotomy. The Journal of Foot and Ankle Surgery, 52(2), 153-157. https://doi.org/10.1053/j.jfas.2012.11.005
Saxena, A., & McCammon, D. (1997). The ludloff osteotomy: A critical analysis. The Journal of Foot and Ankle Surgery, 36(2), 100-105. https://doi.org/10.1016/S1067-2516(97)80053-1
Schuh, R., Adams, S., Hofstaetter, S. G., Krismer, M., & Trnka, H.-J. (2010). Plantar loading after chevron osteotomy combined with postoperative physical therapy. Foot & Ankle International, 31(11), 980-986. https://doi.org/10.3113/FAI.2010.0980
Schuh, R., Hofstaetter, S. G., Adams, S. B., Pichler, F., Kristen, K.-H., & Trnka, H.-J. (2009). Rehabilitation after hallux valgus surgery: Importance of physical therapy to restore weight bearing of the first ray during the stance phase. Physical Therapy, 89(9), 934-945. https://doi.org/10.2522/ptj.20080375
Schuh, R., Hofstaetter, S. G., Kristen, K.-H., & Trnka, H.-J. (2008). [Effect of physiotherapy on the functional improvement after hallux valgus surgery-A prospective pedobarographic study]. Zeitschrift Fur Orthopadie Und Unfallchirurgie, 146(5), 630-635. https://doi.org/10.1055/s-2008-1038800
Tarantino, D., Palermi, S., Sirico, F., Balato, G., D‘Addona, A., & Corrado, B. (2020). Achilles tendon pathologies: How to choose the best treatment. Journal of Human Sport and Exercise, 15(4proc), S1300-S1321. https://doi.org/10.14198/jhse.2020.15.Proc4.29
Tarantino, D., Palermi, S., Sirico, F., & Corrado, B. (2020). Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play. Journal of Functional Morphology and Kinesiology, 5(4), 95. https://doi.org/10.3390/jfmk5040095
Torkki, M., Malmivaara, A., Seitsalo, S., Hoikka, V., Laippala, P., & Paavolainen, P. (2001). Surgery vs orthosis vs watchful waiting for hallux valgus: A randomized controlled trial. JAMA, 285(19), 2474-2480. https://doi.org/10.1001/jama.285.19.2474
Weitzel, S., Trnka, H.-J., & Petroutsas, J. (2007). Transverse medial slide osteotomy for bunionette deformity: Long-term results. Foot & Ankle International, 28(7), 794-798. https://doi.org/10.3113/FAI.2006.0794
Williams, D. T., Price, P., & Harding, K. G. (2006). The influence of diabetes and lower limb arterial disease on cutaneous foot perfusion. Journal of Vascular Surgery, 44(4), 770-775. https://doi.org/10.1016/j.jvs.2005.06.040
Wülker, N. (1997a). Hallux valgus - Hallux rigidus. Orthopäde 26, 731–740. https://doi.org/10.1007/s001320050149
Wülker, N. (1997b). [Hallux valgus]. Der Orthopade, 26(7), 654-664. https://doi.org/10.1007/s001320050137
Wülker, N. (2011). Allgemeine Operationstechnik an Fuß und Sprunggelenk. Der Orthopäde, 40(5), 378. https://doi.org/10.1007/s00132-010-1719-9
Wülker, N., & Mittag, F. (2012). The treatment of hallux valgus. Deutsches Arzteblatt International, 109(49), 857-867; quiz 868. https://doi.org/10.3238/arztebl.2012.0857
Wülker, N., Stephens, M. M., & Cracchiolo, A. I. (2007). Operationsatlas Fuß und Sprunggelenk. Thieme.
Wülker, N., & Suckel, A. (2005). [Metatarsal osteotomies for hallux valgus]. Der Orthopade, 34(8), 726, 728-734. https://doi.org/10.1007/s00132-005-0830-9
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