Nonsurgical management of hallux valgus: findings of a randomised pilot and feasibility trial

Hylton B Menz; Polly Q X Lim; Sheree E Hurn; Karen J Mickle; Andrew K Buldt; Matthew P Cotchett; Edward Roddy; Anita E Wluka; Bircan Erbas; Mehak Batra; Shannon E Munteanu

doi:10.1186/s13047-023-00677-1

Nonsurgical management of hallux valgus: findings of a randomised pilot and feasibility trial

J Foot Ankle Res. 2023 Nov 13;16(1):78. doi: 10.1186/s13047-023-00677-1.

Authors

Affiliations

¹ School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia. h.menz@latrobe.edu.au.
² School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia.
³ School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia.
⁴ Applied Sport Science and Exercise Testing Laboratory, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, NSW, 2258, Australia.
⁵ Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK.
⁶ Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK.
⁷ School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.
⁸ School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.

Abstract

Background: Hallux valgus is a common and disabling condition. This randomised pilot and feasibility trial aimed to determine the feasibility of conducting a parallel group randomised trial to evaluate the effectiveness of a nonsurgical intervention for reducing pain associated with hallux valgus.

Methods: Twenty-eight community-dwelling women with painful hallux valgus were randomised to receive either a multifaceted, nonsurgical intervention (footwear, foot orthoses, foot exercises, advice, and self-management) or usual care (advice and self-management alone). Outcome measures were obtained at baseline, 4, 8 and 12 weeks. The primary outcome was feasibility, evaluated according to demand (recruitment rate and conversion rate), acceptability, adherence, adverse events, and retention rate. Limited efficacy testing was conducted on secondary outcome measures including foot pain, foot muscle strength, general health-related quality of life, use of cointerventions, and participants' perception of overall treatment effect.

Results: Between July 8, 2021, and April 22, 2022, we recruited and tested 28 participants (aged 44 to 80 years, mean 60.7, standard deviation 10.7). This period encompassed two COVID-related stay-at-home orders (July 16 to July 27, and August 5 to October 21, 2021). The predetermined feasibility thresholds were met for retention rate, foot pain, mental health-related quality of life, and use of cointerventions, partly met for acceptability, adverse events, and muscle strength, and not met for demand (recruitment rate or conversion rate), adherence, physical health-related quality of life and perception of overall treatment effect.

Conclusion: In its current form, a randomised trial of footwear, foot orthoses, foot exercises, advice and self-management for relieving pain associated with hallux valgus is not feasible, particularly due to the low adherence with the intervention. However, it is difficult to determine whether the trial would be feasible under different circumstances, particularly due to COVID-19 stay-at-home orders. Future trials will need to consider improving the aesthetics of the footwear and making the exercise program less burdensome.

Trial registration: Australian and New Zealand Clinical Trial Registry (ACTRN12621000645853).

Publication types

Randomized Controlled Trial

MeSH terms

Australia
Feasibility Studies
Female
Hallux Valgus* / complications
Hallux Valgus* / therapy
Humans
Pain
Pilot Projects
Quality of Life

Abstract

Publication types

MeSH terms

Grants and funding