Hallux valgus orthosis characteristics and effectiveness: a systematic review with meta-analysis.
Ontology highlight
ABSTRACT: Objective
The treatment effect of orthoses for hallux valgus (HV) is unclear with little interventional studies, the design involves multiple complex factors, and therefore a systematic analysis with meta-analysis is necessary. The objective of this systematic review and meta-analysis is to determine whether current foot orthoses are effective in treating HV.Design
Systematic review with meta-analysis.Data sources
Electronic databases (PubMed, Scopus, Cinahl and Medline) are searched up to February 2020.Eligibility criteria for selecting studies
Interventional studies with content focus on HV orthosis design and any of the outcomes related to effectiveness for treating HV are included. The standardised mean differences are calculated. The risk of bias in included studies is assessed using the Cochrane Collaboration's risk of bias tools.Results
In total, 2066 articles are identified. Among them, nine are selected and quality rated, and data are extracted and closely examined. A meta-analysis is conducted, where appropriate. The main causes of potential bias are missing outcome data and outcome measurement error. The results show that orthosis with a toe separator has the best effect of correcting the HV angle (standardised mean difference: 0.50, 95% CI: 0.189 to 0.803).Conclusion
The orthoses design with a toe separator or an element that allows for the foot anatomic alignment is critical for reducing the HV angle and relieving foot pain. The results contribute to a better selection of treatment for patients.Prospero registration number
CRD42021260403.
SUBMITTER: Kwan MY
PROVIDER: S-EPMC8375760 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Background and purpose - The quality of life (QoL) of patients with hallux valgus (HV) usually improves postoperatively. Evidence regarding the effect of HV surgery on different domains of patient QoL remains inconclusive. This systematic review and meta-analysis estimates the effect of HV surgery on patient QoL through distinguishing effects on physical domains (comprising physical function and body pain domains) using the EuroQol-5D, short form (SF) health survey-12, and SF-36 QoL scales and a visual analogue scale (VAS) score and mental and social domains using QoL scales.Patients and methods - MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2019 for studies on the effect of HV surgery on patient QoL. A standardized mean difference score was calculated for each specific QoL domain (mental, social, pain, physical, and VAS) using Cohen's d index. The pooled effect size (ES) was estimated using a random-effects model based on the DerSimonian and Laird method.Results - From 12 published studies selected, the estimated pooled ES for QoL was 1.01 (95% confidence interval [CI] 0.52-1.51; I2 = 87%) for body pain and 0.43 (CI 0.31-0.55, I2 = 35%) for physical function. Regarding the composite mental and social domains of QoL, the pooled ES estimates were 0.24 (CI 0.00-0.47, I2 = 80%) and 0.42 (CI 0.21-0.63, I2 = 6.4%), respectively. The pooled difference in means for the VAS score was -4.1 (CI -4.5 to -3.6, I2 = 90%).Interpretation - Our data showed that HV surgery decreased patients' perceptions regarding pain. Furthermore, the data confirmed that HV surgery increased patients' QoL, particularly concerning physical and social domains.
| S-EPMC8023907 | biostudies-literature
Project description:BackgroundThough hallux valgus is a common foot deformity, the integrated information on its global prevalence and incidence is relatively lacking. The aim of this research was to assess the global prevalence and incidence of hallux valgus, thus providing reliable data reference for clinical practice.MethodsA systematic review of global hallux valgus research publications concerning its prevalence and incidence was performed based on six electronic databases ((PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), China Online Journals and CQVIP)) from their inception to November 16, 2022. The search terms included "hallux valgus or bunion and prevalence or incidence or epidemiology." All languages were included. Data were extracted by country, continent, age group, gender and other information. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data by using random-effects models to synthesize available evidence.ResultsA total of 45 studies were included in the meta-analysis. The overall pooled estimated prevalence was 19% (95% CI, 13% to 25%) (n=186,262,669) for hallux valgus. In subgroup meta-analyses, the prevalence of hallux valgus was 21.96% (95% CI, 10.95% to 35.46%) in Asia, 3% (95% CI, 0% to 15%) in Africa, 18.35% (95% CI, 11.65% to 26.16%) in Europe, 29.26% (95% CI, 4.8% to 63.26%) in Oceania, and 16.1% (95% CI, 5.9% to 30.05%) in North America, respectively. The pooled prevalence of hallux valgus by gender was 23.74% (95% CI, 16.21% to 32.21%) for females and 11.43% (95% CI, 6.18% to 18%) for males. The prevalence was 11% (95% CI, 2% to 26%) in individuals younger than 20 years old, 12.22% in adults aged 20-60 years (95% CI, 5.86% to 20.46%) and 22.7% in elderly people aged over 60 years (95% CI, 13.1% to 33.98%).ConclusionThis research provided the global prevalence and incidence of hallux valgus in terms of its spatial, temporal, and population distribution. The global estimated pooled prevalence and incidence of hallux valgus was 19%. A higher prevalence of hallux valgus was found in females, Oceania countries, and among people aged over 60 years. Due to the high heterogeneity of the included studies, the findings should be interpreted with caution.
| S-EPMC10510234 | biostudies-literature
Project description:BackgroundHallux valgus (HV) is a foot deformity commonly seen in medical practice, often accompanied by significant functional disability and foot pain. Despite frequent mention in a diverse body of literature, a precise estimate of the prevalence of HV is difficult to ascertain. The purpose of this systematic review was to investigate prevalence of HV in the overall population and evaluate the influence of age and gender.MethodsElectronic databases (Medline, Embase, and CINAHL) and reference lists of included papers were searched to June 2009 for papers on HV prevalence without language restriction. MeSH terms and keywords were used relating to HV or bunions, prevalence and various synonyms. Included studies were surveys reporting original data for prevalence of HV or bunions in healthy populations of any age group. Surveys reporting prevalence data grouped with other foot deformities and in specific disease groups (e.g. rheumatoid arthritis, diabetes) were excluded. Two independent investigators quality rated all included papers on the Epidemiological Appraisal Instrument. Data on raw prevalence, population studied and methodology were extracted. Prevalence proportions and the standard error were calculated, and meta-analysis was performed using a random effects model.ResultsA total of 78 papers reporting results of 76 surveys (total 496,957 participants) were included and grouped by study population for meta-analysis. Pooled prevalence estimates for HV were 23% in adults aged 18-65 years (CI: 16.3 to 29.6) and 35.7% in elderly people aged over 65 years (CI: 29.5 to 42.0). Prevalence increased with age and was higher in females [30% (CI: 22 to 38)] compared to males [13% (CI: 9 to 17)]. Potential sources of bias were sampling method, study quality and method of HV diagnosis.ConclusionsNotwithstanding the wide variation in estimates, it is evident that HV is prevalent; more so in females and with increasing age. Methodological quality issues need to be addressed in interpreting reports in the literature and in future research.
| S-EPMC2955707 | biostudies-literature
Project description:Recurrence is a frequent and undesirable outcome after hallux valgus (HV) surgery. However, the prevalence of HV recurrence and the pre- and postoperatory factors associated with it have not been adequately studied. This study aimed to quantify the prevalence rate of HV recurrence and to analyze its predisposing factors. MEDLINE and EMBASE databases were systematically searched for observational studies including individuals undergoing HV surgical correction. The random-effects restricted maximum likelihood model was used to estimate the pooled effect size (correlation coefficient (r)). Twenty-three studies were included, yielding a total of 2914 individuals. Pooled prevalence of HV recurrence was 24.86% (95% confidence interval (CI), 19.15 to 30.57, I2 = 91.92%, p = 0.00). Preoperative HV angle (HVA) (r = 0.29; 95% CI, 0.14 to 0.43) and preoperative intermetatarsal angle (IMA) (r = 0.13; 95% CI, 0.00 to 0.27) showed a moderate positive relationship with recurrence. Postoperative HVA (r = 0.57; 95% CI, 0.21 to 0.94) and sesamoid position (r = 0.46; 95% CI, 0.31 to 0.60) showed strong relationships with recurrence. In conclusion, preoperative HVA, IMA, and postoperative HVA and sesamoid position are significant risk factors for HV recurrence, and the association of these factors with recurrence is affected by age.
| S-EPMC8708542 | biostudies-literature
Project description:While hallux valgus (HV) surgeries are useful for correcting skeletal alignment problems, their effects on plantar load, which reflects forefoot functions, are less understood. The objective of this study is to conduct a systematic review and meta-analysis on the plantar load change after HV surgeries. A systematic search of Web of Science, Scopus, PubMed, CENTRAL, EMBASE, and CINAHL was performed. Studies that assessed the pre- and post-operative plantar pressure of HV patients undergoing surgeries and reported load-related parameters over the hallux, medial metatarsal, and/or central metatarsal regions were included. Studies were appraised by using the modified NIH quality assessment tool for before-after study. Studies suitable for meta-analysis were pooled with the random-effects model, using the standardized mean difference of the before-after parameters as an effect measure. Twenty-six studies containing 857 HV patients and 973 feet were included for the systematic review. Meta-analysis was conducted on 20 of them, and most studies did not favor HV surgeries. Overall, HV surgeries reduced the plantar load over the hallux region (SMD -0.71, 95% CI, -1.15 to -0.26), indicating that forefoot function worsened after surgeries. For the other five outcomes, the overall estimates were not statistically significant, indicating that surgeries did not improve them either. There was substantial heterogeneity among the studies, which in most cases could not be resolved by pre-planned subgroup analyses by surgical classification, year of publication, median age of patients, and length of follow-up. Sensitivity analysis removing lower-quality studies showed that the load integrals (impulse) over the central metatarsal region significantly increased (SMD 0.27, 95% CI, 0 to 0.53), indicating that surgeries increased the risk of transfer metatarsalgia. There is no solid evidence that HV surgeries could improve forefoot functions from a biomechanical point perspective. Currently available evidence even suggests that surgeries might reduce the plantar load over the hallux and adversely affect push-off function. The reasons behind and the effectiveness of alternative surgical methods warrant further investigation.
| S-EPMC9965975 | biostudies-literature
Project description:BackgroundHallux valgus (HV) has been linked to functional disability and increased falls risk in older adults. However, specific gait alterations in individuals with HV are unclear. This systematic review investigated gait parameters associated with HV in otherwise healthy adults.MethodsElectronic databases (Medline, Embase, CINAHL) were searched to October 2011, including cross-sectional studies with clearly defined HV and non-HV comparison groups. Two investigators independently rated studies for methodological quality. Effect sizes (95% confidence intervals (CI)) were calculated as standardized mean differences (SMD) for continuous data and risk ratios (RR) for dichotomous data.ResultsNine studies included a total of 589 participants. Three plantar pressure studies reported increased hallux loading (SMD 0.56 to 1.78) and medial forefoot loading (SMD 0.62 to 1.21), while one study found reduced first metatarsal loading (SMD -0.61, CI -1.19 to -0.03) in HV participants. HV participants demonstrated less ankle and rearfoot motion during terminal stance (SMD -0.81 to -0.63) and increased intrinsic muscle activity (RR 1.6, 1.1 to 2.2). Most studies reported no differences in spatio-temporal parameters; however, one study found reduced speed (SMD -0.73, -1.25 to -0.20), step length (SMD -0.66 to -0.59) and less stable gait patterns (SMD -0.86 to -0.78) in older adults with HV.ConclusionsHV impacts on particular gait parameters, and further understanding of potentially modifiable factors is important for prevention and management of HV. Cause and effect relationships cannot be inferred from cross-sectional studies, thus prospective studies are warranted to elucidate the relationship between HV and functional disability.
| S-EPMC3602054 | biostudies-literature
Project description:This systematic review and meta-analysis addresses the effects of minimally invasive surgical techniques, specifically the Reverdin Isham osteotomy, on functional and radiological outcomes in patients with moderate Hallux Valgus, a common foot deformity. The review included randomized and non-randomized controlled trials, as well as case reports, assessing the osteotomy in adults with moderate to severe Hallux Valgus. Searches were conducted in electronic databases such as MEDLINE and Web of Science up until July 2023, and the Joanna Briggs Institute's critical appraisal tool was used to assess the risk of bias. Meta-analytical analyses employed a random-effects model with small-sample correction, presenting results as standardized mean differences and mean differences with 95% confidence intervals. Seven studies involving 554 patients and 643 operated feet were included, showing significant improvements in AOFAS scores (an average improvement of 36 points from 28.61 to 45.16) and reductions in radiological angles such as the distal metatarsal angle and hallux valgus angle post-surgery (IMA improved by - 3.07° from - 4.68 to - 1.46, DMAA by - 6.12° from - 9.52 to - 2.71, and HVangle by - 15.27° from - 17.98 to - 12.57). Despite these positive outcomes, most studies exhibited risks of bias and other methodological limitations, impacting the generalizability of the results. Overall, the findings highlight the efficacy of the Reverdin Isham osteotomy in improving both functional and radiological parameters in patients with moderate Hallux Valgus, although further research is warranted to solidify these results. No specific funding was received for this study, and the protocol was registered on PROSPERO with the number CRD-42023445886.
| S-EPMC11208448 | biostudies-literature
Project description:Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics. The precise biomechanical etiology remains under debate. Predisposing factors include female sex, age, constricting footwear, and family history. Metatarsus adductus, equinus contracture, hammertoe deformity, and pes planus often coexist with hallux valgus. Nonoperative treatment involves patient education, shoe modifications, toe pads and positioning devices, and activity modifications. Surgery is considered in patients who fail nonoperative treatment with the goal of pain relief, correction of the deformity, improved first ray stability, and improved quality of life. More than 100 different procedures have been described to treat hallux valgus; they include combinations of soft tissue balancing, metatarsal osteotomies, and fusion of either the metatarsophalangeal (MTP) or tarsometatarsal (TMT) joint. The choice of procedures depends on the severity and location of the deformity as well as surgeon preference. Recent advances in operative techniques include minimally invasive surgery and correction of rotational deformity.
| S-EPMC8696753 | biostudies-literature
Project description:PurposeThe objective of the study is to compare the radiographic and clinical results of two techniques for the treatment of hallux valgus that have the same indication, the open scarf/Akin (SA) technique and the percutaneous Chevron/Akin (PECA).MethodsA meta-analysis was performed with the studies found during a systematic review of articles included in electronic databases until 30 May 2020. The pooled analysis was summarized according to clinical outcomes, such as visual analog pain scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) score, radiographic outcomes and complications, with a 95% confidence interval.ResultsThree studies comparing the open scarf/Akin (SA) versus the PECA techniques were added to the analysis, corresponding to 235 feet, 102 in the PECA group and 133 in the SA. The final mean difference in the hallux valgus angle was 0.80 degrees and in the intermetatarsal angle 0.53, in the last radiographic evaluation. In the AOFAS score, the final mean difference was 4.97 points and in the VAS 0.14 in relation to the last clinical evaluation. Exposure to radiation during the surgical procedure was higher in the PECA group with a mean of 35.53 seconds.ConclusionsThe PECA surgical technique for the treatment of hallux valgus when compared with SA demonstrated similar radiographic correction, pain and function after six months of follow-up but with a longer radiation exposure time.Register of systematic review (prospero)CRD42018096613.
| S-EPMC7888602 | biostudies-literature
Project description:BACKGROUND:Hallux valgus, one of the most common structural foot deformities, is highly heritable. However, previous efforts to elucidate the genetic underpinnings of hallux valgus through a genome-wide association study (GWAS) conducted in 4409 Caucasians did not identify genome-wide significant associations with hallux valgus in both gender-specific and sex-combined GWAS meta-analyses. In this analysis, we add newly available data and more densely imputed genotypes to identify novel genetic variants associated with hallux valgus. METHODS:A total of 5925 individuals of European Ancestry were categorized into two groups: 'hallux valgus present' (n?=?2314) or 'no deformity' (n?=?3611) as determined by trained examiners or using the Manchester grading scale. Genotyping was performed using commercially available arrays followed by imputation to the Haplotype Reference Consortium (HRC) reference panel version 1.1. We conducted both sex-specific and sex-combined association analyses using logistic regression and generalized estimating equations as appropriate in each cohort. Results were then combined in a fixed-effects inverse-variance meta-analyses. Functional Mapping and Annotation web-based platform (FUMA) was used for positional mapping, gene and gene-set analyses. RESULTS:We identified a novel locus in the intronic region of CLCA2 on chromosome 1, rs55807512 (OR?=?0.48, p?=?2.96E-09), an expression quantitative trait locus for COL24A1, a member of the collagen gene family. CONCLUSION:In this report of the largest GWAS of hallux valgus to date, we identified a novel genome-wide significant locus for hallux valgus. Additional replication and functional follow-up will be needed to determine the functional role of this locus in hallux valgus biology.
| S-EPMC7057609 | biostudies-literature