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A Cochrane review 1 [withdrawn from publication] included 21 studies on interventions used to correct hallux valgus, with a total of 1304 subjects. The methodological quality was generally poor and trial sizes were small.
There was no evidence of difference in outcomes between conservative treatments and no treatment (3 trials, 332 participants). In a comparison of surgery to conservative treatment, there was an improvement in all outcomes in patients receiving chevron osteotomy compared with those receiving orthoses (140 participants) or those receiving no treatment (140 participants). In six trials (309 participants), the Chevron (and Chevron-type) osteotomy offered no advantages as compared to other surgical techniques. For
some outcomes, other techniques gave better results.
There was no advantage or disadvantage using Keller's arthroplasty over other surgical techniques (2 trials, 133 participants). Distal osteotomy showed evidence of improving the intermetatarsal angle and preserving joint range of motion as compared to Keller's arthroplasty. The arthroplasty had less impact on walking ability than an arthrodesis.
There was no evidence of better outcomes with surgeon's adaptations as compared to original operations (3 trials, 157 participants) nor of detrimental outcomes with the new methods of fixation as compared to traditional methods (3 trials, 71 participants).
The use of continuous passive motion in post-operative rehabilitation appeared to give an improved range of motion and earlier recovery following surgery (4 trials, 162 participants). Early weightbearing or the use of a crepe bandage were not found to be detrimental to final outcome.
In several trials, 25 to 33% of patients remained dissatisfied at follow-up even when the hallux valgus angle and pain had improved. Few trials maintained follow-up for 3 years which is still a minimal time-scale given that the patients will be on their feet for at least another 20–30 years after treatment.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).