Hallux valgus (bunions).

INTRODUCTION: Hallux valgus (bunions) are prominent and often inflamed metatarsal heads and overlying bursae. They are associated with valgus deviation of the great toe which moves towards the second toe. Hallux valgus is found in at least 2% of children aged 9 to 10 years, and almost half of adults, with greater prevalence in women. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of conservative treatments for hallux valgus (bunions)? What are the effects of osteotomy for hallux valgus (bunions)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 15 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: chevron osteotomy plus adductor tenotomy; distal metatarsal osteotomy; minimally invasive surgery (percutaneous distal metatarsal osteotomy, SERI [Simple, Effective, Rapid, Inexpensive] distal metatarsal osteotomy); phalangeal (Akin) osteotomy plus distal chevron osteotomy; proximal osteotomy; night splints; and orthoses (including antipronatory orthoses in children). QUESTIONS What are the effects of conservative treatments for hallux valgus (bunions)?. . . . . . . . . . . . . . . . . . . . . . . . . . . 3 What are the effects of osteotomy for hallux valgus (bunions)?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 INTERVENTIONS CONSERVATIVE TREATMENTS Unknown effectiveness Night splints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Orthoses to treat hallux valgus in adults . . . . . . . . . 3 Antipronatory orthoses in children . . . . . . . . . . . . . . 6 OSTEOTOMY TREATMENTS Likely to be beneficial Distal chevron osteotomy (more effective than no treatment or orthoses, but insufficient evidence to compare with scarf osteotomy and other types of distal or proximal osteotomies) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Unknown effectiveness Minimally invasive surgery (percutaneous distal metatarsal osteotomy, SERI [Simple, Effective, Rapid, Inexpensive] distal metatarsal osteotomy) New . . 19 Chevron osteotomy plus adductor tenotomy versus chevron osteotomy alone . . . . . . . . . . . . . . . . . . . . 25 Phalangeal (Akin) osteotomy plus distal chevron osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Proximal chevron osteotomy versus other types of proximal osteotomy . . . . . . . . . . . . . . . . . . . . . . . . 34 Proximal osteotomy versus distal chevron osteotomy . . 3 7