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

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

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).

Citation

Menz, H. B., Lim, P. Q. X., Hurn, S. E., Mickle, K. J., Buldt, A. K., Cotchett, M. P., …Munteanu, S. E. (in press). Nonsurgical management of hallux valgus: findings of a randomised pilot and feasibility trial. Journal of Foot and Ankle Research, 16(1), Article 78. https://doi.org/10.1186/s13047-023-00677-1

• Journal Article Type: Article
• Acceptance Date: Oct 27, 2023
• Online Publication Date: Nov 13, 2023
• Deposit Date: Nov 20, 2023
• Journal: Journal of Foot and Ankle Research
• Print ISSN: 1757-1146
• Electronic ISSN: 1757-1146
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 16
• Issue: 1
• Article Number: 78
• DOI: https://doi.org/10.1186/s13047-023-00677-1