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. 2021 Apr 6;18(7):3841.
doi: 10.3390/ijerph18073841.

Adjusted Indirect and Mixed Comparisons of Conservative Treatments for Hallux Valgus: A Systematic Review and Network Meta-Analysis

Jianhua Ying  1 , Yining Xu  1   2 , Bíró István  3 , Feng Ren  2
Affiliations

Adjusted Indirect and Mixed Comparisons of Conservative Treatments for Hallux Valgus: A Systematic Review and Network Meta-Analysis

Jianhua Ying et al. Int J Environ Res Public Health. .

Abstract

Background: Hallux valgus (HV) deformity is a common, potentially debilitating deformity. And evidence with high-quality for the conservative treatments of HV deformity is still required.; AIMS: To compare the effects of different conservative treatments for hallux valgus deformity by using the method of network meta-analysis.; Study Design: A systematic review and network meta-analysis of randomized controlled trials identified by searching PubMed, EMBASE, MEDLINE, OVID, and CINAHL. The included studies should have the characteristics that: (1) participants with hallux valgus deformity of any age (2) conservative treatments (3) Reported the hallux valgus (HVA), the intermetatarsal angle (IMA), the score of the Visual Analog Scale, and the score of Foot Function Index.; Results: 11 studies were included in this review. The agreement between reviewers reached a kappa value of 0.75. The results of the network meta-analysis showed that a combination of exercise and toe separator, night splints, and dry needling are most likely to be the best choice for reducing the hallux valgus angle (HVA) and intermetatarsal angle, and toe separators (with or without exercise), dry needling, and manipulation (with or without ice treatment) have advantages in improving the subjective feeling of patients.; Conclusions: Multi-disciplinary conservative treatments have a great potential for hallux valgus deformity. More research with high-quality is needed to give a comprehensive and reasonable scheme of a holistic and long-term treatment protocol.

Keywords: bunion; conservative; hallux valgus deformity; network meta-analysis; non-surgical.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The PRISMA 2009 flow diagram of search and study selection.
Figure 2
Figure 2
The result of the risk of bias assessment. (a) Risk of bis summary; (b) Risk of bias graph.
Figure 3
Figure 3
The network geometry of the interventions for hallux valgus angle (HVA) of the patients with hallux valgus. (a) Mixed comparison of DO, FO, TS, NS, DS, ET, and Blank, (b) Adjusted indirect comparison of DN, injection, and placebo treatment. (DO: Dynamic Orthosis; FO: Foot Orthosis; TS: Toe Separator; NS: Night Splints; DS: Designed Slippers; ET: A combination of exercise and toe separator; DN: Dry Needling).
Figure 4
Figure 4
The ranking of measures and probabilities of the interventions for hallux valgus angle (HVA) of the patients with hallux valgus. (a) Mixed comparison of DO, FO, TS, NS, DS, ET, and Blank, (b) Adjusted indirect comparison of DN, injection, and placebo treatment. (DO: Dynamic Orthosis; FO: Foot Orthosis; TS: Toe Separator; NS: Night Splints; DS: Designed Slippers; ET: A combination of exercise and toe separator).
Figure 5
Figure 5
The network geometry of the interventions for the intermetatarsal angle (IMA) of patients with hallux valgus. (a) Adjusted indirect comparison of DO, ET, FO, and Blank, (b) Adjusted indirect comparison of DS, TS, and NS. (DO: Dynamic Orthosis; FO: Foot Orthosis; TS: Toe Separator; NS: Night Splints; DS: Designed Slippers; ET: A combination of exercise and toe separator).
Figure 6
Figure 6
The ranking of measures and probabilities of the interventions for the intermetatarsal angle (IMA) of patients with hallux valgus. (a) Adjusted indirect comparison of DO, ET, FO, and Blank, (b) Adjusted indirect comparison of DS, TS, and NS. (DO: Dynamic Orthosis; FO: Foot Orthosis; ET: A combination of exercise and toe separator).
Figure 7
Figure 7
The network geometry of the interventions for the score of Visual Analog Scale (VAS) of patients with hallux valgus. (a) Adjusted indirect comparison of manipulation, night splints, and toe separators, (b) Head-to-head comparison of Blank and ET, (c) Head-to-head comparison of DN and Placebo. (TS: Toe Separator; NS: Night Splints; ET: A combination of exercise and toe separator; DN: Dry Needling).
Figure 8
Figure 8
The ranking of measures and probabilities of the interventions for the score of Visual Analog Scale (VAS) of patients with hallux valgus.
Figure 9
Figure 9
The forest plots of the direct comparisons of interventions. (a) Exercise + Toe Sep vs. Blank; (b) Placebo vs. Dry Needling.
Figure 10
Figure 10
The network geometry of the interventions for the score of Foot Function Index (FFI) of patients with hallux valgus. (a) Adjusted indirect comparison of manipulation, night splints, and toe separators, (b) Head-to-head comparison of Manipulation and Night Splints. (DN: Dry Needling; IM: Ice + Manipulation).
Figure 11
Figure 11
The ranking of measures and probabilities of the interventions for the score of Foot Function Index (FFI) of patients with hallux valgus.
Figure 12
Figure 12
The forest plots of the direct comparisons of interventions.
See this image and copyright information in PMC

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