Hallux valgus orthosis characteristics and effectiveness: a systematic review with meta-analysis

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.

Keywords: adult orthopaedics; anatomy; bone diseases; foot & ankle; health economics; quality in healthcare.

Figure 1

PICO question and a list of search strategy.

Figure 2

(A) Visualisation of main keywords from 148 papers and (B) flowchart of study selection procedure. HAV, hallux valgus angle.

Figure 3

Risk of bias in included studies. (A) Risk of bias for randomised studies. (B) Risk of bias for non-randomised studies.

Figure 4

Comparison of observations.^aSMD ≥0.2 or ≤−0.2 highlighted in yellow; SMDs ≥0.5 or ≤−0.5 in orange and SMDs ≥0.8 or ≤−0.8 in green. FAOS, Foot and Ankle Outcome Score; HVA, hallux valgus angle; IMA, intermetatarsal angle; ROM, range of motion; RTV, room temperature vulcanising; SMD, standardised mean difference; VAS, Visual Analogue Scale.