Hallux Valgus: Prevalence and Treatment Options

Abstract

Background: Hallux valgus is a common deformity. Surgical treatment strategies have evolved markedly in recent years. We report on the administrative prevalence of this condition and the available treatments for it.

Methods: The administrative prevalence of hallux valgus and the treatments provided for it in Germany were determined from data supplied by BARMER, a statutory health insurance carrier. The classification and treatment of hallux valgus are outlined in a narrative overview, with particular attention to a meta-analysis.

Results: The administrative prevalence of hallux valgus in Germany is nearly 2%; 83% of the affected persons are women. Over a 6-year period, the number of operations declined, and there was a trend toward outpatient treatment. Hallux valgus should be classified as either mild/moderate or severe. The common surgical procedures achieved comparable correction of the bony deformity. The AOFAS score improved by an average of 33.8 points (95% CI: [30.5; 37.0]) across all surgical techniques, reaching average postoperative values that ranged from 81.4±7.7 and 90.1±4.8 points depending on the particular technique used. The choice of technique and the duration of follow-up had no significant effect on the subjective treatment outcome. The overall complication rate after surgical correction was 18.5%. The common complications were metatarsalgia, recurrent deformity, stiffness of the first metatarsal joint, wound-healing disorders, and hallux varus.

Conclusion: The primary treatment of hallux valgus should be conservative. The various surgical techniques correct the bony deformity with comparable efficacy and good postoperative AOFAS scores. Patients with more severe deformities and greater impairment seem to have a higher potential for improvement in the AOFAS score.

Figure 1

Prevalence of hallux valgus in Germany, based on the dataset of BARMER, stratified by sex to the German population (reference population from 2019).

Figure 2

Schematic representation of current treatment recommendations based on the new bilateral classification. The dashed lines are “may” recommendations, the solid lines are “should” recommendations. MTP, metatarsophalangeal joint; HVA, hallux-valgus angle; IMA, intermetatarsal angle; TMT, tarsometatarsal joint

Figure 3

Presentation of the pre- and postoperative (final follow-up) values of the AOFAS score, by the various surgical techniques. N, cumulative number of patients; n, number of studies; Mis, minimally invasive surgery; M Delta, difference between pre- and postoperative data, including95% confidence interval; M FU, mean values at the last follow-up, including 95% confidence interval; data taken from (5). A valid statement on complications is only possible with limitations due to the heterogeneous terminology used. The mean complication rate is 18.5%; it is comparable among the surgical techniques discussed. The most common complications include metatarsalgia, recurrent deformity and stiffness of the first metatarsal joint (MTP I). Severe complications, such as necrosis, non-union and pain syndrome are rare and occur in up to 5% of cases.

eFigure

Prevalence of hallux valgus in Germany, based on the dataset of BARMER, stratified by age and sex to the German population (reference population from 2019) a) Surgical treatment of hallux valgus in Germany based on the dataset of BARMER, stratified by age and sex to the German population (reference population from 2019); shown for b) sex and c) main surgical techniques d) ratio of inpatient and outpatient procedures by types of treatment (2014–2023) MTP, metatarsophalangeal joint; TMT, tarsometatarsal