Hallux valgus (bunions)


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Substantive changes at this update

Distal metatarsal osteotomy (excluding minimally invasive surgery): Four RCTs added.[11][12][13][14] Categorisation unchanged (likely to be beneficial).

Minimally invasive surgery (osteotomy): New option. Two RCTs found.[12][13] Categorised as unknown effectiveness.

Phalangeal (Akin) osteotomy: One RCT added.[14] Categorisation unchanged (unknown effectiveness).

Proximal osteotomy versus distal chevron osteotomy: One RCT added.[25] Categorisation unchanged (unknown effectiveness).


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).

Cite as

Ferrari J. Hallux valgus (bunions). Systematic review 1112. BMJ Clinical Evidence. . 2014 April. Accessed [date].

Latest citations

Sodium hyaluronate in the treatment of hallux rigidus. A single-blind, randomized study. ( 02 March 2016 )

Prospective Randomized Study of Chevron Osteotomy Versus Mitchell`s Osteotomy in Hallux Valgus. ( 02 March 2016 )