Gait biomechanics evaluation of the treatment effects for hallux valgus patients: A systematic review and meta-analysis.

BACKGROUND

Hallux valgus (HV) is a foot deformity characterized by lateral deviation of the big toe and medial deviation of the first metatarsal.

RESEARCH QUESTION: This study aimed to shed light on the treatment effects of different interventions and surgical procedures for HV deformity to determine the effectiveness of gait biomechanics correction.

METHODS

English-language searches of the electronic databases were conducted in the Cochrane Library, Web of Science, PubMed, Scopus, and Embase. Gait biomechanics evaluation before and after conservative or operative treatments was essential for inclusion in this review. Methodological quality was assessed by the Institute of Health Economics (IHE) quality appraisal tool. All pooled analysis was based on the random-effects model.

RESULTS

Twenty-five articles (1003 participants) were identified in this review. Three studies chose conservative therapies for HV deformity, incorporating foot orthotics and minimalist running intervention, and surgeries were performed in twenty-two studies. For the pressure parameter alteration under the hallux, the effect size (ES) in the conservative treatment subgroup was - 0.95 with 95%CI [- 1.69, - 0.21]. It demonstrated a moderate ES of - 0.44% and 95%CI [- 0.81, - 0.07] in the surgery subgroup. The five operations' peak pressure alteration under the hallux demonstrated a moderate ES of - 0.45% and 95%CI [- 0.54, - 0.36].

SIGNIFICANCE: Both non-operative and operative treatments could achieve the forefoot pressure redistribution, decreasing loading beneath the hallux and first metatarsal regions，However, the treatment effects of surgeries were not very robust. The percutaneous DSTR-Akin technique is recommended as an adequate operative treatment, with a large ES and moderate heterogeneity. The negative gait return effect should be noticed while using Scarf osteotomy, despite positive clinical and radiographic outcomes.