Hallux valgus: Prevalence and treatment options

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.