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QUESTION: In patients with hallux valgus, what are the effectiveness and cost of surgical, orthotic, and no treatment?
Randomised (allocation concealed*), blinded (outcome assessors),* controlled trial with 1 year of follow up.
4 hospitals in a health district in Finland.
211 patients who had a painful bunion with the hallux valgus angle ≤ 35° and the intermetatarsal angle ≤ 15°. Exclusion criteria were previous bunion surgery, hallux rigidus, hallux limitus, rheumatoid arthritis, use of foot orthoses, pregnancy, or age > 60 years. Baseline data were obtained for 209 patients (mean age 48 y, 92% women). Follow up was 98% and 97% at 6 and 12 months, respectively.
Patients were allocated to surgery (chevron procedure) (n=71), foot orthosis (negative cast technique) (n=69), or watchful …
Sources of funding: Finnish Office for Health Technology Assessment; Finnish Medical Foundation; Scientific Foundation of Jorvi Hospital; Scientific Foundation of Mehiläinen Hospital.
For correspondence: Dr M. Torkki, Department of Orthopaedic Surgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland. Fax +1 358 947 187551.