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Therapeutics
Surgery was more effective than orthosis for hallux valgus

https://doi.org/10.1136/ebm.6.6.180

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    (2001) JAMA 285, 2474. Torkki M, Malmivaara A, Seitsalo S, et al.. Surgery vs orthosis vs watchful waiting for hallux valgus. A randomized control trial.. May 16;. :. –80.
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 QUESTION: In patients with hallux valgus, what are the effectiveness and cost of surgical, orthotic, and no treatment?

    Design

    Randomised (allocation concealed*), blinded (outcome assessors),* controlled trial with 1 year of follow up.

    Setting

    4 hospitals in a health district in Finland.

    Patients

    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.

    Intervention

    Patients were allocated to surgery (chevron procedure) (n=71), foot orthosis (negative cast technique) (n=69), or watchful …

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    Footnotes

    • 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.

    • ↵* See glossary.