Short term results of dynamic splinting for hallux valgus — A prospective randomized study
Introduction
Hallux valgus (HV) is one of the most common diagnoses in orthopedic practice. The prevalence of radiologic HV is up to 23% in 18–65 year old women and >35% in women older than 65 [1]. Approximately half of these cases can become symptomatic. Women in their fourth to sixth decade are most often affected, and children show an incidence of 2% [1,2]. The etiology of HV is not completely understood and appears to be multifactorial. Family history, female gender, occupational foot stress, shoe style and configuration of the first metatarsale and the first metatarso-phalangeal joint (MTP 1), have been correlated with HV [[2], [3], [4]].
Different conservative treatment options have been proposed for first-line treatment, including different kinds of physiotherapy (PT), orthoses and splints [5,6].
Orthoses have been proposed to reduce the elevated plantar pressure under the medial ray in patients with HV and reduce pain [[7], [8], [9]]. When combined with a toe separator, orthosis may also help to correct alignment, at least when the orthoses are used consistently [10]. In a prospective series examining the effect of orthosis on juvenile and adult HV patients, no effect on HV position and progression was observed [11,12]. Two-thirds of the patients treated using an orthosis for HV still required surgery, which is comparable to patients who do not receive orthosis [13].
Splints are used in the treatment of HV, mostly postoperatively, to secure the soft-tissue balancing [14,15]. Du Plessis et al. [5] found a reduction in pain in patients wearing night splints, but less than in patients treated using manual therapy and they did not assess the influence of HV position. Milachowski and Krauss [16] showed a reduction of the hallux valgus angle (HVA) through a worn HV splint, but did not analyze the effect on pain or function.
A method to improve joint mobility used in many areas of orthopedic treatment is continuous traction on a joint. Previously, a dynamic Quengel splint for HV treatment has been shown to reduce the HVA, but no clinical data were collected [17].
To evaluate the clinical and radiological effect on HV of a dynamic splint, a prospective randomized study was performed.
Section snippets
Study design
Between May 2011 and October 2013, patients scheduled for a surgical HV correction were included in a prospective randomized single-center study. The study was approved by the relevant ethics committee (MHH Nr. 1009–2009) and registered at the German clinical trials register (DRKS00013920). All patients provided their written informed consent.
Inclusion criteria were symptomatic HV and the potential to wear the splint for at least 3 months. Exclusion criteria were hindfoot deformities,
Radiographic parameters
Neither the baseline-, the follow-up, nor the change in HVA (p = 0.378; p = 0.358; p = 0.784) and IMA (p = 0.368; p = 0.484; p = 0.948) differed significantly between the groups (Table 2). The ICC for IMA at baseline was 0.91 (CI: 0.86–0.94) and at follow-up it was 0.87 (CI: 0.79–0.92) and for HVA the equivalent values were 0.97 (CI: 0.95–0.98) and 0.97 (CI: 0.95–0.98), respectively, indicating a very good inter-reader agreement.
Clinical parameters
At baseline there was no significant difference between the groups
Discussion
This prospective randomized study shows a reduction in pain during activity in patients with symptomatic HV when wearing a dynamic HV splint with a Quengel mechanism for several hours per day. Radiologically, no difference in the HV position was found, but fewer patients in the intervention group experienced a subjective deterioration in the HV position.
In general, our results concur with the recent literature. Because of the pathomechanism of HV, the effectiveness of a conservative treatment
Conclusion
The current study shows that the treatment of patients with a symptomatic HV using a dynamic splint can reduce pain, delay subjective deterioration of the toe position and is well accepted by patients. It may be more effective in patients with a smaller, more flexible HV deformity than in the current study population. In the present study, the treatment did not influence the objective radiologic position of the hallux, and no patients rejected surgery because of the effect of the splint.
Conflict of interest
The study was financially supported by Albrecht GmbH, Stephanskirchen, Germany.
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