Torkki hallux valgus RCT

Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial

Torkki M, Malmivaara A, Seitsalo S, et al. JAMA 2001 · PMID 11368700 · doi:10.1001/jama.285.19.2474

Question

For painful hallux valgus, does surgery give better outcomes than orthoses or watchful waiting?

Design

Three-arm RCT in four community hospitals in Finland with 12-month follow-up.

Patients

Adults (mostly women) with a painful bunion and a hallux valgus angle of 35 degrees or less.

Intervention

Distal chevron osteotomy

Comparison

Orthosis, or a 1-year waiting list (watchful waiting)

Primary outcome

Pain intensity on walking (visual analogue scale) at 6 and 12 months

Key result

Surgery gave significantly less pain and better function and satisfaction at 12 months than orthoses or waiting. Orthoses gave only short-term symptom relief.

Limitations

Restricted to mild to moderate deformity and a single osteotomy type; one-year follow-up.

Impact on practice

Supports surgical correction for symptomatic hallux valgus that fails simple measures, while orthoses can be offered for short-term relief.