*Department of Podiatry, Ascension St. Vincent, Indianapolis, IN.
J Am Podiatr Med Assoc. 2024 Jul-Aug;114(4). doi: 10.7547/23-171.
Hallux abducto valgus (HAV), commonly referred to as a bunion, is a prevalent foot deformity with multifactorial etiology, including genetic predisposition, biomechanical abnormalities, and footwear choices. HAV is often managed conservatively with orthotic devices aimed at reducing deformity progression and alleviating associated pain. However, the effectiveness of orthotics in altering radiographic measurements of HAV remains debated. This systematic review aims to evaluate the impact of orthotic interventions on radiographic parameters.
A comprehensive search of five electronic databases-PubMed, Cochrane Library, CINAHL, Medline, and EMBASE-was conducted, covering the period from inception to March 2021. The search included terms related to HAV and orthotic interventions. Studies were included if they provided pre- and post-treatment radiographic measurements of halux abductus angle (HAA), hallux valgus angle (HVA), or intermetatarsal angle (IMA) and involved the use of orthotics. A total of 523 references were initially identified, with five studies meeting the inclusion criteria for review. Data extraction focused on study characteristics, orthotic type, radiographic measurements, and follow-up duration.
The systematic review found insufficient high-quality evidence to support the effectiveness of orthotics in slowing the progression of HAV deformity. Of the five studies included, results were mixed: two studies reported changes in radiographic measurements following orthotic use, though one of these involved toe spacers rather than traditional orthotics. The remaining studies found no significant impact of orthotics on HAA, HVA, or IMA. The heterogeneity in study design, population, and orthotic types limited the ability to draw robust conclusions.
Current evidence does not conclusively support the use of orthotics for altering the radiographic progression of HAV. The reviewed studies highlight significant variability in outcomes and suggest that while orthotics may provide symptomatic relief, their role in deformity correction remains unclear. Whether and to what extent orthotics affect common radiographic measures of HAV deformity should be proven with further studies and investigation.
拇外翻（HAV），通常被称为拇囊炎，是一种常见的足部畸形，其病因具有多因素性，包括遗传易感性、生物力学异常和鞋类选择。HAV 通常采用矫形器进行保守治疗，旨在减缓畸形进展并缓解相关疼痛。然而，矫形器在改变 HAV 的放射影像学测量结果方面的效果仍存在争议。本系统评价旨在评估矫形干预对放射影像学参数的影响。
全面检索了五个电子数据库 - PubMed、Cochrane 图书馆、CINAHL、Medline 和 EMBASE，检索时间从建库至 2021 年 3 月。检索词涉及 HAV 和矫形干预。如果研究提供了拇外展角（HAA）、拇外翻角（HVA）或跖骨间角（IMA）的治疗前后放射影像学测量值，且使用了矫形器，则纳入本研究。最初共识别出 523 篇参考文献，其中有 5 项研究符合纳入标准。数据提取侧重于研究特征、矫形器类型、放射影像学测量值和随访时间。
本系统评价发现，支持矫形器减缓 HAV 畸形进展效果的高质量证据不足。纳入的 5 项研究结果各异：有 2 项研究报告了使用矫形器后放射影像学测量值的变化，但其中 1 项研究涉及的是脚趾间隔器而不是传统矫形器。其余研究发现矫形器对 HAA、HVA 或 IMA 没有显著影响。研究设计、人群和矫形器类型的异质性限制了得出可靠结论的能力。
目前的证据不能明确支持使用矫形器来改变 HAV 的放射影像学进展。综述中的研究突出了结果的显著变异性，并表明尽管矫形器可能提供症状缓解，但它们在畸形矫正中的作用仍不清楚。矫形器是否以及在何种程度上影响 HAV 畸形的常见放射影像学测量值，应通过进一步的研究和调查来证实。
