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Bunions - Evidence
Evidence on orthosis and night splints
One small trial found that, compared with no treatment, people using orthoses were more likely to say they were better off than they were 1 year ago. There is no good-quality evidence that night splints or orthoses (devices, usually plastic, worn in shoes to provide control of the foot position) correct the hallux valgus angle or reduce pain associated with bunions.
- A Cochrane systematic review (search date: March 2003) assessed 21 randomized controlled trials of interventions (e.g. surgery, night splints, orthoses) used to correct hallux valgus [Ferrari et al, 2004]. The methodological quality of the trials was generally poor, and sample sizes were small.
- Only three trials (n = 332) were found that evaluated conservative treatments (orthoses and night splints) versus no treatment. There was no evidence of a difference in outcomes (pain and correction of the hallux valgus angle) between treatment and no treatment:
- Global assessment:
- One trial (n = 28) found that, compared with people using an orthosis, people not given an orthosis were more likely to say that they were no better off than they were 1 year previously (OR 0.38, 95% CI 0.18 to 0.78) [Torkki et al, 2001].
- Pain:
- In one small trial (n = 28), no significant difference was detected between the number of people remaining in pain when prescribed night splints and those who received no treatment (OR 2.20, 95% CI 0.47 to 10.35) [Juriansz, 1996].
- A second, larger, trial (n = 209) found no evidence of a difference in pain scores reported on a visual analogue scale in people receiving orthoses and those receiving no treatment (mean difference 0, 95% CI –8.19 to +8.19) [Torkki et al, 2001].
- Correction of hallux valgus angle:
- One small RCT (n = 28) found no evidence that night splints corrected the hallux valgus angle compared with no treatment (mean difference 0.30 degrees, 95% CI –3.40 to +4.00) [Juriansz, 1996].
- A second, larger, RCT (n = 122) that assessed orthoses compared with no treatment in children showed evidence of a difference in hallux valgus angle in favour of the no treatment group (mean difference 2.56 degrees, 95% CI 0.40 to 4.72). The hallux valgus angle in both the treatment and control groups deteriorated, and the deterioration was greater in the group treated with orthoses [Kilmartin et al, 1994].
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