Clinical Consensus Statement on Hallux Valgus by American College of Foot and Ankle Surgeons

The following represents a clinical consensus statements (CCS) sponsored by the American College of Foot and Ankle Surgeons (ACFAS) on the topic of the adult hallux valgus deformity. An 8-member panel undertook a modified Delphi method in an attempt to develop consensus on a series of 13 statements utilizing not only the best available evidence but also a degree of clinical experience and common sense. The CCS was published in The Journal of Foot & Ankle Surgery.

The panel reached a consensus that the following statements were "appropriate":

− The hallux valgus deformity should be considered a chronic, progressive, and degenerative condition.

− The juvenile hallux valgus deformity should be evaluated and managed differently than the adult hallux valgus deformity.

− Effective assessment of the hallux valgus deformity requires radiographic evaluation.

− The outcome of hallux valgus surgical correction is independent of procedure selection.

− Physical medicine and rehabilitation interventions should be implemented for patients undergoing hallux valgus surgical correction.

• The panel reached a consensus that the following statement was "inappropriate":

− Hallux valgus should only be addressed surgically with joint preserving procedures.

− The panel reached a consensus that the following statements were "neither appropriate nor inappropriate":

− Procedural decision-making for hallux valgus should address the specific pathoanatomy of the deformity.

− There is no role for biologic augmentation in the surgical correc tion of hallux valgus.

− Postoperative evaluation of hallux valgus should include an assessment of functional outcome measures.

• The panel was unable to reach a consensus on the following statements:

− The natural course of the hallux valgus deformity might be interrupted with nonsurgical interventions.

− The presence of first ray hypermobility directly affects the prognosis of the hallux valgus deformity and intervention outcome.

− Procedural selection for hallux valgus should be based on the severity of the deformity.

− The postoperative course for hallux valgus correction should involve a period of non-weightbearing immobilization.

It is important to appreciate that consensus statements do not represent clinical practice guidelines, formal evidence reviews, recommendations, or evidence based guidelines. Instead, a CCS reflects information synthesized from an organized group of experts based on the best available evidence. Still, it also may contain, and to some degree embraces, opinions, uncertainties, and minority viewpoints. A CCS should open the door to discussion on a topic, as opposed to providing definitive answers.

Key Words: hallux abductovalgus, HV, HAV, met primus varus, bunion, The Journal of Foot & Ankle Surgery, CCS

Further reading:

The American College of Foot and Ankle Surgeons Clinical Consensus Statement: Hallux Valgus

A.J. Meyr et al. / The Journal of Foot & Ankle Surgery 61 (2022) 369−383

https://doi.org/10.1053/j.jfas.2021.08.011