Foot Mobilization and Exercise Program Combined with Toe Separator Improves Outcomes in Women with Moderate Hallux Valgus at 1-Year Follow-up A Randomized Clinical Trial

J Am Podiatr Med Assoc. 2018 Nov;108(6):478-486. doi: 10.7547/17-026. Epub 2018 Apr 23.


Background:: Few studies have documented the outcome of conservative treatment of hallux valgus deformities on pain and muscle strength. We sought to determine the effects of foot mobilization and exercise, combined with a toe separator, on symptomatic moderate hallux valgus in female patients.

Methods:: As part of the randomized clinical trial, 56 women with moderate hallux valgus were randomly assigned to receive 36 sessions for 3 months or no intervention (waiting list). All patients in the treatment group had been treated with foot joint mobilization, strengthening exercises for hallux plantarflexion and abduction, toe grip strength, stretching for ankle dorsiflexion, plus use of a toe separator. Outcome measures were pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. Objective measurements included ankle range of motion, plantarflexion and abduction strength, toe grip strength, and radiographic angular measurements. Outcome measures were assessed by comparing pretreatment, posttreatment, and 1-year follow-up after the intervention. Mixed-model analyses of variance were used for statistical assessment.

Results:: Patients who were treated with 3 months of foot mobilization and exercise combined with a toe separator experienced greater improvement in pain, AOFAS scores, ankle range of motion, hallux plantarflexion and abduction strength, toe grip strength, and radiographic angular measurements than those who did not receive an intervention 3 months and 1 year postintervention ( P < .001 for all comparisons).

Conclusions:: These results support the use of a multifaceted conservative intervention to treat moderate hallux valgus, although more research is needed to study which aspects of the intervention were most effective.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Conservative Treatment / methods*
  • Exercise Therapy / methods*
  • Female
  • Follow-Up Studies
  • Foot Orthoses
  • Hallux Valgus / diagnostic imaging
  • Hallux Valgus / therapy*
  • Humans
  • Middle Aged
  • Pain Measurement*
  • Range of Motion, Articular / physiology*
  • Severity of Illness Index
  • Treatment Outcome