Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists

Background Patients with hallux valgus (HV) frequently present to podiatrists for non-surgical management, with a wide range of concerns including pain, footwear difficulty and quality of life impacts. There is little research evidence guiding podiatrists’ clinical decisions surrounding non-surgical management of HV. Thus practitioners rely largely upon clinical experience and expert opinion. This survey was conducted to determine whether a consensus exists among Australian podiatrists regarding non-surgical treatment of HV, and secondly to explore common presenting concerns and physical examination findings associated with HV. Methods An online survey was distributed to Australian podiatrists in mid-2013 via the professional association in each state (approximately 1900 members). Podiatrists indicated common treatments recommended, presenting problems and physical examination findings associated with HV in juveniles, adults and older adults. Proportions were calculated to determine the most common responses, and Chi-squared tests were used to examine differences in treatment recommendations according to HV patient age group and podiatrist demographics. Results Of 210 survey respondents, 65 % (136) were female and 80 % (168) were private practitioners. Complete survey responses were received from 159 podiatrists for juvenile HV, 146 for adults and 141 for older adults. Seven different non-surgical treatment options were commonly recommended (by >50 % podiatrists), although recommendations differed between adult, older adult and juvenile HV. Common treatments included footwear advice or modification, custom and prefabricated orthotic devices, addition of padding, and muscle strengthening/retraining exercises. Padding was more likely to be utilised in older adults, while exercises were more likely to be prescribed for juveniles. A diverse range of presenting problems and physical examination findings were reported to be associated with HV. Conclusions Despite the lack of empirical evidence in this area, there appears to be a consensus among Australian podiatrists regarding non-surgical management of HV, and these recommendations are largely aligned with available clinical consensus documents. Presenting concerns and physical examination findings associated with HV are diverse and have implications for treatment decisions. Management strategies differ across patient age groups, thus any updated clinical guidelines should differentiate between adult and juvenile HV. This study provides useful data to inform clinical practice, education, policy and future research. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0146-5) contains supplementary material, which is available to authorized users.

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1. Please indicate below that you have read the above information.
2. Please indicate your consent to particpate in this research project.
3. What is your gender? 4. Please indicate your age category. 5. In which state do you primarily conduct your podiatry practice? 6. How many years have you practiced podiatry?
7. In what setting do you practice podiatry in your primary role/employment? The following series of questions asks about common presenting complaints, physical examination findings and conservative treatment options offered to hallux valgus patients. You will be asked to answer these questions based on four different scenarios: 1) a typical HV patient, 2) a juvenile HV patient, 3) an adult with HV and 4) an older adult with HV.
The same questions are repeated for each of the four patient scenarios, and your responses to ALL questions will greatly assist this research.
The questions below ask you about the presentation of a typical patient suffering from HV, your findings on examination and the most common treatments offered.

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. Please indicate the five (5) most common complaints of a typical patient presenting with HV (as the primary diagnosis or concern) Please rate in order from 1 5 with 1 being most common and 5 being least common.
Typical case study of HV presentation and treatment. Please rate in order from 1 5 with 1 being most common and 5 being least common. 13. Please indicate the five (5) most common treatments that you would recommend to a typical patient suffering from HV.
Please rate in order from 1 5 with 1 being most common and 5 being least common.
14. Is there any other information that you would consider important for a typical HV The questions below ask you about the presentation of a juvenile patient suffering from HV, your findings on examination and the most common treatments offered.
16. Please indicate the five (5) most common complaints of a juvenile patient presenting with HV (as the primary diagnosis or concern) Please rate in order from 1 5 with 1 being most common and 5 being least common.
Juvenile (under 18) case study of HV presentation and treatment. The questions below ask you about the presentation of an adult patient suffering from HV, your findings on examination and the most common treatments offered.

Please indicate the five (5) most common complaints of a adult patient presenting
with HV (as the primary diagnosis or concern) Please rate in order from 1 5 with 1 being most common and 5 being least common.
Adult (1865) case study of HV presentation and treatment. Please rate in order from 1 5 with 1 being most common and 5 being least common. The questions below ask you about the presentation of an older adult patient suffering from HV, your findings on examination and the most common treatments offered.
26. Please indicate the five (5) most common complaints of a older adult patient presenting with HV (as the primary diagnosis or concern) Please rate in order from 1 5 with 1 being most common and 5 being least common.
Older Adult (65+) case study of HV presentation and treatment. Please rate in order from 1 5 with 1 being most common and 5 being least common.