title: Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists.
abstract: 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.
authors.affiliation: Queensland University of Technology, School of Clinical Sciences, Kelvin Grove, QLD 4059 Australia ; Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD 4059 Australia.
authors.forename: Sheree E
authors.initials: SE
authors.lastname: Hurn
authors.affiliation: Division of Physiotherapy, University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD 4072 Australia.
authors.forename: Bill T
authors.initials: BT
authors.lastname: Vicenzino
authors.affiliation: Division of Physiotherapy, University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD 4072 Australia.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001315:Australia; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D005260:Female; D061826:Foot Orthoses; D006215:Hallux Valgus / Q000150:complications / Q000534:rehabilitation*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D010808:Physical Examination / Q000379:methods; D011032:Podiatry / Q000379:methods*; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000706:statistics & numerical data*; D011788:Quality of Life; D012775:Shoes; D055815:Young Adult