Review Article
This review synthesizes current evidence on sports and rehabilitation medicine for hallux valgus, detailing muscle training, neuromuscular control, orthoses, and digital rehabilitation, and proposes integrated, patient-centered strategies that improve pain, gait, and function while guiding future precision, data-driven care.
Hallux valgus (HV) is one of the most common forefoot deformities and can substantially impair daily function and quality of life. With rapid advances in sports medicine and rehabilitation science, management strategies have shifted from passive structural correction toward active functional restoration. Growing evidence supports the role of muscle strengthening, neuromuscular control, proprioceptive retraining, and biomechanical optimization in improving pain, stability, and gait performance in patients with HV. This narrative review summarizes recent progress in nonsurgical interventions for HV from the perspective of sports and rehabilitation medicine. It discusses the mechanisms and clinical effectiveness of key therapeutic modalities, including intrinsic and extrinsic foot muscle training, kinesiology taping (KT), biofeedback and gait retraining, orthotic and manual therapy, physical modalities, patient education, and digital rehabilitation technologies. In addition, it explores evidence supporting combined and individualized treatment strategies aimed at enhancing long-term outcomes. By integrating current findings, this review provides a comprehensive reference for developing multidisciplinary, function-oriented, and precision-based management approaches primarily for patients with isolated or uncomplicated hallux valgus. For postoperative patients or those with concomitant forefoot disorders, rehabilitation strategies should be individualized, as direct evidence remains limited.
Hallux valgus (HV) is one of the most common forefoot deformities among shoe-wearing populations, with a pooled prevalence of approximately 23% among adults aged 18–65 years, according to a systematic review and meta-analysis of population-based surveys1. It occurs more frequently in women, ballet dancers2, and older adults3. Clinically, HV is characterized by lateral deviation of the first metatarsophalangeal joint4, and is often accompanied by pain, gait disturbances, and footwear discomfort, all of which can markedly impair quality of life. The severity of HV is typically classified as mild, moderate, or severe according to the hallux valgus angle (HVA) and intermetatarsal angle (IMA)5. Traditional interventions include surgery, conservative treatment, and pharmacological management. Surgery remains an important treatment option, particularly for moderate-to-severe cases, with more than 200,000 HV procedures performed annually in the United States6. Common surgical strategies include osteotomy7, tarsometatarsal fusion8, and Akin osteotomy9, all of which aim to relieve pain, correct deformity, and improve forefoot biomechanics. Although these procedures can achieve satisfactory radiographic and clinical correction, postoperative recurrence10,11, avascular necrosis12, and nerve injury13, are not uncommon. Minimally invasive surgery (MIS) may reduce soft tissue trauma and shorter recovery time14, but it carries a risk of specific complications such as skin burns and soft tissue injury when performed improperly13. In addition, procedure-related problems such as transfer metatarsalgia15, and hardware-related irritation may still occur, and restoration of radiographic alignment does not necessarily ensure full recovery of gait mechanics or forefoot function16,17. These considerations underscore the importance of perioperative functional restoration in addition to structural correction.
Conservative approaches, including orthotic insoles and toe separators, may help relieve pain and improve footwear comfort18. However, current evidence suggests that their ability to correct deformity progression is limited, and their long-term effectiveness in preventing progression of the HVA remains uncertain19. Therefore, they are better regarded as adjuncts for symptom relief rather than definitive corrective interventions. Botulinum toxin injections may also provide symptomatic relief, but they do not restore joint alignment or biomechanical stability20. Compared with surgery, pharmacological therapy, or orthotic management alone, sports medicine and rehabilitation strategies place greater emphasis on restoring dynamic foot control, gait efficiency, and functional capacity, while also serving as important adjuncts in perioperative recovery and long-term symptom management.
Patients with HV may exhibit altered foot function, biomechanical loading, and movement coordination, which provides a rationale for function-oriented management21. This perspective has shifted treatment goals beyond deformity correction alone toward pain reduction, gait optimization, and preservation of daily function. Sports medicine interventions primarily target muscle strengthening and dynamic control through supervised or home-based exercise therapy, toe function training, and footwear- or orthosis-supported exercise programs22,23. Rehabilitation medicine further incorporates kinesiology taping (KT) and multimodal conservative strategies to improve pain, function, and foot alignment24. In clinical practice, these approaches are particularly applicable to patients with mild-to-moderate HV, to individuals with pain or functional limitation who do not yet require surgery, and to perioperative rehabilitation in moderate-to-severe HV for preoperative functional optimization or postoperative recovery. Patient education and lifestyle modification are equally essential for maintaining therapeutic effects and preventing recurrence25,26. Growing evidence from clinical and rehabilitation-oriented studies suggests that these strategies may improve pain, foot function, balance, and selected gait-related outcomes, particularly when delivered as part of multimodal programs27,28. However, the current literature remains limited by small sample sizes, short intervention or follow-up durations, heterogeneous outcome measures (e.g., pain scores, radiographic parameters, plantar pressure, and gait metrics), and a relative lack of studies evaluating integrated or severity-stratified treatment pathways. Therefore, this review aims to systematically summarize current research on the application of sports and rehabilitation medicine in HV management, evaluate the evidence for different modalities, and explore integrated, patient-centered approaches for function-oriented and precision-based conservative treatment. For consistency throughout this review, short-term effects are defined as outcomes assessed within 3 months after intervention, whereas long-term effects are defined as outcomes assessed at 6 months or longer.
Sports medicine interventions and HV
Sports medicine interventions for HV focus on restoring dynamic balance within the foot-ankle complex through targeted muscle strengthening, biomechanical correction, and neuromuscular reeducation. Unlike surgical or purely orthotic approaches, sports medicine emphasizes active participation and functional retraining to optimize gait, enhance intrinsic muscle activation, and help prevent deformity progression. This section summarizes the pathomechanical basis of HV related to muscular dysfunction and outlines key exercise-based strategies for improving foot stability and functional outcomes.
Muscle function and the pathogenesis of HV
Beyond bony malalignment, HV is closely linked to imbalances in foot–ankle musculature and disordered limb dynamics. Imaging and electromyographic studies indicate that reduced recruitment of the abductor hallucis (AH) is an early and pivotal change; its dysfunction contributes to lateral deviation of the hallux and medial displacement of the first metatarsal29. Concurrently, the flexor hallucis brevis (FHB) and flexor digitorum brevis (FDB) often undergo compensatory hypertrophy, while adductor hallucis (AdH) activity is relatively increased, producing a medial–lateral strength imbalance across the forefoot30,31,32. The resultant shift in force vectors weakens arch support, promotes forefoot pronation, and increases the intermetatarsal angle, creating a cycle of muscle imbalance, metatarsal rotation, and forefoot hypermobility. In addition, altered pull from extrinsic foot muscles, including the peroneus longus, tibialis anterior, and tibialis posterior, may modify arch height and forefoot rotational moments, thereby facilitating first metatarsal internal rotation and contributing to HV33,34. Gait analyses further show excessive rearfoot eversion, instability during the propulsion phase, and abnormal plantar pressure distribution in HV, with compensatory kinematic changes at the hip and pelvis35,36,37. Age-related neuromuscular changes may exacerbate these kinetic chain disturbances, particularly in older adults38. Collectively, degradation of foot–ankle muscle function and dynamic abnormalities represent key biomechanical substrates for the onset and progression of HV.
Foot-ankle muscle strengthening
Foot-ankle strengthening is foundational to sports medicine care for HV. The short-foot exercise (SFE) and toe-function drills (e.g., toe-spread-out and towel curls) actively recruit the AH, FHB, and FDB to enhance medial longitudinal arch stability and optimize plantar pressure distribution19,39,40,41. Performed alone, SFE can significantly increase AH electromyographic activity and improve dynamic balance and gait parameters in HV42. When SFE is combined with other methods—such as breathing-coupled practice, isometric hip abduction, or sensorimotor training—AH activation can be further augmented, suggesting robust adaptability across training contexts43,44,45. Lower-limb synergy training (e.g., closed-chain resisted work for the peroneus longus and tibialis anterior) also helps restore coordinated control of the longitudinal and transverse arches46,47. Multimodal programs pairing SFE with synergy training have reduced the HVA, relieved pain, and improved gait dynamics within 6–8 weeks48. While SFE and toe-function training show clear benefits for pain and foot function, the optimal frequency, intensity, and parameters for long-term adherence remain to be standardized. Nevertheless, to improve clinical operability, representative implementation parameters for common exercise-based interventions for HV are summarized in Table 1.
KT and proprioceptive restoration
KT extends neuromuscular training by providing short-term pain relief and improved hallux alignment in HV. By redistributing plantar load and enhancing cutaneous sensory input, KT promotes AH recruitment, increases foot stability, and improves dynamic balance and gait measures49,50,51. Rigid taping protocols can immediately improve arch support and hallux alignment in moderate HV, and combining taping with a home-based exercise program outperforms exercise alone for pain and balance49,52,53. Through proprioceptive feedback, KT also facilitates neuromuscular re-education to maintain correct foot posture during daily tasks54. Although evidence for durable structural correction is limited, KT has clear value as an adjunct for short-term analgesia and function-focused training.
Biofeedback, gait, and functional movement re-education
Dynamic re-education grounded in neuromechanical principles has become a key direction in HV care. Biofeedback-based systems can improve coordinated contractions of intrinsic foot muscles and arch stability, with downstream gains in gait performance, plantar sensation, and trunk–pelvic postural adjustments55,56. Gait retraining and minimalist footwear interventions can encourage forefoot strike, reduce fascicle shortening and velocity in the triceps surae, increase muscle–tendon unit excursion and peak recoil velocity, and thereby improve kinetic performance in HV57.
More recently, combining Functional Movement Re-education (FMR) with Global Postural Re-education (GPR) has been proposed as a promising avenue58. FMR focuses on restoring foot–ankle–knee–hip coordination and neuromotor control during functional tasks, whereas GPR employs global myofascial chain lengthening and postural realignment to normalize muscle tone and joint positioning59. The two approaches are complementary: GPR reduces lower-limb chain tightness and optimizes pelvic posture, while FMR refines task-specific kinetic-chain coordination37. Early studies suggest that integrating chain-release techniques with task-oriented training can reduce metatarsal loading, improve gait parameters, and enhance quality of life in HV60.
Evidence summary and limitations in sports medicine
Most sports medicine studies in HV are small randomized or controlled trials showing that foot–ankle strengthening combined with functional movement re-education may improve pain, function, and selected imaging or alignment metrics19,25,58,61. However, these findings should be interpreted with caution because outcome measures vary substantially across studies, ranging from patient-reported pain scales and clinician-based functional assessments, such as VAS and AOFAS, to objective parameters, including HVA/IMA, plantar pressure distribution, and spatiotemporal gait metrics62. This heterogeneity limits direct comparison across trials and may lead to overinterpretation when different outcome domains are considered together. In addition, many trials lack objective functional outcomes, such as plantar pressure mapping or spatiotemporal gait metrics, further limiting comparability and generalizability63,64,65.
Rehabilitation medicine interventions and HV
Rehabilitation interventions for HV aim to restore both structural alignment and functional performance by improving neuromuscular coordination, enhancing proprioception, and optimizing plantar load distribution and gait patterns. Current rehabilitation strategies have evolved from passive orthotic support to comprehensive multimodal approaches that incorporate neuromuscular control training, individualized orthotic devices, KT, physical modalities, and patient education and lifestyle modification. Rehabilitation medicine has become a cornerstone of conservative HV management, providing a scientific foundation for continuous interventions spanning structural correction, functional restoration, and long-term maintenance.
Neuromuscular control and proprioceptive training
Deficits in neuromuscular control and proprioceptive function are key contributors to the functional imbalance in HV. Reduced activation of intrinsic foot muscles and impaired proprioception of the ankle–metatarsophalangeal complex diminishes postural regulation and lower-limb balance, resulting in compensatory rearfoot eversion and forefoot internal rotation during gait66,67. The primary goal of rehabilitation is to restore these critical functions through neuromotor re-education. Training on unstable surfaces (e.g., balance boards, foam pads, BOSU balls) stimulates plantar receptors and postural reflexes, facilitating synergistic contraction of foot muscles68,69. Closed-chain exercises such as single-leg stance and semi-squat weight shifting strengthen neural integration between intrinsic and extrinsic muscles, improving dynamic stability19,70. Recent studies show that combining electrical stimulation with sensory input training enhances neural responsiveness, sensitivity, and reflex speed, accelerating motor relearning71. Electromyographic analysis confirms significant improvements in balance, gait symmetry, and plantar pressure distribution, accompanied by pain reduction and enhanced quality of life56. Thus, neuromuscular control and proprioceptive retraining are foundational to active functional recovery for HV rehabilitation, providing essential support for subsequent structural and functional improvement.
Advances in orthotic technologies
Orthoses and splints are commonly used in HV rehabilitation to alter external loading patterns and improve short-term biomechanical support. Night splints and dynamic splints effectively relieve pain and improve footwear comfort in the short term but show inconsistent results in long-term angular correction of HVA and IMA18,62,72. Multimodal strategies—such as exercise combined with toe separators or night splints combined with manual therapy—may provide greater short-term pain relief and functional improvement than single interventions. Nevertheless, current evidence indicates that the corrective effect of toe separators alone on hallux valgus alignment remains limited61,73. Recent advances in individualized insoles and 3D printing technologies have enabled greater precision in orthotic design74. Custom insoles and ankle–foot orthoses (AFOs) based on plantar pressure analysis and arch modeling effectively redistribute forefoot loads, improve metatarsophalangeal joint alignment, reduce pain, and enhance gait stability75. Material composition, geometric features, and support placement critically influence efficacy, with the balance between flexibility and rigidity determining both comfort and corrective potential76. While orthotic insoles show significant short-term pain relief and biomechanical benefits, their role as a core component of long-term functional management remains uncertain, as evidence for sustained prevention of HVA progression is still limited. Therefore, orthotic devices are better regarded as adjuncts to long-term management, particularly when combined with neuromuscular training and other function-oriented rehabilitation strategies.
Manual therapy and physical modalities
Manual therapy and selected physical modalities may serve as adjunctive options in HV rehabilitation, particularly for short-term pain relief and improvement of soft-tissue flexibility. Manual approaches include joint mobilization, soft-tissue techniques, and KT77,78. KT is commonly applied along the hallux and first ray to provide gentle corrective alignment and enhance sensory guidance during standing and gait-related tasks. Its potential mechanisms may include augmentation of cutaneous proprioceptive input, redistribution of plantar loading, and facilitation of neuromuscular control64,79. Joint mobilization restores mobility of the first metatarsophalangeal joint through passive distraction and gliding80, while soft-tissue release of the plantar fascia and gastrocnemius may reduce compensatory tension, improve fascial extensibility, and decrease abnormal forefoot stress, thereby relieving pain81. In addition, when manual therapy is combined with SFE, strengthening of the plantar intrinsic muscles may further stabilize the first metatarsal ray and reduce sesamoid subluxation, providing a biomechanical basis for additional pain reduction in patients with HV80,82. However, the current evidence base remains limited, with small sample sizes, heterogeneous protocols, and limited certainty regarding long-term functional and structural benefits. Therefore, these interventions should be interpreted as supportive rather than definitive treatments, and high-quality randomized controlled trials are still needed.
Procedure-specific considerations in postoperative rehabilitation
Postoperative rehabilitation should be individualized according to the surgical procedure, fixation stability, and whether concomitant procedures were performed. Available evidence suggests that, after selected distal soft-tissue corrective procedures, accelerated protected weight-bearing may improve short-term symptoms and function without increasing recurrence or implant failure83,84. In contrast, osteotomy- or fusion-based procedures generally require a more protective progression, with loading and mobilization advanced only after adequate structural stability and soft-tissue have been achieved85,86. Therefore, postoperative rehabilitation should be procedure-specific and surgeon-guided, rather than standardized across all hallux valgus procedures.
Patient education and lifestyle modification
Patient education and behavioral interventions are integral to successful HV rehabilitation. Programs based on the Information–Motivation–Behavioral Skills (IMB) model encourage self-management, improving adherence, and sustaining functional recovery87,88.
Lifestyle modification aims to reduce pathological forefoot stress and delay deformity progression. Proper footwear selection—such as wide-toe-box, low-heeled shoes with soft insoles—significantly decreases pressure in the first metatarsophalangeal region and improves comfort and balance89,90. Weight control, regular walking, and personalized education are critical for long-term management19,87,91. Integrating patient education with lifestyle modification helps establish a healthy rehabilitation loop.
Remote monitoring and digital rehabilitation
Remote monitoring technologies are increasingly being incorporated into HV rehabilitation and follow-up programs. Patient-reported outcome measures (PROMs) such as the SAFE-Q and PROMIS scales allow dynamic monitoring of pain, function, and quality of life, whereas three-dimensional imaging and radiographic assessment provide structural information relevant to deformity progression and rehabilitation planning, including key parameters such as the distal metatarsal articular angle (DMAA), HVA, and IMA87,92,93. Together, these tools reflect different outcome domains, including subjective symptom burden, clinician- or imaging-based structural status, and objectively measured functional biomechanics.
Digital rehabilitation—an emerging integration of rehabilitation medicine and information technology—is transforming HV management from episodic assessment to continuous, data-supported care. Wearable sensors, smart insoles, inertial measurement units (IMUs), and tele-rehabilitation platforms can be used to monitor gait, plantar loading, posture, weight-bearing behavior, and training adherence in home and outpatient settings55,94,95. These technologies may improve the objectivity of follow-up and support more personalized exercise progression, orthotic adjustment, and feedback-based gait retraining. More specifically, they may be applied in home rehabilitation to improve exercise adherence and remote supervision, in postoperative follow-up to track recovery status and gait-related function, in home-based intervention for mild HV to support early conservative management, and in preoperative functional optimization for moderate-to-severe HV to improve muscle activation, balance, and functional readiness before surgery96,97,98.
AI-assisted sensing systems and gait-recognition models further offer the potential to identify abnormal movement patterns, quantify biomechanical compensation, and support the prediction of progression or treatment response99. However, the current evidence base remains relatively underdeveloped. Many digital tools cited in foot and ankle rehabilitation have been validated in general gait analysis, remote monitoring, or plantar-pressure applications rather than in HV-specific prospective studies. In addition, important challenges remain regarding device standardization, measurement validity in HV populations, integration of structural and functional data, and the clinical interpretability of AI-generated outputs. Therefore, future research should move beyond proof-of-concept descriptions and establish disease-specific, prospective, and multicenter digital rehabilitation pathways that integrate PROMs, imaging, plantar pressure, and gait metrics into precision rehabilitation for HV. At present, evidence for digital rehabilitation in postoperative hallux valgus remains limited and is derived largely from isolated cases or small-scale studies. Accordingly, such protocols may be more applicable to patients with isolated or uncomplicated hallux valgus, whereas postoperative patients with concomitant deformities may require individualized adjustments.
Evidence summary and limitations in rehabilitation medicine
The role of rehabilitation medicine in HV management is increasingly recognized. Integrated multimodal strategies—combining neuromuscular control training, orthotic support, physical modalities, and patient education—have helped establish a systematic continuum from pain relief to functional restoration. However, current evidence is constrained by small sample sizes, short intervention and follow-up durations, and the lack of standardized parameters for training frequency, intensity, and orthotic configuration.
Future research should advance rehabilitation toward greater precision, objectivity, and digital integration. High-quality, multicenter randomized controlled trials using objective functional metrics—such as gait dynamics, plantar pressure mapping, and electromyographic measures—are essential to establish standardized, reproducible pathways. Interdisciplinary collaboration should involve sports medicine, rehabilitation medicine, foot and ankle surgery, biomechanics, and radiology to optimize rehabilitation strategies. In this model, sports medicine is primarily responsible for exercise prescription and functional progression; rehabilitation medicine for neuromuscular retraining, orthotic coordination, and longitudinal follow-up; foot and ankle surgery for structural assessment, perioperative planning, and postoperative precautions; biomechanics for gait and plantar-pressure analysis; and radiology for imaging-based evaluation of deformity severity, correction, and progression. Through regular multidisciplinary assessment and feedback, these disciplines may jointly refine individualized rehabilitation pathways across conservative, perioperative, and postoperative stages.
In particular, digital rehabilitation and artificial intelligence should be developed not only as adjunctive technologies, but also as clinically meaningful tools for longitudinal monitoring, home-based adherence assessment, gait retraining feedback, and individualized treatment adjustment. Wearable sensors, smart insoles, tele-rehabilitation platforms, and AI-assisted gait analysis may help bridge the gap between clinic-based assessment and real-world functional recovery. However, their current application in HV remains limited by insufficient disease-specific validation, lack of standardized digital endpoints, and uncertainty regarding the clinical interpretability of algorithm-generated outputs. Therefore, future studies should prioritize prospective HV-specific validation and the integration of PROMs, imaging, plantar pressure, and gait data into unified digital rehabilitation pathways. This evolution marks the transition of HV rehabilitation from experience-based practice to evidence-based, technology-enabled precision care. In addition, future rehabilitation research should more explicitly address perioperative pathways for patients undergoing HV surgery, including postoperative gait retraining, plantar pressure redistribution, functional recovery, and recurrence prevention.
To improve clinical applicability, conservative interventions for hallux valgus should be stratified according to deformity severity. Table 2 summarizes the core and adjunctive management options for mild, moderate, and severe HV.
Synergistic mechanisms and future pathways of integrated exercise-rehabilitation interventions
HV management is progressively shifting from single-discipline models to an integrated exercise–rehabilitation paradigm. Sports medicine primarily focuses on muscle strengthening and dynamic control, emphasizing active training to restore the biomechanical environment of the foot79,100. Rehabilitation medicine, in contrast, emphasizes neuromuscular coordination, orthotic support, and functional maintenance. The integration of these two disciplines enables a continuous intervention pathway from “active correction” to “functional stabilization”73,101.
Combined approaches—such as “exercise training plus orthotic bracing” or “muscle strengthening combined with manual therapy”—have shown potential benefits across multiple outcome domains, including pain relief, patient-reported function, radiographic alignment (e.g., HVA and IMA), and selected gait parameters19,87. However, the current evidence base primarily involves patients with isolated or uncomplicated hallux valgus, and the applicability of these integrated strategies to postoperative patients with concomitant forefoot disorders remains uncertain. In addition, these outcomes are not equivalent in clinical meaning or measurement properties, and cross-study comparisons should be interpreted cautiously because subjective and objective endpoints are often reported inconsistently.
Looking forward, developing a precision-based, data-driven framework of “exercise–rehabilitation–intelligent management” will be central to future HV care. This integrated strategy aims to unify biomechanical correction, neuromuscular optimization, and long-term functional sustainability, representing a paradigm shift toward individualized, intelligent, and evidence-based rehabilitation. To facilitate interpretation of this narrative review, the main intervention categories and their predominant evidence types are summarized in Table 3. Because the currently available literature is heterogeneous and has not been uniformly appraised using formal grading systems, the table is intended to provide a pragmatic overview of the relative strength of evidence rather than a formal evidence-rating framework.
The management of HV is undergoing a paradigm shift from structural correction to functional restoration and, more recently, to intelligent rehabilitation. The overall trend reflects a move toward multimodal integration, data-driven decision-making, and patient-centered functional outcomes. Sports medicine interventions focus on restoring muscular balance and biomechanical efficiency, while rehabilitation approaches emphasize neuromuscular coordination and proprioceptive enhancement. Combined intervention models appear promising across several domains, including pain relief, functional improvement, gait-related performance, and structural outcomes. However, the current evidence base primarily involves patients with isolated or uncomplicated hallux valgus; therefore, postoperative patients with concomitant forefoot disorders such as hammer toes or metatarsalgia may require individualized rehabilitation adjustments. Nevertheless, the interpretation of overall effectiveness is constrained by heterogeneity in reported endpoints, as subjective measures and objective biomechanical or radiographic measures are often mixed across studies. Future research should prioritize the development of multidisciplinary, technology-enabled rehabilitation systems that integrate artificial intelligence, wearable sensors, and advanced imaging. Such frameworks will support a dynamic balance between structural correction and functional restoration, marking a critical step toward personalized, evidence-based, and sustainable hallux valgus management.
| Intervention | Main target | Representative parameters | Progression strategy | Expected clinical value |
| Short-foot exercise (SFE) | Activate plantar intrinsic muscles, especially the abductor hallucis (AH), and improve medial longitudinal arch control | 4 days/week for 8 weeks; 2 sets × 10 repetitions; 30-s rest between sets | Weeks 1–2: seated, 5-s hold per repetition; Weeks 2–4: seated, 10-s hold; Weeks 4–6: standing, 10-s hold; Weeks 6–8: single-leg standing or higher-demand position, 10-s hold | Improve AH activation, dynamic balance, gait control, and foot function |
| Toe-spread-out exercise | Improve hallux alignment control and intrinsic toe-muscle recruitment | 4 days/week for 8 weeks; 2 sets × 10 repetitions; 30-s rest between sets | Same staged progression as SFE, from seated to standing and then single-leg conditions | Improve toe motor control, plantar pressure distribution, and functional support of the forefoot |
| Towel curls / towel toe-curl exercise | Strengthen toe flexors and support plantar stabilization | 4 days/week for 8 weeks; 2 sets × 10 repetitions; 30-s rest between sets | Begin in seated position; increase hold time and task difficulty gradually according to tolerance | Improve toe-flexor strength, foot stability, and functional loading |
| Stretching / hallux traction-related exercise | Reduce soft-tissue tightness and improve flexibility around the first ray | 5 repetitions; 30-s hold for each repetition | Can be used during warm-up phase and combined with strengthening drills | Improve soft-tissue extensibility and facilitate subsequent corrective exercise |
| Lower-limb synergy training (e.g., resisted peroneus longus / tibialis anterior work) | Enhance coordination of longitudinal and transverse arch control | Typically incorporated into multimodal programs over 6–8 weeks | Progress from low-load motor-control training to more functional closed-chain tasks | Improve coordinated foot control, gait dynamics, and load transfer |
Table 1: Representative implementation parameters for exercise-based interventions in hallux valgus. The parameters listed in the table represent published or clinically reported examples of exercise dosage and progression rather than a universal prescription. Current evidence remains heterogeneous across studies, and exercise dosage should be individualized according to deformity severity, symptom burden, functional level, and tolerance. Abbreviations: HV, hallux valgus; SFE, short-foot exercise; AH, abductor hallucis.
| Severity | Core interventions | Adjunctive / combined measures | Main clinical goal |
| Mild HV | Patient education, footwear modification, short-foot exercise (SFE), toe-function training | Orthotic insoles, toe separators, kinesiology taping (KT) as needed | Symptom relief, improvement of dynamic control, and delay of progression |
| Moderate HV | Supervised exercise therapy, intrinsic foot muscle strengthening, orthotic support | KT, toe separators, multimodal rehabilitation, selected manual or physical modalities | Improvement of pain, function, gait performance, and selected alignment-related outcomes |
| Severe HV | Symptom-oriented conservative care, footwear adaptation, prehabilitation or postoperative rehabilitation support | Orthoses for comfort, individualized adjunctive rehabilitation | Functional maintenance and consideration of surgical evaluation when symptoms or disability persist |
Table 2: Severity-stratified recommendations for conservative management of hallux valgus. These recommendations represent a pragmatic clinical framework based on the current evidence base. Evidence is strongest for mild-to-moderate HV, whereas in severe deformity, conservative treatment is primarily supportive rather than definitively corrective. Abbreviations: HV, hallux valgus; SFE, short-foot exercise; KT, kinesiology taping.
| Intervention category | Main examples | Predominant evidence type | Overall evidential support | Main interpretation |
| Exercise-based sports medicine interventions | SFE, toe-spread-out, towel curls, lower-limb synergy training | RCTs, supervised/home-program comparative studies, narrative synthesis | Moderate | Most consistent evidence supports improvement in pain, foot function, muscle activation, and selected gait outcomes, particularly in mild-to-moderate HV |
| Orthotic and footwear-based interventions | Foot orthoses, toe separators, footwear modification | Pilot RCTs, systematic reviews/meta-analyses, feasibility studies | Moderate but variable | May improve pain and footwear comfort, but corrective effects on deformity progression and radiographic alignment are limited or inconsistent |
| Kinesiology taping (KT) | Hallux/first-ray taping, KT combined with corrective exercise | Small clinical studies, mechanistic studies, short-term intervention studies | Limited to moderate | Evidence mainly supports short-term benefits in pain, balance, and gait-related neuromuscular control; long-term corrective efficacy remains uncertain |
| Manual therapy and physical modalities | Joint mobilization, soft-tissue techniques, ESWT, low-level laser therapy, ultrasound | Small studies, case-based evidence, heterogeneous intervention studies | Limited | May be useful as adjunctive symptomatic treatments, but current evidence is low-certainty and insufficient for strong recommendations |
| Patient education and lifestyle modification | Footwear advice, self-management, adherence strategies | Clinical recommendations, supportive studies, narrative evidence | Limited but clinically important | Often used as a foundation of conservative care, although direct HV-specific high-level evidence remains limited |
| Digital rehabilitation and remote monitoring | Wearable sensors, smart insoles, tele-rehabilitation, AI-assisted gait analysis | Pilot studies, technology-validation studies, isolated postoperative reports | Emerging / limited | Promising for home rehabilitation, follow-up, and adherence monitoring, but disease-specific prospective validation in HV is still insufficient |
| Integrated / multimodal rehabilitation | Exercise + orthoses; exercise + manual therapy; exercise + digital monitoring | Mixed evidence, combined-program studies, narrative synthesis | Moderate but heterogeneous | Multimodal pathways appear promising, but cross-study heterogeneity in outcomes and protocols limits definitive conclusions |
Table 3: Summary of intervention categories and predominant evidence types in hallux valgus management. This table provides a pragmatic summary of the predominant evidence types supporting each intervention category in this narrative review. It is not intended to replace a formal evidence-grading framework based on systematic risk-of-bias assessment. Abbreviations: HV, hallux valgus; SFE, short-foot exercise; KT, kinesiology taping; ESWT, extracorporeal shockwave therapy.
The authors declare no conflicts of interest related to this work.
This work was supported by the Key Research Program of Science and Technology in Tibet Autonomous Region (XZ202201ZY0038G).