Management of Bilateral Hallux Valgus

Initial Assessment and Conservative Management

The American College of Cardiology recommends prescribing appropriate therapeutic footwear that accommodates the hallux valgus deformity for a 71-year-old male patient with bilateral hallux valgus and redness on the medial aspect of both feet 1
Shoes should have sufficient width at the metatarsal phalangeal joints to accommodate the bunion deformity, adequate length (1-2 cm longer than the foot), adjustable features to accommodate dressings if needed, firm support with comfortable fit, and open-backed design to reduce pressure on inflamed areas 1, 2, 3, 4
Custom or prefabricated orthoses can help redistribute pressure and reduce pain in patients with hallux valgus, according to the American Academy of Orthopaedic Surgeons 1
Cushioning insoles can reduce pressure on the medial aspect of the feet, and assessment of weight distribution with appropriate padding can reduce hyperkeratosis build-up, as recommended by the British Association of Dermatologists 5

Daily inspection of feet, especially the reddened areas, regular washing with careful drying, especially between toes, proper nail care (cutting straight across), application of emollients for dry skin, but not between toes, avoidance of barefoot walking, and daily change of socks, preferably with seamless options, are recommended for patients with hallux valgus, according to the American Diabetes Association 2

Ice application to reduce inflammation in the reddened areas, rest and activity modification to reduce pressure on the affected joints, and physical therapy for strengthening exercises and gait education can help manage inflammation and pain in patients with hallux valgus, as recommended by the American Academy of Family Physicians 4, 7
NSAIDs can be used for pain and inflammation management if not contraindicated, and topical analgesics can be used as an alternative for patients who cannot tolerate oral NSAIDs, according to the American Academy of Family Physicians 4

Regular podiatric assessment every 3-6 months is recommended for patients with hallux valgus, especially in elderly patients, to monitor for progression of deformity and development of complications, as recommended by the American College of Cardiology 1
Monitoring for signs of ulceration, especially in patients with risk factors such as age and presence of redness, is crucial, according to the American Diabetes Association 8
Evaluating vascular status by checking pedal pulses to ensure adequate circulation for healing is essential, as recommended by the American Diabetes Association 9

Assessment for peripheral neuropathy is essential, as decreased sensation increases risk of ulceration, according to the American Diabetes Association 8
The presence of redness on the medial aspect of both feet suggests inflammation that requires immediate attention to prevent potential ulceration, as recommended by the American College of Cardiology 1