Effects of exercise combined with external support on hallux valgus angle and pain: A systematic review and network meta-analysis.

Background: Hallux valgus (HV) is a common foot deformity that causes pain and functional limitations. For mild-to-moderate cases, conservative treatment such as exercise therapy and external supports is preferred. Optimal protocols remain uncertain due to variation in exercise types and combinations. This study compares conservative approaches to rank their effectiveness in reducing the hallux valgus angle (HVA) and pain relief.

Methods: PubMed, Cochrane Library, EMBASE, Medline, Web of Science, CNKI, and Wanfang were searched from inception to June 15, 2025, for RCTs evaluating exercise therapy alone or with external supports in HV patients. Outcomes included HVA and pain relief. Network meta-analyses calculated the mean differences (MD) with 95 % CIs, and interventions were ranked using SUCRA.

Results: Eleven RCTs involving 401 HV patients were included. Exercise therapy (MD = -3.32, 95 % CI: -4.40 to -2.23) was significantly superior to adjusted placebo for HVA. Exercise combined with taping was the most effective intervention (MD = -6.72, 95 % CI: -9.34 to -4.11; 89.5 %), followed by exercise combined with orthoses (MD = -6.67, 95 % CI: -9.70 to -3.64; 85.6 %). For pain relief, exercise combined with taping ranked first (MD = -3.76, 95 % CI: -4.79 to -2.73; 92.7 %), followed by exercise combined with orthoses (MD = -3.43, 95 % CI: -3.98 to -2.87; 72.6 %).

Conclusion: For mild-to-moderate HV, exercise therapy was effective in reducing HVA. Exercise combined with external support provides greater benefits for HVA reduction and pain relief. Further large-scale, high-quality RCTs are needed confirm these findings and assess potential adverse events.