In total 210 surveys were returned (11 % response rate based on approximately 1900 members on mailing distribution list). Sixty-nine of the returned surveys were partially completed (33 %); however, no significant demographic differences were identified between completed and partially completed survey responses (Chi2 p >0.05). There were 146 complete survey responses for adult HV, 159 for juvenile HV, and 141 for older adults.
Of 210 total survey respondents, 65 % (136) were female and 35 % (74) were male. Table 1 displays participants’ demographic information. All states and territories were represented, albeit with a larger proportion of responses from Queensland (31 %) and Victoria (30 %). A range of podiatrists of varying ages and years of experience were included in the study. Full-time podiatrists represented 70 % of survey respondents, and 80 % worked in the private sector. Eighty-two participants (39 %) reported having seen more than 10 HV cases in the past month, and 25 % reported having seen less than five cases.
Treatment of HV
Upon preliminary analysis, it became apparent that survey respondents offered very similar responses for the ‘typical’ HV patient compared to an adult patient with HV. Consequently, for clarity, our results are presented for the three categories: adult HV, juvenile HV and older adults. Table 2 shows the proportions of podiatrists who would recommend each different treatment option for HV. Seven treatment options emerged as being commonly recommended by podiatrists for one or more patient types: advice regarding different footwear, custom orthotic devices, prefabricated orthotic devices, footwear modification, in-shoe padding, bunion shield padding, and muscle strengthening/retraining exercises (See Fig. 1).
Three treatments clearly emerged as most often recommended for treatment of adult HV: advice regarding different footwear (92 % of podiatrists would recommend), custom orthotic devices (75 %) and prefabricated orthotic devices (54 %).
In older adult patients with HV, advice regarding different footwear still clearly emerged as a mainstay of treatment (91 % of podiatrists would recommend). Beyond that, there appeared to be less agreement, with a further five treatments emerging as commonly recommended: modification of existing footwear (e.g. stretching) (59 %), in-shoe padding (55 %), bunion shield padding (55 %), custom orthotic devices (52 %) and prefabricated orthotic devices (49 %).
Slightly different treatment recommendations emerged for juvenile HV patients. Advice regarding different footwear was still the most frequently recommended (77 %), while prefabricated orthotic devices were second (67 %) and muscle strengthening/retraining was third (51 %).
Treatment recommendations across patient type
Podiatrists were significantly less likely to offer custom orthoses to juvenile HV patients compared to adult patients (43 % vs 75 %, p <0.001), but were more likely to offer prefabricated orthotic devices (67 % vs 54 %, p <0.001). Podiatrists were also less likely to utilize such conservative treatments as footwear modification and padding techniques in juvenile HV patients compared to adults. In cases of juvenile HV, muscle strengthening/retraining and stretching exercises (p <0.001), as well as night splints (p <0.001), were more likely to be recommended.
Associations with podiatrist demographics
Compared to those without any surgical specialty training, podiatrists with surgical training were significantly more likely to recommend non-steroidal anti-inflammatory medication for adults (45 % (five out of 11) vs 15 % (20 out of 135), p <0.01) and juveniles (25 % (three out of 12) vs 2 % (three out of 147), p <0.001). Female podiatrists were more likely to offer bunion shield padding to adults with HV (43 % (40 out of 94) vs 17 % (nine out of 52), p = 0.002), and were more likely to recommend strapping for juvenile HV (43 % (43 out of 101) vs 22 % (13 out of 58), p = 0.01) compared to male podiatrists. In contrast, male podiatrists were more likely to offer custom orthoses to older adults with HV (67 % (34 out of 51) vs 44 % (40 out of 90), p = 0.01). No other podiatrist demographic variables were associated with significant differences in treatment recommendations (age, state/territory, years of experience, public/private sector or part-time/full-time status).
Descriptive comparison with clinical guidelines
The top treatments for HV in adults and older adults appear to be aligned with available clinical guidelines published by the American College of Foot and Ankle Surgeons . One notable exception is that very few podiatrists reported that they would often recommend non-steroidal anti-inflammatory medications. The treatments for juvenile HV clearly differed in our survey responses, but to the authors’ knowledge there is no current clinical guideline that differentiates conservative treatments for juvenile versus adult HV.
Open-ended survey responses
When open-ended responses were examined, two themes clearly emerged. Thirty-two respondents (15 %) indicated the importance of surgical referral or surgical advice in their treatment pathway. A further ten respondents (5 %) mentioned manual therapy (joint mobilization or manipulation) techniques, which had not been captured in the list of possible responses for treatment options.
Common presenting concerns in HV
Table 3 displays a list of common presenting concerns associated with HV, and the proportion of podiatrists who identified these to be in their ‘top 5’ observed presenting concerns. The most common presenting concerns associated with HV in adults were trouble fitting shoes (84 % podiatrists reported), big toe pain (82 %), and corns or calluses (75 %). A very similar presentation was reported for older adults with HV: trouble fitting shoes (91 %), corns or calluses (91 %) and big toe pain (76 %). The four most common concerns in juvenile HV emerged as: concern about appearance (89 %), big toe pain (72 %), family history (71 %), and trouble fitting shoes (67 %).
Common physical examination findings in HV
Table 4 presents the list of physical examination findings included in the survey, and the proportion of podiatrists who selected these to be in their ‘top five’ observed findings associated with HV. In adult HV, excessive pronation was commonly noted (50 %) as well as the presence of a bony exostosis (65 %) and degenerative change associated with the first metatarsophalangeal joint (51 %). In older adults, podiatrists more commonly reported the presence of a bony exostosis (70 %) and first metatarsophalangeal joint degenerative change (69 %), in addition to lesser toe deformities (53 %) and corns or callus formation (54 %). Juvenile HV was reported to be associated with excessive pronation (75 %) and a positive family history of HV (62 %).