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It argues that efficient non-operative management should be prioritized and highlights multi-modal conservative strategies supported by systematic review evidence, including exercise, orthoses, and splinting. The letter emphasizes synergy between intrinsic muscle strengthening and external supports such as taping or splints, recommends organized physiotherapy and podiatry programs, and calls for robust long-term randomized trials. 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A significant number of patients want to evade or postpone surgical intervention, making the need for efficient non-operative therapy a critical clinical and public health concern. Consequently, elucidating the effectiveness of conservative therapies is essential for steering evidence-based therapy.  \nRecent data increasingly supports a multi-modal conservative strategy. A recent systematic review and meta-analysis of randomised controlled trials indicated that interventions such as exercise, orthoses, and splinting can yield substantial pain relief and may result in minor yet statistically significant enhancements in the hallux valgus angle (HVA) and cinter metatarsal angle[1] . Certain foot training regimens have shown efficacy in alleviating foot-related discomfort and enhancing quality of life [2] . Furthermore, research indicates that the integration of intrinsic muscle strengthening with external supports, such as taping or splints, often yields more favorable results than each intervention used in isolation[3,4] . This indicates a synergistic impact, whereby workouts rectify the fundamental muscle imbalance while supports facilitate the preservation of biomechanical alignment and symptom management.  \nThe clinical consequence provides a compelling justification to transition from passive monitoring to active, organised care for patients with mild-to-moderate hallux valgus. Physiotherapists, podiatrists, and other healthcare professionals may reliably recommend programmes that include strengthening, stretching, and retraining the gait of the foot muscles, along with the right external supports. This gives patients a way to take care of their disease that could save them from having to have more intrusive operations.  \naDepartment of Medicine, Gujranwala Medical College, Gujranwala, Pakistan, bDepartment of Dentistry, Bolan Medical College, Quetta, Pakistan and cDepartment of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal  \nSponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara 33700, Nepal. Tel.: +977-9745829807. E-mail: [raghabendra.mahato2024@gmcthrc.edu](raghabendra.mahato2024@gmcthrc.edu)[ ](raghabendra.mahato2024@gmcthrc.edu)(R. K. Mahato).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons AttributionNon Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Annals of Medicine & Surgery (2026) 88:1072–1073  \nReceived 12 November 2025; Accepted 13 November 2025  \nPublished online 25 November 2025  \n[http://dx.doi.org/10.1097/MS9.0000000000004429](http://dx.doi.org/10.1097/MS9.0000000000004429)  \nEven while these results are encouraging, there are still big gapsin our understanding. The ideal “dose” of exercise, including the precise kind, frequency, and duration, has yet to be established, and there is less agreement on the most efficacious external assistance at various stages of the deformity[5]. The majority of studies are constrained by short-term follow-up, hence raising questions about the long-term efficacy of these conservative therapies. Moreover, we do not possess strong guidelines to ascertain what individuals are now most probable to gain ","cbCaii6lBD17gvex","https://ap.wps.com/l/cbCaii6lBD17gvex","pdf",163653,"English","# Letter to the Editor\n## Conservative multi-modal management\n## Clinical implications and recommendations\n## Evidence gaps and future research\n## AI transparency and declarations","[{\"question\":\"Why is non-operative hallux valgus therapy considered important?\",\"answer\":\"Many patients want to avoid or delay surgery, making effective conservative care a critical clinical and public health need.\"},{\"question\":\"What conservative interventions does the letter highlight as potentially beneficial?\",\"answer\":\"It cites evidence that exercise, orthoses, and splinting can reduce pain and may improve hallux valgus measurements, alongside foot training regimens.\"},{\"question\":\"What research directions does the letter propose to address current uncertainties?\",\"answer\":\"It calls for reliable, prolonged randomized controlled studies with standardized methods, directly comparing exercise alone versus exercise combined with different supports, and assessing long-term outcome durability.\"}]","The synergistic role of exercise and external supports in hallux valgus management - Letter to the Editor | PDF",1790673918]