## 1 Introduction  
Hallux valgus (HV) is one of the most common foot deformities. It is characterized by a structural alteration of the first toe ray, particularly a medial prominence resulting from the lateral deviation and pronation of the hallux, which represents the most visible feature of the complex three-dimensional deformity associated with HV. This condition causes aesthetic discomfort and negatively impacts plantar support and foot functionality, resulting in painful symptoms and limitations in daily activities [1,2]. The exact causes and progression of HV remain poorly understood. It affects approximately 23% of adults aged 18-65 years and 35% of those over 65 years [3]. This condition is complex and multifactorial, with various possible contributing factors that have not yet been fully elucidated. Specifically, HV shows a higher prevalence in females [4]. In fact, women tend to have higher rates of ligamentous laxity and different bony anatomy that may play a role in the deformity's development. In certain individuals, foot and toe muscular balance may be compromised due to a genetic predisposition to abnormal bone alignment and flexibility among the static stabilizers [5]. Additionally, wearing inappropriate footwear can exacerbate this condition, along with factors such as occupation, excessive walking, high body mass index (BMI), or weight-bearing activities, which are commonly significant factors favoring the worsening of HV. For these reasons, as well as for aesthetic considerations, there is an increasing tendency toward surgical intervention to correct hallux valgus [6]. The anatomical changes in HV involve a complex interplay between bones, soft tissues, muscles, and ligaments of the foot. The first metatarsal bone has a medial shift, whereas the proximal phalanx usually tilts laterally. This misalignment can result in increased stress on the surrounding structures, leading to inflammation, osteophyte formation, and capsular thickening around the metatarsophalangeal joint [7]. Moreover, the abnormal positioning of the great toe can cause altered weight distribution during walking, exacerbating symptoms such as pain in other joints, including the hip and knee joints, due to ankle imbalance, contributing to progression of the deformity [8]. Currently, there is no definitive solution for this condition apart from surgery, and the other available treatments do not seem to effectively reverse the deformity. Conservative management options for HV, such as orthotic devices, physical therapy, and lifestyle modifications, are widely used as first-line treatments due to their non-invasive nature. Orthotic devices help redistribute foot pressure and alleviate discomfort, whereas physical therapy focuses on strengthening foot muscles and improving biomechanics. Lifestyle changes, including weight management and appropriate footwear, can further enhance patients' quality of life. However, literature supporting the effectiveness of these conservative treatments is still limited, with a lack of high-quality clinical trials demonstrating long-term efficacy. Consequently, although these conservative options are beneficial, more rigorous research is needed to establish their role in achieving lasting relief and preventing the progression of HV [9]. When conservative approaches fail to reach satisfactory results, up to 30% of individuals with HV may require surgery, especially in cases of moderate-to-severe deformity. The most common complications following surgery for hallux valgus, such as first ray shortening, osteeonecrosis, hallux varus, and recurrence, have been reported to occur in up to 50% of cases. Specifically, current data on recurrence rates are lacking, with the literature reporting variability, reaching 16% [10, 11, 12]. As a consequence, the need to improve the effectiveness of conservative treatments and the scientific evidence supporting them is an ever-present challenge, not only to avoid or delay surgery but also as a complementary tool to enhance the efficacy of surgery.