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On Tuesday 21st of May 2019 the CCG will launch a new commissioned pathway for hallux valgus (bunions). Full details of the new pathway can be found on the Devon Formulary and Referral Website using the below links.
The new pathway puts more emphasis on conservative management with advice on footwear modification. Patients with hallux valgus who robustly address their footwear with better fitting shoes, insoles and rocker bottom shoes often report improvement in their symptoms and this is therefore the mainstay of management.
As part of the pathway, patients will be expected to have demonstrated footwear and lifestyle modifications for 12 months before referral. After 12 months, a referral to a community assessment service can be made via DRSS who will assess, treat and refer onward to secondary care if appropriate. Such referrals will be expected to confirm that footwear modification has been tried and that the symptoms severely limit essential activities. Referrals without this information will be returned to the referring practice.
Patients with red flags (infection, inflammatory arthritis, complex foot deformity, ulceration or imminent risk of ulceration) can be referred directly to secondary care via DRSS without waiting 12 months.