The topics: pelvic pain and hallux valgus.
I was unsurprised by the statistic that up to 55% of women with chronic pelvic pain remain undiagnosed following investigation, and by the advice that it is important to clarify to women undergoing diagnostic laparoscopy that the procedure is diagnostic rather than therapeutic and may well not even prove to be the former, given the statistics. Possible treatments include the COC, although there isn’t really much evidence as to whether or not it works; medroxyprogesterone, which is often helpful in the short term although the effect tends to wear off after some months; and the usual treatments for chronic pain.
Hallux valgus has a strong family history. Don’t assess it with the patient standing – this exaggerates the deformity (although I would have thought that a deformity exaggerated on standing is going to be more of a problem to the patient?) Up to 15 degrees of lateral deviation is counted as within normal limits. Wide shoes with a soft sole and low heel may be helpful in conservative management, as may OTC felt bunion pads/posts. If that does not help, chiropody referral for custom-made night splints, or orthotic referral, can sometimes be options short of surgery if a patient wishes. The natural history is of slow progression and trying conservative treatment first doesn’t jeopardise the final outcome. The problem can recur after surgery, and worsened function is a possible risk of surgery.