{"content":[{"text":"SHIP8 Clinical Commissioning Groups Priorities Committee","bbox":{"left":0.160459,"top":0.112174,"width":0.678954,"height":0.02223}},{"text":"No. 51","bbox":{"left":0.849019,"top":0.147523,"width":0.05565400000000009,"height":0.018061999999999995}},{"text":"Policy Recommendation:","bbox":{"left":0.095728,"top":0.177606,"width":0.22080300000000003,"height":0.018061999999999995}},{"text":"Bunions","bbox":{"left":0.337649,"top":0.177606,"width":0.07396000000000003,"height":0.018061999999999995}},{"text":"Date of issue:","bbox":{"left":0.095728,"top":0.237629,"width":0.12120200000000002,"height":0.018061999999999995}},{"text":"April 2019","bbox":{"left":0.27714,"top":0.237629,"width":0.08855299999999999,"height":0.018061999999999995}},{"text":"The committee considered the operative management of Hallux Valgus (bunions). It heard from a \n variety of orthopaedic consultants as well as an in-depth evidence review. The committee makes \n the following recommendations:","bbox":{"left":0.095728,"top":0.267824,"width":0.7941619999999999,"height":0.04810499999999995}},{"text":"Management of patients with bunions and peripheral neuropathy or diabetes is outside of the \n scope of this review and needs to continue to be managed carefully through a multi-disciplinary \n approach.","bbox":{"left":0.095728,"top":0.327989,"width":0.7768539999999999,"height":0.04810500000000001}},{"text":"The trial evidence for benefit from interventions was lacking. The committee recommends that this \n intervention should be low priority.","bbox":{"left":0.095728,"top":0.388012,"width":0.800006,"height":0.03313499999999997}},{"text":"However, patients with significant functional impairment that does not respond to conservative \n measures must be assessed through the MSK triage service to ascertain if they are likely to benefit \n from intervention.","bbox":{"left":0.095728,"top":0.433065,"width":0.808202,"height":0.048128000000000004}},{"text":"In this instance ‘significant’ is taken to mean;","bbox":{"left":0.095728,"top":0.493254,"width":0.364771,"height":0.018022000000000038}},{"text":"","bbox":{"left":0.125998,"top":0.525105,"width":0.008528000000000008,"height":0.016069}},{"text":"Symptoms of significant functional impairment that prevent them from properly fulfilling \n work, domestic or carer duties or educational responsibilities; AND \n Significant functional impairment is present more than half the time; AND \n This impairment happens frequently over the preceding 30 days","bbox":{"left":0.156227,"top":0.524192,"width":0.7055600000000001,"height":0.06492799999999999}},{"text":" \n ","bbox":{"left":0.125998,"top":0.556043,"width":0.008528000000000008,"height":0.03203800000000001}},{"text":"Review date: April 2023","bbox":{"left":0.095728,"top":0.856652,"width":0.20642900000000003,"height":0.018062000000000022}}],"images_bbox":[],"images_bbox_not_text_overlap":[]}