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Nix SE, Vicenzino BT, Smith MD. Foot pain and functional limitation in healthy adults with hallux valgus: a cross-sectional study. BMC Musculoskelet Disord 2012; 13:197. [PMID: 23067345 PMCID: PMC3526426 DOI: 10.1186/1471-2474-13-197] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 10/11/2012] [Indexed: 11/10/2022] Open
Abstract
Background Hallux valgus (HV) is a very common deformity of the first metatarsophalangeal joint that often requires surgical correction. However, the association between structural HV deformity and related foot pain and disability is unclear. Furthermore, no previous studies have investigated concerns about appearance and difficulty with footwear in a population with HV not seeking surgical correction. The aim of this cross-sectional study was to investigate foot pain, functional limitation, concern about appearance and difficulty with footwear in otherwise healthy adults with HV compared to controls. Methods Thirty volunteers with HV (radiographic HV angle >15 degrees) and 30 matched controls were recruited for this study (50 women, 10 men; mean age 44.4 years, range 20 to 76 years). Differences between groups were examined for self-reported foot pain and disability, satisfaction with appearance, footwear difficulty, and pressure-pain threshold at the first metatarsophalangeal joint. Functional measures included balance tests, walking performance, and hallux muscle strength (abduction and plantarflexion). Mean differences (MD) and 95% confidence intervals (CI) were calculated. Results All self-report measures showed that HV was associated with higher levels of foot pain and disability and significant concerns about appearance and footwear (p < 0.001). Lower pressure-pain threshold was measured at the medial first metatarsophalangeal joint in participants with HV (MD = −133.3 kPa, CI: -251.5 to −15.1). Participants with HV also showed reduced hallux plantarflexion strength (MD = −37.1 N, CI: -55.4 to −18.8) and abduction strength (MD = −9.8 N, CI: -15.6 to −4.0), and increased mediolateral sway when standing with both feet with eyes closed (MD = 0.34 cm, CI: 0.04 to 0.63). Conclusions These findings show that HV negatively impacts on self-reported foot pain and function, and concerns about foot appearance and footwear in otherwise healthy adults. There was also evidence of impaired hallux muscle strength and increased postural sway in HV subjects compared to controls, although general physical functioning and participation in physical activity were not adversely affected.
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Affiliation(s)
- Sheree E Nix
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, QLD, Australia.
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52
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Uritani D, Fukumoto T, Matsumoto D. Intrarater and Interrater Reliabilitiesfor a Toe Grip Dynamometer. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.639] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Daisuke Uritani
- 1) Department of Physical Therapy, Faculty of Health Science, Kio University
| | - Takahiko Fukumoto
- 1) Department of Physical Therapy, Faculty of Health Science, Kio University
| | - Daisuke Matsumoto
- 1) Department of Physical Therapy, Faculty of Health Science, Kio University
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53
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Der alternde Fuß. MANUELLE MEDIZIN 2011. [DOI: 10.1007/s00337-011-0872-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Munteanu SE, Zammit GV, Menz HB. Factors associated with foot pain severity and foot-related disability in individuals with first metatarsophalangeal joint OA. Rheumatology (Oxford) 2011; 51:176-83. [PMID: 22096012 DOI: 10.1093/rheumatology/ker344] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether participant characteristics and localized structural factors are associated with foot pain and foot-related disability in patients with symptomatic first MTP joint OA. METHODS One hundred and fifty-one participants (56 women and 95 men) aged 22-81 [mean age 54.5 (11.2)] years with symptomatic first MTP joint OA underwent a standardized clinical interview and assessment. Participant characteristics [age, gender, height, weight, BMI, duration of symptoms and total years of formal education (education attainment)] and localized factors (first MTP joint dorsiflexion range of motion, severity of radiographic OA, foot posture and plantarflexion strength of the hallux) were determined as potentially associated variables. Outcome variables were foot pain and foot-related disability, determined using the Foot Health Status Questionnaire. Univariate analyses were performed between potentially associated variables and outcome variables. Variables with significant univariate associations were then entered into multivariate linear regression models to identify independently associated variables. RESULTS Education attainment and BMI were both significantly and independently associated with foot pain severity and foot-related disability. However, these variables only explained ∼10-12% of the variance in foot pain and foot-related disability. CONCLUSIONS People with symptomatic first MTP joint OA that have an increased BMI and/or lower level of education attainment experience more foot pain and have greater foot-related disability. Prospective studies are required to confirm these findings and identify other factors associated with foot pain and foot-related disability in people with symptomatic first MTP joint OA.
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Affiliation(s)
- Shannon E Munteanu
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria 3086, Australia.
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55
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Kim YW, Kwon OY, Cynn HS, Weon JH, Yi CH, Kim TH. Comparison of Toe Plantar Flexors Strength and Balancing Ability between Elderly Fallers and Non-fallers. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yong-Wook Kim
- Department of Physical Therapy, College of Alternative Medicine, Jeonju University
| | - Oh-Yun Kwon
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Dept. of Physical Therapy, College of Health Science, Yonsei University
| | - Heon-Seock Cynn
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Dept. of Physical Therapy, College of Health Science, Yonsei University
| | - Jong-Hyuck Weon
- Department of Rehabilitation Medicine, Wonju Christian Hospital, Wonju College of Medicine, Yonsei University
| | - Chung-Hwi Yi
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Dept. of Physical Therapy, College of Health Science, Yonsei University
| | - Tae-Ho Kim
- Department of of Physical Therapy, Daegu Health College
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Hartmann A, Murer K, de Bie RA, de Bruin ED. The effect of a training program combined with augmented afferent feedback from the feet using shoe insoles on gait performance and muscle power in older adults: a randomised controlled trial. Disabil Rehabil 2010; 32:755-64. [PMID: 20491152 DOI: 10.3109/09638280903295441] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Aged-related loss of afferent feedback of the feet plays an important role in gait performance. Although strength, balance and gait training can significantly improve the muscle power and functional abilities of older individuals, it remains unclear whether training effects can be enhanced by augmenting afferent feedback from the feet adding shoe insoles complementary to conventional training. OBJECTIVE The current study investigated the effect of physical exercise combined with wearing MedReflex shoe insoles on the gait performance and muscle power in older adults. METHODS Twenty-eight independent living, older adults aged 65-91 years were randomly assigned to either an insole group (IG; n=14) or a training group (TG; n=14). Further 14 subjects matched to the IG and TG were recruited as a control group (CG; n=14) (no exercise). The IG and TG completed the same training program consisting of aerobic exercises, progressive resistance strength training and stretching exercises twice per week for 12 weeks, whereas, the IG wore the insoles during everyday life and during training sessions. Assessments included the Falls Efficacy Scale - International (FES-I), gait analysis and muscle power measurements of the knee and ankle joint at pre- and post-training. RESULTS There were significant time x group interactions in walking speed, step length and in several muscle power measurements. The positive effects of gait parameters ranged between 1% and 12% and between 1% and 8% and the trend to improvements of muscle power ranged between 15-79% and 20-79% for the IG and TG, respectively. The IG and TG did not differ significantly in their improvements. The CG showed a trend to deteriorations between 0% and-5% for gait parameters and between-4% and-14% for muscle power. No significant change in FES-I score occurred in neither groups. CONCLUSIONS The results of this study provide evidence of significant improvements in gait performance and muscle power after a conventional training program in independent living, older adults. However, there is no additional effect of long-term adaptation of gait caused by wearing insoles concurrent to physical training.
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Affiliation(s)
- Antonia Hartmann
- Institute of Human Movement Sciences and Sport, ETH, Zurich, Switzerland.
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Hartmann A, Murer K, de Bie RA, de Bruin ED. The effect of a foot gymnastic exercise programme on gait performance in older adults: a randomised controlled trial. Disabil Rehabil 2010; 31:2101-10. [PMID: 19888840 DOI: 10.3109/09638280902927010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Aged-related loss of ankle dorsiflexion range of motion (ROM) and toe plantarflexor strength play an important role in gait performance. Further, conventional strength, balance and gait training can significantly improve the lower extremity muscle power and functional abilities of older individuals. It remains unclear, however, whether training effects can be enhanced by augmenting ankle ROM and toe plantarflexor strength complementary to training. OBJECTIVE This study investigated the effect of physical exercise combined with foot gymnastics on the gait performance in older adults. METHODS Fifty-six independent living, older adults aged 66-91 years were randomly assigned to either foot gymnastics group (FG; n = 28) or training group (TG; n = 28). Further, 14 subjects were integrated as a control group (CG; n = 14) (no exercise). The FG and TG completed the same training program consisting of aerobic exercises, progressive resistance strength training and stretching exercises twice per week for 12 weeks, whereas the FG performed additional foot gymnastic exercises at the end of the training session and a 10-min foot gymnastics home-program daily. Assessments included the Falls Efficacy Scale - International (FES-I), Expanded Timed Get-up-and-Go test (ETGUG), gait analysis and muscle power measurements of the knee and ankle joint at pre- and post-training. Results. No significant change in FES-I score occurred in either group. The FG showed a significant improvement of ankle ROM. There were significant time x group interactions in walking speed, step length, in several muscle power measurements and in ETGUG. The positive effects of gait parameters ranged between 1 and 11% and between 2 and 12%, of muscle power between 14 and 34% and 14 and 46% and of ETGUG were 10 and 8% for the FG and TG, respectively. The FG and TG did not differ significantly in their improvements. The CG showed a trend to deteriorations between 0 and -6% for gait parameters, between -4 and -14% for muscle power and 0% for ETGUG. CONCLUSIONS The results of this study provide evidence of significant improvements in gait performance, muscle power and ETGUG after a conventional training program in independent living, older adults. However, there is no additional effect on physical performance after foot gymnastic exercises.
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Affiliation(s)
- Antonia Hartmann
- Institute of Human Movement Sciences and Sport, ETH, Zurich, Switzerland.
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Kwon OY, Tuttle LJ, Johnson JE, Mueller MJ. Muscle imbalance and reduced ankle joint motion in people with hammer toe deformity. Clin Biomech (Bristol, Avon) 2009; 24:670-5. [PMID: 19535185 PMCID: PMC2751588 DOI: 10.1016/j.clinbiomech.2009.05.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 05/14/2009] [Accepted: 05/17/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiple factors may contribute to hammer toe deformity at the metatarsophalangeal joint. The purposes of this study were to (1) compare the ratio of toe extensor/flexor muscle strength in toes 2-4 among groups with and without hammer toe deformity, (2) to determine correlations between the ratio of toe extensor/flexor muscle strength in toes 2-4, and metatarsophalangeal joint deformity (3) to determine if other clinical measures differ between groups and if these measures are correlated with metatarsophalangeal joint angle. METHODS Twenty-seven feet with visible hammer toe deformity and 31 age matched feet without hammer toe deformity were tested. Toe muscle strength was measured using a dynamometer and the ratio of toe extensor muscle strength to flexor muscle strength was calculated. Metatarsophalangeal joint angle was measured from a computerized tomography image. Ankle and subtalar joint range of motion, and tibial torsion were measured using goniometry. FINDINGS Extensor/flexor toe muscle strength ratio was 2.3-3.0 times higher in the hammer toe group compared to the non-hammer toe group, in toes 2-4. The ratios of extensor/flexor toe muscle strength for toes 2-4 and metatarsophalangeal joint angle were highly correlated (r=0.69-0.80). Ankle dorsiflexion and metatarsophalangeal joint angle were negatively correlated for toes 2-4 (r=-0.38 to -0.56) as were eversion and metatarsophalangeal joint angle. INTERPRETATION These results provide insight into potential risk factors for the development of hammer toe deformity. Additional research is needed to determine the causal relationship between hammer toe deformity and the ratio of toe extensor/flexor muscle strength in toes 2-4.
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Affiliation(s)
- OY Kwon
- Department of Physical Therapy, College of Health Science, Yonsei University, South Korea
| | - LJ Tuttle
- Movement Science Program, Washington University, St. Louis, MO
| | - JE Johnson
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO
| | - MJ Mueller
- Movement Science Program, Washington University, St. Louis, MO,Program in Physical Therapy, Washington University, St. Louis, MO
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Munteanu SE, Menz HB, Zammit GV, Landorf KB, Handley CJ, Elzarka A, Deluca J. Efficacy of intra-articular hyaluronan (Synvisc(R)) for the treatment of osteoarthritis affecting the first metatarsophalangeal joint of the foot (hallux limitus): study protocol for a randomised placebo controlled trial. J Foot Ankle Res 2009; 2:2. [PMID: 19146707 PMCID: PMC2636797 DOI: 10.1186/1757-1146-2-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 01/16/2009] [Indexed: 11/27/2022] Open
Abstract
Background Osteoarthritis of the first metatarsophalangeal joint (MPJ) of the foot, termed hallux limitus, is common and painful. Numerous non-surgical interventions have been proposed for this disorder, however there is limited evidence for their efficacy. Intra-articular injections of hyaluronan have shown beneficial effects in case-series and clinical trials for the treatment of osteoarthritis of the first metatarsophalangeal joint. However, no study has evaluated the efficacy of this form of treatment using a randomised placebo controlled trial. This article describes the design of a randomised placebo controlled trial to evaluate the efficacy of intra-articular hyaluronan (Synvisc®) to reduce pain and improve function in people with hallux limitus. Methods One hundred and fifty community-dwelling men and women aged 18 years and over with hallux limitus (who satisfy inclusion and exclusion criteria) will be recruited. Participants will be randomised, using a computer-generated random number sequence, to receive a single intra-articular injection of up to 1 ml hyaluronan (Synvisc®) or sterile saline (placebo) into the first MPJ. The injections will be performed by an interventional radiologist using fluoroscopy to ensure accurate deposition of the hyaluronan in the joint. Participants will be given the option of a second and final intra-articular injection (of Synvisc® or sterile saline according to the treatment group they are in) either 1 or 3 months post-treatment if there is no improvement in pain and the participant has not experienced severe adverse effects after the first injection. The primary outcome measures will be the pain and function subscales of the Foot Health Status Questionnaire. The secondary outcome measures will be pain at the first MPJ (during walking and at rest), stiffness at the first MPJ, passive non-weightbearing dorsiflexion of the first MPJ, plantar flexion strength of the toe-flexors of the hallux, global satisfaction with the treatment, health-related quality of life (assessed using the Short-Form-36 version two questionnaire), magnitude of symptom change, use of pain-relieving medication and changes in dynamic plantar pressure distribution (maximum force and peak pressure) during walking. Data will be collected at baseline, then 1, 3 and 6 months post-treatment. Data will be analysed using the intention to treat principle. Discussion This study is the first randomised placebo controlled trial to evaluate the efficacy of intra-articular hyaluronan (Synvisc®) for the treatment of osteoarthritis of the first MPJ (hallux limitus). The study has been pragmatically designed to ensure that the study findings can be implemented into clinical practice if this form of treatment is found to be an effective treatment strategy. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12607000654459
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Affiliation(s)
- Shannon E Munteanu
- Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia.
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KANEKO R, FUJISAWA S, SASAKI M. Influence of Toe Flexor Muscle Strength Training on Floor Reaction Force during Maximum Speed Walk. ACTA ACUST UNITED AC 2009. [DOI: 10.1589/rika.24.411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ryo KANEKO
- Department of Rehabilitation, Moritake Onsen Hospital
| | | | - Makoto SASAKI
- Department of Physical Therapy, Graduate School of Health Sciences, Akita University
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Spink MJ, Menz HB, Lord SR. Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: study protocol for a randomised trial. BMC Geriatr 2008; 8:30. [PMID: 19025668 PMCID: PMC2613884 DOI: 10.1186/1471-2318-8-30] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 11/25/2008] [Indexed: 11/16/2022] Open
Abstract
Background Falls in older people are a major public health problem, with at least one in three people aged over 65 years falling each year. There is increasing evidence that foot problems and inappropriate footwear increase the risk of falls, however no studies have been undertaken to determine whether modifying these risk factors decreases the risk of falling. This article describes the design of a randomised trial to evaluate the efficacy of a multifaceted podiatry intervention to reduce foot pain, improve balance, and reduce falls in older people. Methods Three hundred community-dwelling men and women aged 65 years and over with current foot pain and an increased risk of falling will be randomly allocated to a control or intervention group. The "usual cae" control group will receive routine podiatry (i.e. nail care and callus debridement). The intervention group will receive usual care plus a multifaceted podiatry intervention consisting of: (i) prefabricated insoles customised to accommodate plantar lesions; (ii) footwear advice and assistance with the purchase of new footwear if current footwear is inappropriate; (iii) a home-based exercise program to strengthen foot and ankle muscles; and (iv) a falls prevention education booklet. Primary outcome measures will be the number of fallers, number of multiple fallers and the falls rate recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the Medical Outcomes Study Short Form 12 (SF-12), the Manchester Foot Pain and Disability Index, the Falls Efficacy Scale International, and a series of balance and functional tests. Data will be analysed using the intention to treat principle. Discussion This study is the first randomised trial to evaluate the efficacy of podiatry in improving balance and preventing falls. The trial has been pragmatically designed to ensure that the findings can be generalised to clinical practice. If found to be effective, the multifaceted podiatry intervention will be a unique addition to common falls prevention strategies already in use. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12608000065392
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Affiliation(s)
- Martin J Spink
- Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia.
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