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Sarika, Sadhnani A. Evaluation and comparison of plantar pressure distribution and gait parameters in athletes with and without hallux valgus. Foot (Edinb) 2024; 60:102120. [PMID: 39111069 DOI: 10.1016/j.foot.2024.102120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/18/2024] [Indexed: 09/17/2024]
Abstract
The aim of the study was to measure and compare plantar pressures, forces and gait parameters in athletes with and without hallux valgus. It was a cross sectional study with the sample Size: 106 [53 for each group (Hallux valgus and without hallux valgus)]. Hallux valgus angle was calculated with digital photographs uploaded on Karasunpo software. Participants only with the moderate and severe hallux valgus angle were selected. For participant having hallux valgus in both the feet, one with the greater angle of hallux valgus was selected. Participants without hallux valgus were the ones whose hallux valgus angle was less than 15 degrees. The participants of both groups were asked to walk on predetermined speed of 4.8 kmph. The device used was Zebris FDM-T (Zebris® Medical GmbH, Germany) for the pedobarographic and gait parameter measurement. On an average, measurement was recorded for 20 steps during the different phases of gait in all subjects and corresponding mean values were calculated. Mean values for all the readings were documented and statistically calculated. Statistical analysis was done using SPSS (v.27.0.1) with unpaired t-test to compare between both the groups. Shapiro-Wilk test was used to check normality of data. Significant p-values for forefoot forces (0.001), forefoot pressures (<0.001) and midfoot pressures (0.002) were found. There is clear evidence of increased foot loading in young adult athletes with hallux valgus on the forefoot and midfoot regions while performing activities.
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Affiliation(s)
- Sarika
- MYAS-GNDU Department of Sports Sciences & Medicine, Guru Nanak Dev University, Amritsar, Punjab, India.
| | - Aakash Sadhnani
- MYAS-GNDU Department of Sports Sciences & Medicine, Guru Nanak Dev University, Amritsar, Punjab, India.
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Menz HB, Lim PQX, Hurn SE, Mickle KJ, Buldt AK, Cotchett MP, Roddy E, Wluka AE, Erbas B, Munteanu SE. Effectiveness of footwear and foot orthoses in reducing medial metatarsophalangeal joint pressure in women with hallux valgus. Gait Posture 2024; 111:156-161. [PMID: 38703444 DOI: 10.1016/j.gaitpost.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/24/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Hallux valgus is a common condition where the subluxation of the first metatarsophalangeal joint and lateral deviation of the hallux at the interphalangeal joint creates difficulty with footwear fit. Footwear and foot orthoses are commonly prescribed nonsurgical treatments for hallux valgus. RESEARCH QUESTION Do extra-width footwear and foot orthoses influence peak pressure at the medial aspect of the metatarsophalangeal and interphalangeal joints in women with hallux valgus? METHODS Community-dwelling women with symptomatic hallux valgus underwent gait testing when wearing their own shoes and when wearing extra-width footwear fitted with three-quarter length, arch-contouring prefabricated foot orthoses. Peak pressure (kPa) on the medial aspect of the metatarsophalangeal and medial interphalangeal joints and on the plantar surface of the foot (hallux, lesser toes, metatarsophalangeal joint 1, metatarsophalangeal joints 2-5, midfoot and heel) were measured using the novel pedar®-X system with the pedar® pad and pedar® insole, respectively (Novel, GmbH, Munich, Germany). Paired samples t-tests were used to calculate the differences between the two conditions, and the magnitude of observed differences was calculated using Cohen's d. RESULTS We tested 28 participants (aged 44-80 years, mean 60.7, standard deviation 10.7). Compared to their own footwear, wearing the intervention footwear and orthoses was associated with a statistically significant decrease in pressure on the medial aspect of the metatarsophalangeal joint (58.3 ± 32.8 versus 42.6 ± 32.8, p=0.026, d=0.49), increased pressure under the midfoot (70.7 ± 25.7 versus 78.7 ± 23.6, p=0.029, d=0.33) and decreased pressure underneath the heel (137.3 ± 39.0 versus 121.3 ± 34.8, p=0.019, d=0.45). SIGNIFICANCE The intervention footwear and orthoses significantly decreased peak pressure on the medial aspect of the first metatarsophalangeal joint but had no significant effect on the interphalangeal joint. Further studies are required to determine whether these changes are associated with improvements in symptoms associated with hallux valgus.
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Affiliation(s)
- Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia.
| | - Polly Q X Lim
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia
| | - Karen J Mickle
- Applied Sport Science and Exercise Testing Laboratory, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, New South Wales 2258, Australia
| | - Andrew K Buldt
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Matthew P Cotchett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom; Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire ST6 7AG, United Kingdom
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Shannon E Munteanu
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia
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Rosemberg DL, Gustafson JA, Bordignon G, Bohl DD, Leporace G, Metsavaht L. Biokinetic Evaluation of Hallux Valgus during Gait: A Systematic Review. Foot Ankle Int 2023; 44:763-777. [PMID: 37086002 DOI: 10.1177/10711007231166667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
BACKGROUND Foot pathologies can affect the kinetic chain during gait, leading to altered loading at other joints that can lead to subsequent pathologies. Although hallux valgus is the most common foot disease, little has been discussed about the biokinetic effects of hallux valgus on the foot and lower limb. This systematic review evaluated the kinematic, kinetic, and pedobarographic changes of the hallux valgus foot compared to a healthy one. METHODS Several electronic databases were searched up to January 2022, including only cross-sectional studies with clearly defined isolated hallux valgus diseases and healthy groups. Two investigators independently rated studies for methodological quality using the NIH Study Quality Assessment Tool for cross-sectional studies. Kinetic data were extracted, including temporal data, kinematics of the foot joint, kinematics of the proximal lower limb, and pedobarography. We did meta-analyses tests with a random effects model using the metafor package in R. RESULTS Hallux valgus patients walk slower compared to a disease-free control group -0.16 m/s (95% CI -0.27, -0.05). Hallux valgus patients exhibited significantly reduced coronal plane motion of the hindfoot-shank during preswing 1.16 degrees (95% CI 0.31, 2.00). Hallux valgus patients generated less force in the hallux region 33.48 N (95% CI 8.62, 58.35) but similar peak pressures in the hallux compared to controls. Hallux valgus patients generated less peak pressure at the medial and lateral hindfoot as compared to controls: 8.28 kPa (95% CI 2.92, 13.64) and 8.54 kPa (95% CI 3.55, 13.52), respectively. CONCLUSION Although hallux valgus is a deformity of the forefoot, the kinematic changes due to the pathology are associated with significant changes in the range of motion at other joints, underscoring its importance in the kinetic chain. This is demonstrated again with the changes of peak pressure. Nevertheless, more high-quality studies are still needed to develop a fuller understanding of this pathology.
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Affiliation(s)
- Dov Lagus Rosemberg
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, RJ, Brasil
- Midwest Orthopedics at Rush (MOR), Chicago, IL, USA
- RUSH-IBTS International Fellowship Program, Chicago, IL, USA
- Lab. Prof. Manlio Mario Marco Napoli, Departamento de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Jonathan A Gustafson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Glaucia Bordignon
- Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, RJ, Brasil
- Midwest Orthopedics at Rush (MOR), Chicago, IL, USA
- RUSH-IBTS International Fellowship Program, Chicago, IL, USA
- Departamento de Ortopedia e Traumatologia, Hospital Municipal Universitário de Taubaté, Taubaté, SP, Brasil
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gustavo Leporace
- Institute Brazil of Technologies in Health, Rio de Janeiro, Brazil
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Baravarian B, DiDomenico LA, Volteau M, Armstrong DG, Silva R. Exploring the Relationship Between Clinical Presentation in Hallux Valgus and Response to AbobotulinumtoxinA Treatment. J Foot Ankle Surg 2023; 62:556-562. [PMID: 36804286 DOI: 10.1053/j.jfas.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023]
Abstract
The relationship between pain/disability and angular deviation of the hallux valgus (HV), and the impact of orthotic use, laterality, and pain variability on treatment outcomes remain unclear. This was explored in post hoc analyses of a placebo-controlled trial of abobotulinumtoxinA (aboBoNT-A; Dysport®) for HV-associated pain (NCT03569098). The primary endpoint was not met in this study (change from baseline Numeric Pain Rating Scale [NPRS] score vs placebo at week 8); however, there was a greater reduction from baseline in mean NPRS score at week 12 with aboBoNT-A 500U versus placebo (p = .06). Adults with painful HV without surgery were randomized (1:1:1) to aboBoNT-A 300U, aboBoNT-A 500U, or placebo. NPRS was completed for 7 days before baseline and weeks 4, 8, and 12. Over-the-counter orthoses were permitted. Participants (N = 186) had a mean [standard deviation, SD] age of 48.2 [13.1] years, 18% (33/186) used orthotics, and 67% (124/186) had bilateral HV. No associations between baseline pain severity and angular deviation were identified. Participants with high pain variability at baseline (SD > 2) had a poorer response to aboBoNT-A treatment than those with less variability. In conclusion, no relationship between HV-related pain/disability and angular deviation was observed. PLAIN LANGUAGE SUMMARY: A bunion (medical term: hallux valgus) is a common adult foot problem in which the big toe points inward toward the other toes, and this can be painful. How much the big toe points inward (how deformed the foot is) has been linked to the amount of pain the patient experiences. A better understanding of this foot deformity and bunion pain will help doctors and patients to make the right treatment decisions. A study was completed looking at how injections of a type of botulinum toxin (abobotulinumtoxinA) into specific muscles in the foot may help to reduce bunion pain in patients without surgery. This subsequent analysis of the study data looked at the amount of foot deformity in patients, the bunion pain they experienced, and which factors affected how well abobotulinumtoxinA worked to reduce bunion pain. The results of this study showed that the amount of foot deformity was not linked to the level of bunion pain. When deciding the best treatment option to relieve bunion pain, it is important that doctors not only consider how deformed the foot is, but also other important factors such as foot pain levels.
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Affiliation(s)
| | | | | | - David G Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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郑 文, 陆 芸. [Three-dimensional finite element analysis of Swanson prosthesis-arthroplasty of the first metatarsophalangeal joint combined with osteotomy and bone grafting of the first metatarsal bone for hallux valgus]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1114-1118. [PMID: 36111474 PMCID: PMC9626298 DOI: 10.7507/1002-1892.202204126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 01/24/2023]
Abstract
Objective To analyze the biomechanical changes of hallux valus after Swanson prosthesis-arthroplasty of the 1st metatarsophalangeal joint combined with osteotomy and bone grafting of the 1st metatarsal bone by three-dimensional finite element analysis, so as to provide data basis for studying the changes of foot morphology and physiological function after hallux valus correction surgery. Methods A 65-year-old female patient with severe hallux valus admitted in January 2013 was selected as the research object. The CT data of the right foot was obtained, and the three-dimensional finite element models before and after Swanson prosthesis-arthroplasty of the 1st metatarsophalangeal joint combined with osteotomy and bone grafting of the 1st metatarsal bone were established by Mimics10.01, Geomagic Studio, and ANSYS12.0 software. ANSYS 12.0 software was used for nonlinear static stress analysis, and the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the von Mises stress distributions of the forefoot plantar surface and the 1st to 5th metatarsal bones were observed before and after operation. Results The HVA and IMA were 56.3° and 16.3° before operation and 9.2° and 9.8° after operation, respectively. Before operation, the stress on the forefoot was the largest in the 4th metatarsal head zone and the smallest in the 1st metatarsal head zone; the stress on the medial side of the forefoot was significantly smaller than that on the lateral side, and the center of forefoot pressure was located on the lateral side. After operation, the stress on the forefoot was the largest in the 1st metatarsal head zone and the smallest in the 5th metatarsal head zone; the stress on the lateral side of the forefoot was significantly smaller than that on the medial side, and the center of forefoot pressure was located on the medial side. Before operation, the stress of the 5th metatarsal bone was the largest, and the 1st metatarsal bone was the smallest. After operation, the stress of the 1st metatarsal bone was the largest, and the 4th metatarsal bone was the smallest. Conclusion Swanson prosthesis-arthroplasty of the 1st metatarsophalangeal joint combined with osteotomy and bone grafting of the 1st metatarsal bone can effectively correct hallux valgus and make HVA, IMA, and plantar pressure distribution close to normal. However, postoperative stresses of the 1st to 5th metatarsal bones elevate, which may lead to associated complications.
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Affiliation(s)
- 文源 郑
- 玉林市第一人民医院骨科(广西玉林 537000)Department of Orthopaedics, Yulin First People’s Hospital, Yulin Guangxi, 537000, P. R. China
| | - 芸 陆
- 玉林市第一人民医院骨科(广西玉林 537000)Department of Orthopaedics, Yulin First People’s Hospital, Yulin Guangxi, 537000, P. R. China
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Fotoohabadi M, Spink MJ, Menz HB. Relationship between lower limb muscle strength and hallux valgus severity in older people. Foot (Edinb) 2021; 46:101751. [PMID: 33290977 DOI: 10.1016/j.foot.2020.101751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine differences in lower limb muscle strength between older people with varying degrees of hallux valgus deformity. METHODS Muscle strength was measured at the knee, ankle and foot using hand-held dynamometry and a clinical test of toe strength (the paper grip test) in 157 older people (99 women and 58 men) aged 65 to 91 (mean 74.1, SD 5.9) years. Hallux valgus severity was documented as none, mild, moderate or severe using validated photographs. Differences in muscle strength according to hallux valgus severity were evaluated using analysis of variance, adjusting for age. Paper grip test performance was compared across the hallux valgus severity groups using the chi-square (χ2) statistic. RESULTS Knee extension, ankle joint dorsiflexion, ankle joint plantar flexion, ankle joint inversion, ankle joint eversion and lesser toe plantarflexion strength were not significantly different across the four hallux valgus severity groups. However, there was a significant, dose-response reduction in hallux plantarflexion strength with increasing severity of hallux valgus. This persisted after adjustment for age (F3 = 5.5, p = 0.001) with a medium effect size (partial η2 = 0.10). The number of participants who could successfully complete the paper grip test of the hallux significantly reduced across the four hallux valgus categories (χ2 = 18.5, p < 0.001). CONCLUSIONS There is a specific and progressive reduction in hallux plantarflexion strength with increasing severity of hallux valgus in older people. This finding has potential implications for both the aetiology and treatment of this common and disabling condition.
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Affiliation(s)
- Mohammadreza Fotoohabadi
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Martin J Spink
- School of Health Sciences, Faculty of Medicine and Health, University of Newcastle, Ourimbah, New South Wales 2258, Australia
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria 3086, Australia.
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Yokozuka M, Okazaki K, Sakamoto Y, Takahashi K. Correlation between functional ability, toe flexor strength, and plantar pressure of hallux valgus in young female adults: a cross-sectional study. J Foot Ankle Res 2020; 13:44. [PMID: 32660543 PMCID: PMC7359483 DOI: 10.1186/s13047-020-00411-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/02/2020] [Indexed: 01/29/2023] Open
Abstract
Background The prevalence of hallux valgus (HV) increases with age in females. Several studies have investigated the relationship between foot problems, including HV, and falls in older individuals. This study aimed to examine whether HV causes a decline in functional activity in young females and also evaluate the relationship between HV angle, functional activity, toe flexor strength, and plantar pressure. Methods We assessed 94 females (mean age, 19.6 ± 1.3 years; mean body mass index, 21.2 ± 2.0 kg/m2) not currently receiving treatment for lower limb disease. HV angle was determined using their footprint. Functional reach (FR) and maximum step length (MSL), toe flexor strength, and plantar pressure were measured. Plantar pressure was measured during walking. We also calculated FR and the pressure in eight regions (first toe, second through fifth toes, first metatarsal, second through fourth metatarsals, fifth metatarsal, midfoot, medial heel, and lateral heel). Results There were 39 and 55 participants in the HV and no HV groups, respectively. FR and MSL did not differ significantly between the HV and no HV groups. Toe flexor strength was significantly different between the HV and no HV groups (26.69 ± 9.68 vs. 32.19 ± 8.55, respectively) (p = 0.002, β = 0.206). During walking, plantar pressure was significantly lower in the second through fifth toes in the HV group (p = 0.005, β = 0.187). During FR, plantar pressure was significantly greater in the first metatarsal in the HV group (p = 0.016, β = 0.338). HV angle was negatively correlated with toe flexor strength (r = − 0.315, p = 0.002, β = 0.121) and plantar pressure during walking in the second through fifth toes (r = − 0.362, p < 0.001, β = 0.047), and positively correlated with plantar pressure during FR in the first metatarsal (r = 0.308, p = 0.002, β = 0.137). Toe flexor strength was negatively correlated with plantar pressure during FR in the second through fourth metatarsals (r = − 0.318, p = 0.002, β = 0.115), and there was a positive correlation with MSL (r = 0.330, p = 0.001, β = 0.092). Conclusions This study confirmed that HV reduces toe flexor strength and affects forefoot pressure during walking and FR in young females. Moreover, the toe flexor strength affects MSL. Efforts to prevent the onset and deterioration of HV from a young age might help reduce the risk of falling when older.
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Affiliation(s)
- Mieko Yokozuka
- Preparing Section for New Faculty of Medical Science, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan.
| | - Kanako Okazaki
- Preparing Section for New Faculty of Medical Science, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan
| | - Yuko Sakamoto
- School of Nursing, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan
| | - Koko Takahashi
- School of Nursing, Fukushima Medical University, 1 Hikariga-oka, Fukushima, 960-1295, Japan
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