Gait changes in individuals with bilateral hallux valgus reduce first metatarsophalangeal loading but increase knee abductor moments

Lower limb kinematic changes during gait after hallux valgus surgery: A prospective observational study

BACKGROUND

Patients with hallux valgus are known to alter lower limb joint kinematics during gait. However, little information is available about gait changes following hallux valgus surgery. We aimed to longitudinally investigate lower limb kinematic changes at the mid and terminal stances of gait after hallux valgus surgery.

METHODS

This prospective observational study included 11 female patients (17 feet), who underwent first metatarsal osteotomy. Gait analyses were performed preoperatively and 1- and 2-year postoperatively using a three-dimensional motion capture system. Toe-out angle, ankle, knee, and hip joint angles during gait were calculated from the recorded data. The spatiotemporal parameters and these angles at the mid and terminal stances of gait were statistically compared between preoperative and postoperative periods.

FINDINGS

All spatiotemporal parameters remained unchanged postoperatively. The toe-out angle was significantly greater at 1- and 2-year postoperatively. The ankle pronation angle, the knee abduction angle, and the hip adduction angle at the mid and terminal stances of gait were smaller postoperatively compared to the preoperative. These angular changes showed a similar trend at 1 and 2 years postoperatively. However, the postoperative changes of the sagittal joint angles were relatively small.

INTERPRETATION

Hallux valgus surgery can affect the toe-out angle and the lower limb coronal kinematics at the mid and terminal stances of gait in patients with hallux valgus. However, surgical correction of hallux valgus deformity did not directly improve the gait characteristics in patients with hallux valgus.

Muscle synergy and kinematic synergy analyses during sit-to-stand motions in hallux valgus patients before and after treatment with Kinesio taping

OBJECTIVES

To explore the impact of hallux valgus (HV) on lower limb neuromuscular control strategies during the sit-to-stand (STS) movement, and to evaluate the effects of Kinesio taping (KT) intervention on these control strategies in HV patients.

METHODS

We included 14 young healthy controls (HY), 13 patients in the HV group (HV), and 11 patients in the HV group (HVI) who underwent a Kinesio taping (KT) intervention during sit-to-stand (STS) motions. We extracted muscle and kinematic synergies from EMG and motion capture data using non-negative matrix factorization (NNMF). In addition, we calculated the center of pressure (COP) and ground reaction forces (GRF) to assess balance performance.

RESULTS

There were no significant differences in the numbers of muscle and kinematic synergies between groups. In the HV group, knee flexors and ankle plantar flexors were abnormally activated, and muscle synergy D was differentiated. Muscle synergy D was not differentiated in the HVI group.

CONCLUSION

Abnormal activation of knee flexors and plantar flexors led to the differentiation of module D in HV patients, which can be used as an indicator of the progress of HV rehabilitation. KT intervention improved motor control mechanisms in HV patients.

Determinants of Achilles tendon thickness and their influence on knee function and foot alignment in knee osteoarthritis

Knee osteoarthritis (OA) significantly impacts the quality of life of individuals globally. However, the interconnections between Achilles tendon thickness, knee symptoms/functions, and foot alignment remain understudied in knee OA patients. This study determines the relationships between Achilles tendon thickness (ATT), knee symptoms/functions, and foot alignment in knee OA patients, considering their interconnected biomechanical nature. In a cross-sectional analysis involving 122 knee OA patients, Knee injury and Osteoarthritis Outcome Score (KOOS) assessed knee function and symptoms. Forefoot, midfoot, and rearfoot alignment were measured using hallux valgus angle, navicular/foot ratio, and rearfoot angle. The navicular/foot ratio represented the ratio of navicular height to total foot length. ATT was measured using a digital calliper. Pearson correlations and stepwise multiple linear regression models were employed to explore relationships and determinants. Out of 122 participants, 88 (72.1%) were females. ATT correlated significantly with ankle range of motion, forefoot alignment, and midfoot alignment. In stepwise multivariable regression, ankle range of motion, navicular/foot ratio, and age were significantly associated with ATT (adjusted R2 = 0.44). Similarly, KOOS-Symptoms scores were linked to the OA severity, navicular/foot ratio, ankle range of motion, gastrocnemius strength, and age (adjusted R2 = 0.22). KOOS-Function scores were significantly associated with knee OA severity, gastrocnemius strength, ankle range of motion, and age (adjusted R2 = 0.19). Midfoot alignment was significantly associated with ATT and knee symptoms in patients with Knee OA. This suggests potential benefits of interventions targeting both Achilles tendon properties and foot alignment for improved knee OA outcomes.

Effects of different step lengths at a preferred walking speed on forefoot, midfoot, and hindfoot motion in healthy young adults

Hindfoot, midfoot, and forefoot motion during the stance phase of walking provide insights into the forward progression of the body over the feet via the rocker mechanisms. These segmental motions are affected by walking speed. Increases in walking speed are accomplished by increasing step length and cadence. It is unknown if taking short, medium, and long steps at the same speed would increase hindfoot, midfoot, and forefoot motion similarly to walking speed. We examined effects of different step lengths at the same preferred walking speed on peak forefoot, midfoot, and hindfoot motions related to the foot rockers. Twelve young healthy adults completed five walking trials under three step length conditions in a random order as feet and lower extremity motion were measured via marker positions for the combined Oxford foot and conventional gait models. Peak hindfoot, midfoot, and forefoot joint angles indicating heel, ankle, and forefoot rockers were identified. When walking at the same preferred speed with increase in step length, there were increases in peak hindfoot-tibia plantarflexion angle (p < 0.001; ηp2 = 0.76) in early stance associated with the heel rocker and peak hindfoot-tibia dorsiflexion angle (p = 0.016; ηp2 = 0.39) in midstance associated with ankle rocker. In late stance, the peak hindfoot-tibia plantarflexion angle, forefoot-hindfoot angle, and forefoot-hallux dorsiflexion angle indicating forefoot rocker motion also increased with step length (p < 0.01). When foot kinematics are compared across different individuals or the same individual across different sessions, researchers and clinicians should consider the influence of step length as a contributor to differences in foot kinematics observed.

Biokinetic Evaluation of Hallux Valgus during Gait: A Systematic Review

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.

Effects of Foot-Toe Orthoses on Moment and Range of Motion of Knee Joint in Individuals with Hallux Valgus

Although various types of hallux valgus (HV) orthoses have been used to manage hallux valgus deformity, few previous studies have determined the biomechanical effects of applying a foot-toe orthosis as a therapeutic intervention for HV deformity on the kinetics and kinematics of the knee joint. Biomechanical variables were collected from 24 patients with HV. A three-dimensional motion capture system and force platforms were used to analyze the kinetic and kinematic variables in HV orthosis conditions during gait. To determine the biomechanical effect of each orthosis for HV on knee kinetic and kinematic values, repeated-measures ANOVA was used. The knee adduction moment was significantly decreased under a hard plastic orthosis (HPO) condition compared to that under a without foot-toe orthosis (WTO) condition (p = 0.004). There was a significant decrease in maximal external rotation of the knee joint in HPO than in WTO at the stance phase during gait (p = 0.021). All of the kinetic and kinematic data showed no significant differences between WTO and soft silicone orthosis conditions (p > 0.05). This study indicates that a stronger foot-toe orthosis, such as HPO, to correct HV deformity has a positive effect on the moment and joint motion occurring in the knee joint during walking. In particular, the application of this type of HV orthosis can reduce knee adduction moments associated with the development and progression of knee OA.

Association of Hallux Valgus with Degenerative Spinal Diseases: A Population-Based Cohort Study

Background: Although hallux valgus is known to cause lower-back pain, the association between hallux valgus and spinal degenerative disease remains unclear. Methods: A retrospective cohort study was conducted between 1 January 2000 and 31 December 2015 using data from the Longitudinal Health Insurance Database in Taiwan. After propensity score matching for age, sex, and some potential comorbidities, 1000 individuals newly diagnosed with hallux valgus were enrolled in the study group, while 1000 individuals never diagnosed with hallux valgus served as the control group. Both groups were followed up until 2015 to evaluate the incidence of hallux valgus. Kaplan-Meier analysis was used to determine the cumulative incidence of hallux valgus, while the Cox proportional hazard model was adopted to estimate the hazard ratio (HR) and adjusted hazard ratio (aHR) with 95% confidence intervals (CIs). Results: The incidence densities of spinal degeneration in the hallux valgus and non-hallux valgus groups were 73.10 and 42.63 per 1000 person-years, respectively. An increased risk of spinal degenerative changes was associated with hallux valgus (adjusted HR = 1.75, 95% CI = 1.50−2.05). Age- and sex-stratified analyses showed a significantly higher risk of spinal degeneration in the hallux valgus group. Moreover, sub-outcome evaluations revealed significantly higher risks of spondylosis (aHR = 2.01, 95% CI = 1.55−2.61), intervertebral disorder (aHR = 2.27, 95% CI = 1.62−3.17), and spinal stenosis (aHR = 1.24, 95% CI = 1.47−1.76). There was also an increased risk of spinal degenerative change in those with hallux valgus without surgical intervention (aHR = 1.95, 95% CI = 1.66−2.99, p < 0.001). Conclusions: Hallux valgus was associated with increased risk of degenerative spinal changes and other spinal disorders.

An investigation into the hammer toe effects on the lower extremity mechanics and plantar fascia tension: A case for a vicious cycle and progressive damage

Hammer toes are one of the common deformities of the forefoot that can lead to compensatory changes during walking in individuals with this condition. Predicting the adverse effects of tissue damage on the performance of other limbs is very important in the prevention of progressive damage. Finite element (FE) and musculoskeletal modeling can be helpful by allowing such effects to be studied in a way where the internal stresses in the tissue could be investigated. Hence, this study aims to investigate the effects of the hammer toe deformity on the lower extremity, especially on the plantar fascia functions. To compare the joint reactions of the hammer toe foot (HTF) and healthy foot (HF), two musculoskeletal models (MSM) of the feet of a healthy individual and that of a participant with hammer toe foot were developed based on gait analysis. A previously validated 3D finite element model which was constructed using Magnetic Resonance Imaging (MRI) of the diabetic participant with the hammer toe deformity was processed at five different events during the stance phase of gait. It was found that the hammer toe deformity makes dorsiflexion of the toes and the windlass mechanism less effective during walking. Specifically, the FE analysis results showed that plantar fascia (PF) in HTF compared to HF played a less dominant role in load bearing with both medial and lateral parts of PF loaded. Also, the results indicated that the stored elastic energy in PF was less in HTF than the HF, which can indicate a higher metabolic cost during walking. Internal stress distribution shows that the majority of ground reaction forces are transmitted through the lateral metatarsals in hammer toe foot, and the probability of fifth metatarsal fracture and also progressive deformity was subsequently increased. The MSM results showed that the joint reaction forces and moments in the hammer toe foot have deviated from normal, where the metatarsophalangeal joint reactions in the hammer toe were less than the values in the healthy foot. This can indicate a vicious cycle of foot deformity, leading to changes in body weight force transmission line, and deviation of joint reactions and plantar fascia function from normal. These in turn lead to increased internal stress concentration, which in turn lead to further foot deformities. This vicious cycle cause progressive damage and can lead to an increase in the risk of ulceration in the diabetic foot.

Can a Biomechanical Foot Orthosis Affect Gait in Patients With Hallux Valgus? A Pilot Study

OBJECTIVE

To investigate the effects of customized biomechanical foot orthosis (BFO) on kinematic data during gait in patients with hallux valgus (HV) deformities and compare the results with those of a normal control group.

METHODS

Ten patients with HV deformities and 10 healthy volunteers were enrolled in this study. HV deformity was diagnosed using biomechanical and radiological assessments by a rehabilitation physician. Patients received the customized BFO manufactured at a commercial orthosis laboratory (Biomechanics, Goyang, South Korea) according to the strictly defined procedure by a single experienced technician. The spatiotemporal and kinematic data acquired by the Vicon 3D motion capture system (Oxford Metrics, Oxford, UK) were compared between the intervention groups (control vs. HV without orthosis) and between the HV groups (with vs. without orthosis).

RESULTS

The temporal-spatial and kinematic parameters of the HV group were significantly different from those of the control group. After applying BFO to the HV group, significantly increased ranges of plantar flexion motion and hindfoot inversion were observed. Furthermore, the HV group with BFO showed improved gait cadence, walking speed, and stride length, although the results were not statistically significant.

CONCLUSION

Our results suggest that it is imperative to understand the pathophysiology of HV, and the application of customized BFO can be useful for improving kinematics in HV deformities.

Comparison of the effects of foot-toe orthoses on three-dimensional pelvic kinematics in individuals with hallux valgus during gait

BACKGROUND

Most previous studies focused on the possible relationship between hallux valgus deformity and biomechanical characteristics in the foot and lower leg. Very few investigated the association of pelvic kinematics and hallux valgus during gait according to various foot-toe orthoses for hallux valgus.

OBJECTIVE

To investigate the effect of soft or hard foot-toe orthoses on pelvic kinematics in individuals with hallux valgus deformity during gait.

STUDY DESIGN

This study has a repeated measures design.

METHODS

Three-dimensional range of motion in the pelvic segment was collected from 22 individuals (18 women and 4 men) aged 21 to 52 years (mean 31.7 years, SD 8.7) with hallux valgus. All participants exhibited a hallux valgus angle of more than 20 degree in both feet. A motion analysis system with eight infrared cameras was used to obtain pelvic kinematic data in the hard plastic orthosis, soft silicone orthosis, and without foot-toe orthosis conditions during gait. The two types of hallux valgus orthoses used in this experiment were commercially available products. The participants performed 8-10 walking trials. The walkway length was 6 m. Repeated-measures analysis of variance was used to determine the effects of each orthosis condition on the pelvic kinematic values.

RESULTS

The hard plastic orthosis condition was associated with decreased pelvic motion compared with the soft-type orthosis and no orthosis conditions for depression (F (2,42) = 7.329, P = 0.004), external rotation (F (2,42) = 4.367, P = 0.027), and overall transverse motion (F (2,42) = 4.897, P = 0.019) of the pelvic segment during gait. There were no significant differences in other pelvic motion variables between the without foot-toe orthosis and soft silicone orthosis conditions ( P > 0.05).

CONCLUSIONS

The results of this study suggest that the hard-type foot-toe orthosis for hallux valgus reduced pelvic motion and contributed to preventing excessive pelvic movement during gait.

Association between foot posture and tibiofemoral contact forces during barefoot walking in patients with knee osteoarthritis

Background

Accumulating evidence indicates that abnormal foot posture are risk factors for knee osteoarthritis (OA). However, the relationship between foot posture and tibiofemoral contact force (CF) during habitual weight-bearing activities remains unclear. This study aimed to determine the association between tibiofemoral CF and foot posture while walking.

Methods

In total, 18 patients with knee OA and 18 healthy individuals participated in this cross-sectional study. Foot parameters were evaluated by Foot Posture Index (FPI), Staheli Arch Index (SAI), hallux valgus angle, calcaneus inverted angle relative to the floor as a static rearfoot posture, navicular height, and toe grip strength. In addition, all participants underwent kinetic and kinematic measurements during a self-selected speed gait. The measurement device used was the three-dimensional motion analysis system with a sampling rate of 120 Hz. The musculoskeletal model, which has 92 Hill-type muscle–tendon units with 23 degrees of freedom, was used to calculate tibiofemoral CF. Partial correlations was used to investigate the association between foot parameters and total, medial, and lateral tibiofemoral CF of the first and second peaks while controlling for gait speed.

Results

A significant negative correlation was observed between Walking SAI and first peak medial tibiofemoral CF in control participants (r = -0.505, p = 0.039). SAI was also significantly positively correlated with first peak medial tibiofemoral CF in patients with knee OA (r = 0.482, p = 0.042).

Conclusions

Our findings revealed a correlation between the medial first peak tibiofemoral CF and the SAI. This study indicates that people with knee OA and flatfoot have excessive first medial tibiofemoral CF during walking.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05624-y.

Effect of the manual stretching maneuver for hallux valgus

BACKGROUND

Hallux valgus (HV), which is one of the most common musculoskeletal abnormalities of the foot, is defined as the medial deviation of the first metatarsophalangeal (MTP) joint and the lateral deviation of the great toe.

OBJECTS

This study aimed to investigate the immediate effects of a manual stretching maneuver (MSM) in subjects with HV.

METHODS

Twenty-five subjects with a total of 25 feet with mild HV participated in the study. The MSM, consisting of global stretching of the foot and toes, traction of the hallux, local stretching for hallux, and mobilization of the MTP joint of the hallux. The HV angle between the line of the first metatarsal bone and the proximal phalanx were measured using a goniometer. The cross-sectional area (CSA) of the AbdH was measured using ultrasonography. Zebris FDM was used to measure the static plantar pressure and the movement of the center of pressure (COP) standing on one foot. The dependent variables before and after treatment were compared using paired t-tests. The significance level was set at .05.

RESULTS

The HV angle significantly decreased from 20.25° to 16.96°. The CSA of the AbdH significantly increased from 14.00 mm² to 16.11 mm². The peak pressure on the hallux and 1st, 2nd and 3rd metatarsals increased significantly. The contact area and total pressure on the hallux significantly increased. The sway of the COP on the length of the minor axis and velocity significantly decreased.

CONCLUSION

This study suggests that the MSM can be effective in decreasing the HV angle in subjects with mild HV. However, further longitudinal clinical studies are required to investigate the long-term effects of the MSM in subjects with HV.

A voluntary activation deficit in m. abductor hallucis exists in asymptomatic feet

M. abductor hallucis (AbH) is the strongest intrinsic foot muscle and its dysfunction underlies various foot disorders. Attempts to strengthen the muscle by voluntary exercises are constrained by its complex morphology and oblique mechanical action, which leads to an inability even in asymptomatic individuals to fully activate AbH. This study investigated the extent and magnitude of this inability whilst also providing preliminary evidence for the virtue of targeted sub-maximum neuromuscular electrical stimulation (NMES) as a countermeasure for an AbH activation deficit. The voluntary activation ratio (VAR) was assessed via the twitch interpolation technique in the left AbH of 13 healthy participants during maximum voluntary 1st metatarsophalangeal joint flexion-abduction contractions (MVC). Participants were grouped ("able" or "unable") based on their ability to fully activate AbH (VAR ≥ 0.9). 7 s-NMES trains (20 Hz) were then delivered to AbH with current intensity increasing from 150% to 300% motor threshold (MT) in 25% increments. Perceived comfort was recorded (10 cm-visual analogue scale; VAS). Only 3 participants were able to activate AbH to its full capacity (able, mean (range) VAR: 0.93 (0.91-0.95), n = 3; unable: 0.69 (0.36-0.83), n = 10). However, the maximum absolute forces produced during the graded sub-maximum direct-muscle NMES protocol were comparable between groups implying that the peripheral contractility of AbH is intact irrespective of the inability of individuals to voluntary activate AbH to its full capacity. These findings demonstrate that direct-muscle NMES overcomes the prevailing inability for high voluntary AbH activation and therefore offers the potential to strengthen the healthy foot and restore function in the pathological foot.

Adjustments in the Range of Angular Motion during Walking after Amputation of the Toes: A Case Report

The forefoot plays an important role in providing body support and propulsion during walking. We investigated the effect of forefoot dysfunction on the gait pattern of a young adult with partial bilateral amputation of the toes. We measured our participant’s gait kinematics during barefoot and shod overground walking and analysed time-distance and joint range of motion (RoM) parameters against a group of healthy adults. Forefoot dysfunction gait is improved by footwear and walking experience; however, this improvement was still remarkably different (exceeded 95% CI) when compared to healthy gait at matching walking speed. Compared to healthy gait, walking barefoot had a slower speed and a 30% reduction in ankle and knee joint RoM, but a larger hip RoM. Shod gait resulted in a remarkable increase in ankle RoM and walking speed compared to barefoot gait. These results are consistent with the important role of the forefoot (tarsals and metatarsophalangeal joints) and suggest that footwear can facilitate gait function following toe amputation.

Examination of gait characteristics and related factors in elderly subjects with and without hallux valgus

Objective:

Elderly people with hallux valgus have decreased gait speed, which can result in reduced capacity to perform the activities of daily living. Therefore, this study examined the gait ability and related factors of patients with hallux valgus.

Methods:

The study participants were 10 patients with hallux valgus and 10 without. Ground reaction forces were measured as front–rear (X), lateral (Y), and vertical (Z) components from the early to late stance phases. Three-dimensional motion analysis was used to measure gait speed; touchdown distance; release distance; the angles of the limb joints and trunk at heel contact, toe-off, and peak ground reaction force; and the center of mass (COM) displacement in the sagittal plane. The height of the COM was calculated as a percentage of the body height. The hallux valgus and control groups were compared using the Mann–Whitney U-test.

Results:

In the hallux valgus group, the ground reaction force showed a significant increase in the Y component in each stance phase and in the Z component in the late stance phase. The lowest COM position in the hallux valgus group was significantly higher than that in the control group, resulting in a smaller difference in COM height over a gait cycle.

Conclusions:

The hallux valgus group was found to have reduced gait speed because of a shortened touchdown distance. Moreover, the continued high COM position in the hallux valgus group meant that potential energy could not efficiently be converted to kinetic energy.

Quantifying the Dynamic Stability of Gait Patterns in People with Hallux Valgus

Hallux valgus (HV), which is mainly caused by the wearing of narrow-width and high-heeled shoes, disrupts gait behavior because it deforms lower limb joints. There is limited information regarding the relationship between the foot disease HV and lower limb joints. Previous studies evaluating abnormal gait patterns caused by deformity used spatiotemporal parameters; however, they failed to characterize the overall gait dynamics. To address this issue, this study is aimed at characterizing the gait stability of patients with HV and examining the joints that are critically affected by HV. To assess complex gait dynamics, we quantified the potential changes in gait stability by using the maximum Lyapunov exponent (MLE). Angular displacements of the ankle, knee, and hip in the sagittal plane during walking were investigated to calculate the MLE for gait stability based on foot conditions (i.e., barefoot, flat shoes, and high heels). During walking, a large MLE (P < 0.05) was noted for the knee joints of subjects with HV, relative to the other lower limb joints. HV appears to have the most critical effect on the knee joints during walking. Ankle movement exhibited higher dynamic stability than the other joint movements of the lower limb (P < 0.05). The type of shoe used in the experiment showed no significant dependence with gait stability and joint movement (P > 0.05). Quantitative assessments of dynamic stability using the MLE may help clinicians assess the overall gait dynamics of HV patients and other people suffering from gait disturbances.

Direct muscle electrical stimulation as a method for the in vivo assessment of force production in m. abductor hallucis

In vivo assessment of the force-generating capacity of m. abductor hallucis (AbH) is problematic due to its combined abduction-flexion action and the inability of some individuals to voluntarily activate the muscle. This study investigated direct muscle electrical stimulation as a method to assess isometric force production in AbH about the 1st metatarsal phalangeal joint (1MPJ) at different muscle-tendon lengths, with the aim of identifying an optimal angle for force production. A 7 s stimulation train was delivered at 20 Hz pulse frequency and sub-maximal (150% motor threshold) intensity to the AbH of the left foot in 16 participants whilst seated, and with the Hallux suspended from a force transducer in 0°,5°,10°,15° and 20° 1MPJ dorsal flexion. Reflective markers positioned on the foot and force transducer were tracked with 5 optical cameras to continuously record the force profile and calculate the external 1MPJ joint flexion moment at each joint configuration. A parabolic relationship was found between AbH force production and 1MPJ configuration. The highest 1MPJ joint moments induced by electrical stimulation were found between 10° and 15° of Hallux dorsal flexion. However, the joint angle (p < 0.001; η² = 0.86) changed significantly across all but one 1MPJ configurations tested during the stimulation-evoked contraction, resulting in a significant change in the corresponding external moment arm (p < 0.001; η² = 0.83). Therefore, the changes in joint geometry during contraction should be accounted for to prevent an underestimation of the resulting joint moment. We conclude that direct muscle electrical stimulation combined with dynamometry offers a robust method for standardised assessment of AbH sub-maximal isometric force production.

Preoperative radiographic and clinical factors associated with postoperative floating of the lesser toes after resection arthroplasty for rheumatoid forefoot deformity

Background

This study aimed to clarify the characteristics associated with postoperative floating of the lesser toes, especially focusing on the medial and lateral lessor toes, after arthrodesis of the first metatarsophalangeal joint and resection arthroplasty of the lessor toes in rheumatoid forefoot deformity.

Methods

Fourty-seven feet of 43 people who underwent resection arthroplasty of the metatarsal head of the lesser toes for rheumatoid arthritis of the metatarsophalangeal joints were included. We retrospectively evaluated the preoperative radiographic findings and clinical characteristics of the patients, and the occurrence of postoperative floating of the lesser toes. The mean duration of follow-up was 36.5 (range 12 to 114) months.

Results

Preoperative dislocation grades of the second and third toes that demonstrated postoperative floating were significantly higher than those of toes that did not experience postoperative floating. The hallux valgus deformity before surgery was significantly more severe in toes with postoperative floating of the second and third lessor toes than those with no floating (p < 0.05). In addition, the Japanese Society for Surgery of the Foot (JSSF) hallux scale scores before surgery in toes with postoperative floating of the fourth and fifth lessor toes were significantly worse than those in non-dislocating toes (p < 0.05).

Conclusions

The preoperative condition of the first metatarsophalangeal joint, including hallux valgus deformity, pain, range of motion, activity of daily living, and function is significantly different between postoperative floating of the lesser toes and non-floating of them after resection arthroplasty for rheumatoid forefoot deformity.

Coordination Among Shank, Rearfoot, Midfoot and Forefoot Kinematic Movement During Gait in Individuals With Hallux Valgus

An important step in the management of hallux valgus is the objective analysis of foot mechanics in dynamic conditions. However, the manner which hallux valgus affects the foot motion is poorly understood. Moreover, hallux valgus deformity may affect foot intersegmental coordination patterns. The purpose of this study was to investigate the relative motion and intersegmental foot coordination patterns, considering the midfoot, during gait in individuals with hallux valgus. Fifteen females with hallux valgus and 13 females without hallux valgus were recruited in this study. Three-dimensional positional data during gait were collected using a motion capture system and analyzed using a multisegment foot model and an analysis software. Intersegmental foot coordination patterns were assessed using a modified vector-coding technique. In individuals with hallux valgus, the rearfoot was significantly more everted throughout stance, and forefoot motion during late stance was significantly increased. In intersegmental coordination patterns, individuals with hallux valgus exhibited excessive mobility of the rearfoot relative to the midfoot segment during midstance and increased anti-phase motion between rearfoot and midfoot segments during late stance. Excessive rearfoot eversion and altered intersegmental coordination patterns between rearfoot and midfoot may decrease the proper rigidity of the foot and lead to forefoot hypermobility during late stance in individuals with hallux valgus.

Pilot Study of a 3-Dimensional Method for Analysis of Pronation of the First Metatarsal of Hallux Valgus Patients

BACKGROUND:

The current work sought to quantify pronation of the first metatarsal relative to the second metatarsal and of the proximal phalanx of the great toe relative to the first metatarsal.

METHODS:

Three-dimensional models were reconstructed from weightbearing computed tomography (CT) images (10 hallux valgus, 10 normal). The orientations of bones related to hallux valgus (HV) (ie, the phalanx, first and second metatarsals) were determined from coordinate systems established by selecting landmarks. After determining the hallux valgus and intermetatarsal angles, additional calculations geometrically determined the 3-dimensional (3D) angles using the aeronautical system of yaw-pitch-roll. The 3D geometrically determined angles were compared to the conventional plain radiographic angles.

RESULTS:

HV measurements taken with CT and 3D computer-aided design (3DCAD) geometric methods were the same as measurements taken from plain radiographs (P > .05). The average pronation of the first metatarsal relative to the second metatarsal was 8.2 degrees greater in the hallux valgus group (27.3 degrees) than in the normal group (19.1 degrees) (P = .044). A regression analysis of pronation vs intermetatarsal angle (IMA) was not found to be significant. There was also no correlation between pronation of the great toe and first metatarsal in the HV group.

CONCLUSIONS:

The pronation angle of the first metatarsal relative to the second metatarsal between normal and hallux valgus patients was larger in HV patients but was not well correlated with the IMA.

CLINICAL RELEVANCE:

The findings of this study indicate that pronation may need to be considered in the operative correction of hallux valgus for restoration of normal anatomy.

Association of frontal plane knee alignment with foot posture in patients with medial knee osteoarthritis

Background

To examine the association of radiographic frontal plane knee alignment with three-dimensional foot posture in patients with medial knee osteoarthritis (OA).

Methods

Participants in orthopedic clinics with Kellgren/Lawrence (K/L) grade ≥1 (88 patients and 88 knees; age, 61–91 years; 65.9% female) were enrolled. An anteroposterior radiographic view was used to assess the anatomical axis angle (AAA) after subtracting a sex-specific correction factor. The three-dimensional foot posture was also evaluated.

Results

Multiple regression analyses showed that increased corrected AAA (i.e., valgus direction) was independently associated with a decrease in the hallux valgus angle (regression coefficient: −0.40 per degree, 95% confidence interval [CI]: −0.72, −0.09; P = 0.013) and increase in the pronation angle of the calcaneus relative to floor (regression coefficient: 0.33 per degree, 95% CI: 0.10, 0.56; P = 0.005) adjusted for age, sex, and body mass index. The relationship between the corrected AAA and hallux valgus angle strengthened (regression coefficient: −0.60 per degree, 95% CI: −1.08, −0.13; P = 0.014) in varus-aligned knees examined separately (63 knees). The other foot postures (navicular height, navicular height/foot length, and rearfoot angle) were not significantly associated with corrected AAA.

Conclusions

Radiographic frontal plane knee alignment was associated with hallux valgus angle and calcaneus angle relative to the floor in patients with medial knee OA, particularly in varus-aligned knees. These results indicate a connection between altered frontal knee alignment and foot posture, which may be helpful in understanding the pathogenesis of altered foot posture observed in patients with knee OA.

Characteristics of static and dynamic loading of the plantar surface of the foot in women with hallux valgus deformity

Hallux valgus is one of the most common foot deformations, which occurs twice as frequently in women than in men. The aim of the study was to evaluate the feet soles pressure distribution pattern of young women with hallux valgus deformity. The study sample consisted of 23 young women (21-27 years). Among the participants, 14 demonstrated the presence of single- or double-sided hallux valgus (study group – a total of 22 feet with hallux valgus) and 15 women had the correct angle of the big toe for one or both feet (control group – a total of 23 feet without deformation). The research tool was the Podoscan 2D platform and the FreeMED force platform (Sensor Medica, Italy). Using the FreeStep Professional software on the plantocontourograms of the feet, the angle of hallux valgus was determined (ALFA angle). In statics the following parameters were assessed: maximal fore- and rear-foot loading, percentage loading of forefoot and the Weissflog indicator, and in dynamics (gait): the percentage loading of forefoot and medial part of the foot, the value of maximum foot pressure and the passage point of the center of pressure line. There were no differences between the study and control group regarding loading of the fore- and rear-foot or pressure distribution pattern on the lateral and medial side of the foot, however, statistically significant differences were observed in the value of the Weissflog indicator and the exit place of the center of pressure line. 1. Hallux valgus deformity changes the foot rollover pattern, in which instead of the big toe as the main place to transfer forces during the fi nal support phase, the increased load is transferred through the second foot ray. 2. hallux valgus promotes fl attening of the transverse arch of the foot. 3. changes in foot pressure pattern observed in the group of women with hallux valgus are not dependent on the valgus angle. Masłoń A., Czechowska D., Szczygieł E., Golec J. Characteristics of static and dynamic loading of the plantar surface of the foot in women with hallux valgus deformity. Med Rehabil 2016; 20(2): 5-12. DOI: 10.5604/01.3001.0009.4804

Quality of Life Impact Related to Foot Health in a Sample of Older People with Hallux Valgus

Hallux Valgus (HV) is a highly prevalent forefoot deformity in older people associated with progressive subluxation and osteoarthritis of the first metatarsophalangeal (MTP) joint and it is believed to be associated with varying degrees of HV effect on the quality of life related to foot health. The aim of this study is to compare the impact of varying degrees of HV on foot health in a sample of older people. The sample consisted of 115 participants, mean age 76.7 ± 9.1, who attended an outpatient center where self-report data were recorded. The degree of HV deformity was determined in both feet using the Manchester Scale (MS) from stage 1 (mild) to 4 (very severe). Scores obtained on the Foot Health Status Questionnaire (FHSQ) were compared. This has 13 questions that assess 4 health domains of the feet, namely pain, function, general health and footwear. The stage 4 of HV shown lower scores for the footwear domain (11.23 ± 15.6); general foot health (27.62 ± 19.1); foot pain (44.65 ± 24.5); foot function (53.04 ± 27.2); vigour (42.19 ± 16.8); social capacity (44.46 ± 28.1); and general health (41.15 ± 25.5) compared with stage 1 of HV (P<0.05) and there were no differences of physical activity (62.81 ± 24.6). Often, quality of life decreases in the elderly population based in large part on their foot health. There is a progressive reduction in health in general and foot health with increasing severity of hallux valgus deformity which appears to be associated with the presence of greater degree of HV, regardless of gender.