Epidemiology of Shoe Wearing Patterns Over Time in Older Women: Associations With Foot Pain and Hallux Valgus

The efficacy of shoes modification and orthotics in hallux valgus deformity: a comprehensive review of literature

Hallux valgus (HV) is a frequent forefoot deformity affecting about 23% of adults and 35.7% of people over 65. The exact etiology is not fully understood. The first ray plays a significant role in walking cause it bears the principal amount of weight and maintains the position of the medial arch. Several factors that deteriorate the integrality of the first ray, such as foot deformities, restrictive footwear, and pes planus, may be ascribed to the HV occurrence. Before any surgical correction, conservative treatment should always be initiated first. Currently, there is no consensus that conservative management by shoe modification and foot orthoses could correct the pathology or terminate the clinical worsening of the condition.From a careful analysis of the literature, proper footwear should be a shoe with an adequate length, wide toe box, cushioned sole, and a lowered heel to not increase the load on the metatarsal heads and cause pain. Personalized 3D printed customized toe spreaders may be applied in patients with HV, improving symptoms and bringing pain relief. Compensating the subtalar joint hyperpronation through foot orthoses plays a fundamental role in the HV development, preventing or at least controlling the condition's progress; this, along with weight reduction and regular physical activity.Data obtained suggest that dynamic foot orthoses prefer a biomechanical type with 3/4-length, which is less likely to negatively affect the dorsal or medial pressures, which instead were noted to increase with the sulcus- and full-length orthoses.Although some studies suggest that foot orthoses would favor the correction of HV deformity, results have been very variable and just in few studies appear to correct HV or reduce its progression, improving symptoms and bringing pain relief. In the case of HV surgical correction, orthoses seem to maintain the correct position acquired over time.

Effectiveness of footwear and foot orthoses in reducing medial metatarsophalangeal joint pressure in women with hallux valgus

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.

Enhancing Footwear Safety for Fall Prevention in Older Adults: A Comprehensive Review of Design Features

BACKGROUND

Falls are a global concern affecting people of all ages; however, older adults are particularly vulnerable to age-related factors and foot-related issues. Footwear is critical for preventing falls, as it provides stability and protection against slips, trips, and falls (STFs). However, a significant gap exists in the systematic exploration of the safety aspects of footwear design for fall prevention in older adults.

METHODS

This comprehensive review applied a meticulous search strategy encompassing prominent databases, including Google Scholar, ScienceDirect, SCOPUS, MEDLINE, ResearchGate, and PubMed. This review synthesized and analyzed existing research to bridge knowledge gaps and provide insights into optimal footwear choices for older adults in terms of design features such as fit, fixation, heel height, collar height, slip resistance, and sole/insole hardness.

RESULTS

The results underscore the importance of specific design features for preventing falls among older adults. A proper fit, secure fixation, appropriate heel and collar heights, slip resistance, and sole/insole hardness significantly contributed to fall prevention. These findings offer valuable guidance for optimizing footwear designs to enhance comfort, stability, and safety in the daily lives of older individuals.

CONCLUSION

This comprehensive review fills a critical knowledge gap regarding the safety of footwear designs for fall prevention in older adults. The identified design features play a vital role in reducing the risk of falls and offer practical recommendations for the development of safer footwear. Ultimately, this study contributes to the existing knowledge base and supports efforts to prevent STFs in older adults through improved footwear design.

Footwear and Falls in Long-Term Residential Aged Care Facilities: An Analysis of Video Capture Data

INTRODUCTION

Several footwear characteristics have been shown to affect balance and gait patterns and may therefore influence the risk of falling in older adults. However, attributing a link between footwear and falls is inherently difficult as it often relies on self-report which may be inaccurate.

METHODS

Archival video recordings of falls that occurred in two long-term residential aged care facilities were initially screened to determine whether the footwear worn at the time (barefoot, socks, slippers/sandals, or shoes) could be documented. These falls were then independently evaluated by three additional assessors and a meeting was held to obtain consensus in relation to whether the footwear could have potentially contributed to the fall, and what mechanism may have been responsible. Cross-tabulations were performed in relation to footwear type and fall characteristics (proposed mechanism and fall direction).

RESULTS

There were 300 falls experienced by 118 older adults aged 58 years-98 years (mean age 82.8 years, SD 7.6). Of these falls, footwear could be ascertained in 224 (75%). After the consensus meeting, the proportion of falls considered to be potentially related to footwear was 40 (18%). The likelihood of footwear contributing to the fall was highest when participants were wearing socks (14/19 falls; 74% of all footwear-related falls), followed by being barefoot (2/6 falls; 33%), wearing slippers/sandals (17/100 falls; 17%), and wearing shoes (7/99 falls, 7%).

CONCLUSION

Footwear could be a potential contributor to a substantial number of falls in residential aged care. Wearing socks would appear to place an older person at risk of future falls and should therefore be avoided in this population.

Predictive factors for foot pain in the adult population

BACKGROUND

Foot pain has been associated to factors like: fat, body mass index, age increased, female gender and the presence of pathologies. Although evidence is limited. The purpose is to determine the predictive factors for foot pain in the adult population.

METHODS

From January to December 2021, 457 patients were > 18 years, gave signed informed consent to take part to this cross sectional study. All completed demographic data and various questionnaires related to pain: Foot Function Index, EuroQoL-5D and Visual Analogue Scale (foot pain). Anthropometric measurements were obtained using McPoil platform and foot posture was assessed by the Foot Posture Index (FPI). To determine whether a volume change is a predictive factor for foot pain, a parameter was established: the volumetric index for footwear (VIF). Factors linked to the presence of pain, including the considered VIF variables, were analyzed through multivariable logistic regression.

RESULTS

Among the study population, 40.7% were male and 59.3% female. The mean age of 39.06 years and a body mass index of 25.58 Kg/cm2. The logistic regression model had a classification capability of 72.4%, a sensitivity of 72.3% and a specificity of 73%, in which, the predictors considered were the variables found to have a significant association with FFI-pain > 45 points,, showed that younger women, with a higher BMI, higher values of right FPI (pronation), poorer overall perceived health and with problems in walking were more likely to experience foot pain.

CONCLUSION

Predictive factors for foot pain in the adult population include gender, age, Body Mass Index, FPI on the right foot, perceived health and mobility. Clinical implication, the presented measure aids physicians in assessing their patients´ foot pain likelihood.

Evaluation of Foot Deformities in Patients With Ingrown Nails

INTRODUCTION

Ingrown nail is a condition caused by the perforation of the periungual soft tissues on nail folds by the sides of nail plaque, causing inflammation and severe pain. Recently, the role of foot anatomical disorders in ingrown nail development has been emphasized.

OBJECTIVES

The main objective of this study aimed to determine whether foot deformities played significant roles in ingrown nail development with objective radiological parameters.

METHODS

The study included 64 patients diagnosed with clinical ingrown nail and 71 patients as controls without any ingrown nail history. In both groups, we evaluated the bilateral foot radiographs of patients with ingrown nails for hallux valgus angle (HVA), interphalangeal angle (IPA), and intermetatarsal angle (IMA) associated with hallux valgus, and the calcaneal pitch angle (CPA), talohorizontal angle (THA), and talometatarsal angle (TMA) related to pes planus.

RESULTS

No significant difference was found in terms of hallux valgus radiological measurements of HVA, IPA and IMA as well as pes planus radiological measurements of CPA and TMA values, when compared to controls. THA was statistically significantly higher in the control group (P = 0.025). There was a moderate strength positive relationship between ingrown nail stage and measured TMA for pes planus diagnosis (rho = 0.326; P = 0.04), yet there are no significant correlations between ingrown nail stage and other angles.

CONCLUSIONS

Therefore, we do not recommend foot anatomy correction in the prevention and treatment of ingrown nails, unless there is an accompanying foot deformity; however, pes planus is a foot deformity that can accompany patients with severely ingrown nails.

Assessing the content validity of the Manchester-Oxford Foot Questionnaire in surgically treated ankle fracture patients: a qualitative study

BACKGROUND

Roughly 10% of fractures in adults are ankle fractures. These injuries are found in both sexes and present with different fracture characteristics. The treatment varies with the patients' biology and fracture type, and the goals are to restore stability, prevent pain and maintain ankle function. Clinicians generally use outcomes like assessment of radiography, pain level, or function. The use of patient-reported outcome measures is increasing, and the Manchester-Oxford Foot Questionnaire (MOXFQ) has been shown to have good measurement properties when validated in patients with foot and ankle disorders. However, the instrument has not been validated for ankle fracture patients. This study aims to assess the content validity of the items in MOXFQ in surgically treated ankle fracture patients.

METHODS

A qualitative deductive design was used to investigate patients' response process of the MOXFQ. Individual interviews were conducted using cognitive interviewing based on the theoretical framework of the 4-step model by Tourangeau. Adult patients that were surgically treated for an ankle fracture between four weeks and 18 months were purposively sampled, and interviews followed a semi-structured interview guide. The predetermined categories were comprehension, retrieval, judgement, and response.

RESULTS

Seventeen respondents (65% females) were interviewed. Respondents' age ranged from 27 to 76 years. Some of the respondents in the early recovery phase were limited by post-operative restrictions and did not find the items in the walking/standing domain relevant. Respondents that were allowed weight-bearing as tolerated (WBAT) were able to recall relevant information for most items. Respondents with time since surgery more than 12 months had less pain and remembered fewer relevant episodes in the recall period. Items in the social interaction domain contained ambiguous questions and were generally considered less important by respondents. The summary index score lacked important concepts in measuring overall quality of life.

CONCLUSIONS

Pain was a central concept in the post-operative recovery of ankle fracture patients. The MOXFQ-subscales for pain and walking/standing had acceptable content validity in patients that were allowed WBAT. The social interaction-subscale and the summary index score had insufficient content validity for this patient population.

Nonsurgical management of hallux valgus: findings of a randomised pilot and feasibility trial

BACKGROUND

Hallux valgus is a common and disabling condition. This randomised pilot and feasibility trial aimed to determine the feasibility of conducting a parallel group randomised trial to evaluate the effectiveness of a nonsurgical intervention for reducing pain associated with hallux valgus.

METHODS

Twenty-eight community-dwelling women with painful hallux valgus were randomised to receive either a multifaceted, nonsurgical intervention (footwear, foot orthoses, foot exercises, advice, and self-management) or usual care (advice and self-management alone). Outcome measures were obtained at baseline, 4, 8 and 12 weeks. The primary outcome was feasibility, evaluated according to demand (recruitment rate and conversion rate), acceptability, adherence, adverse events, and retention rate. Limited efficacy testing was conducted on secondary outcome measures including foot pain, foot muscle strength, general health-related quality of life, use of cointerventions, and participants' perception of overall treatment effect.

RESULTS

Between July 8, 2021, and April 22, 2022, we recruited and tested 28 participants (aged 44 to 80 years, mean 60.7, standard deviation 10.7). This period encompassed two COVID-related stay-at-home orders (July 16 to July 27, and August 5 to October 21, 2021). The predetermined feasibility thresholds were met for retention rate, foot pain, mental health-related quality of life, and use of cointerventions, partly met for acceptability, adverse events, and muscle strength, and not met for demand (recruitment rate or conversion rate), adherence, physical health-related quality of life and perception of overall treatment effect.

CONCLUSION

In its current form, a randomised trial of footwear, foot orthoses, foot exercises, advice and self-management for relieving pain associated with hallux valgus is not feasible, particularly due to the low adherence with the intervention. However, it is difficult to determine whether the trial would be feasible under different circumstances, particularly due to COVID-19 stay-at-home orders. Future trials will need to consider improving the aesthetics of the footwear and making the exercise program less burdensome.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Registry (ACTRN12621000645853).

Determination of individual factors associated with hallux valgus using SVM-RFE

INTRODUCTION

This cross-sectional study aimed to determine the factors related to hallux valgus (HV) and their importance using support vector machine-recursive feature elimination (SVM-RFE).

METHODS

A total of 864 participants aged ≥ 18 years were enrolled. The Manchester scale was used to determine the presence of HV (summed scores for both feet ≥ 4). The questionnaire included items such as age, sex, height, weight, and foot measurements. These internal factors were analyzed to determine if they are related to HV using SVM-RFE.

RESULTS

The results of tenfold cross-validation using SVM-RFE revealed that the numbers of feature selections were 10, 10, and 9 for age, sex, and body weight, respectively, and these factors were shown to be related to HV. HV was found to be more common in women than in men (women, 24.9%; men, 7.6%), but the sex difference was not significant in older people.

CONCLUSION

Age and sex were found to be important factors associated with HV identified via feature selection using SVM-RFE.

Wearing high-heeled shoes on a side slope makes standing balance unstable

INTRODUCTION

Many women wearing high-heeled footwear are at high risk of falls. Past studies have examined the balance on level ground or balance during walking. We measured the standing balance on the ground and side slopes for 18 healthy women.

METHOD

Body sway was evaluated based on the center of pressure (COP) while participants stood on level ground on a side slope. The total locus length as well as rectangular and outer peripheral areas were then measured using a Zebris system. Measurements were compared under bare feet, normal shoe, and high-heeled shoe conditions.

RESULTS

On level ground, there were no significant differences among the three conditions. On the side slope, the total locus length (TLL), rectangular area (RA) and outer peripheral areas (OPA) were significantly greater for the high-heeled shoes than for the bare feet and normal shoes. Standing on the side slope caused larger body sway than on the level ground, along with a higher risk of falling.

DISCUSSION

In TLL, OPA, and RA, the COP moved outside substantially when participants stood on a slope in high heels than in shoes. High heels were highly unstable for standing on a slope since the ankle joint of one leg is in plantar flexion, the foot is pronated, and the other side is plantarflexed at the ankle with pronation of the foot.

CONCLUSION

High-heeled shoes significantly alter a person's balance when standing on a side slope, suggesting a high risk of falling.

Incidence and Progression of Hallux Valgus: A Prospective Cohort Study

OBJECTIVE

Hallux valgus is a common and disabling condition. The objective of the present study was to identify factors associated with hallux valgus incidence and progression.

METHODS

Participants were from a population-based prospective cohort study, the Clinical Assessment Study of the Foot. All adults ages ≥50 years who were registered at 4 general practices in North Staffordshire, UK, were invited to take part in a postal survey at baseline and at 7-year follow-up, which included health questionnaires and self-assessment of hallux valgus using line drawings.

RESULTS

Complete baseline and follow-up data were available for 1,482 participants (739 women and 743 men, mean ± SD age 62.9 ± 8.1 years), of whom 450 (30.4%) had hallux valgus in at least 1 foot at baseline. Incident hallux valgus was identified in 207 (20.1%) participants (349 [15.4%] feet) and was associated with baseline age, poorer physical health, foot pain, and wearing shoes with a very narrow toe-box shape between the ages of 20 and 29 years. Hallux valgus progression was identified in 497 (33.6%) participants (719 [24.3%] feet) but was not associated with any baseline factors.

CONCLUSION

Incident hallux valgus develops in 1 in 5 adults ages ≥50 years over a 7-year period and is related to age, poorer physical health, foot pain, and previous use of constrictive footwear. Progression occurs in 1 in 3 adults. These findings suggest that changes in first metatarsophalangeal joint alignment may still occur beyond the age of 50 years.

Causal relationship between thyroid dysfunction and hallux valgus: A two-sample Mendelian randomization study

INTRODUCTION

Previous observational studies have reported that thyroid dysfunction is associated with hallux valgus (HV). However, the causal effect of thyroid dysfunction on hallux valgus is still unknown. To assess whether there is a causal relationship between thyroid dysfunction and hallux valgus, we performed a two-sample Mendelian randomization (MR) study.

METHODS

The data of the two-sample Mendelian randomization study were obtained from public databases. In this study, hypothyroidism, hyperthyroidism, free thyroxine (FT4), and thyrotropin (TSH) were chosen as exposures. The single nucleotide polymorphisms (SNP) of hypothyroidism and hyperthyroidism were from the genome-wide association studies (GWAS) of the IEU database, including 337,159 subjects. Data for FT4 and TSH (72,167 subjects) were extracted from the ThyroidOmics Consortium. HV was used as the outcome. The SNPs associated with HV were selected from a GWAS of 202,617 individuals in the fignngen database. The inverse variance weighted (IVW) method was used as the primary analysis. Four complementary methods were applied, including MR-presso, MR-Egger, and weighted median. In addition, Cochran's Q test, MR-presso, MR-Egger regression, and the leave-one-out test were used as sensitivity analysis, and the MR-pleiotropy test was performed to examine pleiotropy.

RESULTS

According to the results of IVW, we found that there was a causal relationship between hypothyroidism and HV, and hypothyroidism increased the incidence of HV (OR = 2.838 (95% CI: 1.116-7.213); p = 0.028). There were no significant causal effects of hyperthyroidism, FT4, and TSH on HV (p > 0.05). Sensitivity analyses showed that the results were robust and reliable, and no horizontal pleiotropy was detected.

CONCLUSIONS

Our findings provided genetic support that hypothyroidism might increase the risk of HV. It will predict the occurrence of HV in patients with hypothyroidism and provide suggestions for early prevention and intervention.

Analysis of hallux valgus angles automatically extracted from 3D foot scans taken in North America, Europe, and Asia

The forefoot is the foot part most affected by ill-fitting shoes. Footwear fitting considers the measurements of length, width, and arch length. Toe shape has not yet been used in sizing feet and fitting shoes. This study aims to investigate the variation in toe shape, as measured by the hallux valgus angle. An automatic and reproducible hallux valgus angle measuring method using 3D foot scans with no palpation markers is proposed and applied to about half a million samples collected across North America, Europe, and Asia. The measuring method is robust and can detect the medial contour along the proximal phalanx even in extreme cases. The hallux valgus angle has a normal distribution with long tails on both sides in the general population. Large dispersions of HVA values were observed for both genders and in all three geographical regions. Practitioner summary: The hallux valgus angle has a broad distribution in the general population. Females have larger hallux valgus angles than males, and people from Asia have larger hallux valgus angles than people from North America and Europe. Shoe toe boxes should be designed to fit the actual shapes of shoppers' toes. The proposed method for measuring HVA opens a new opportunity to study the causal relationship between shoe wearing habits and HVA on a large scale.

Hallux anatomy: much ado about shoes-an attempt to prove that constrictive V-shaped toe-box shoes deform the hallux

PURPOSE

A question still remains as to whether constrictive toe-box shoes (TBS) cause disability only due to pain on pressure points or if they can cause permanent changes in the hallux anatomy. The aim of this study is to compare the hallux morphology in 3 groups classified according to their use of constrictive or open TBS.

METHODS

424 patients were classified into 3 groups: group A used open TBS daily; group B used constrictive TBS daily; group C used both open and constrictive TBS. Hallux's angles, presence of exostoses and shape of the distal phalanx (DP) were analyzed on dorsoplantar weight-bearing radiographs and compared amongst groups.

RESULTS

The intermetatarsal (IMA), metatarsophalangeal (MTPA), DASA, PASA, interphalangeal (IPA), obliquity (AP1), asymmetry (AP2) and joint deviation (JDA) angles for group A were 10°, 8°, 5°, 4°, 9°, 3°, 5°, 3°; for group B were 9°, 19°, 5°, 6°, 12°, 2°, 8°, 2°; and for group C were 10°, 10°, 4°, 4°, 12°, 3°, 8°, 1°. Only the differences in the MTPA, IPA and AP2 were statistically significant (p < 0.05). The prevalence of exostoses on the tibial side of the DP was 22, 36, and 29% in groups A, B and C, respectively (p < 0.05). We found similar distributions of the different DP shapes in the three groups.

CONCLUSIONS

Our results suggest that the use of constrictive TBS, even if used only occasionally, could change hallux anatomy from a young age increasing MTPA, IPA and AP2. Moreover, we have found that DP exostoses are present as a "normal variation" in patients who wear an open TBS, but their prevalence is higher in those wearing constrictive toe-box shoes. This could be due to a reactive bone formation secondary to the friction caused by the inner border of the shoe.

LEVEL OF CLINICAL EVIDENCE

3.

Footwear, foot orthoses and strengthening exercises for the non-surgical management of hallux valgus: protocol for a randomised pilot and feasibility trial

BACKGROUND

Hallux valgus is a common and disabling condition. This randomised pilot and feasibility trial aims to determine the feasibility of conducting a fully-powered parallel group randomised trial to evaluate the effectiveness of a multifaceted non-surgical intervention for reducing pain associated with hallux valgus.

METHODS

Twenty-eight community-dwelling women with painful hallux valgus will be randomised to receive either a multifaceted, non-surgical intervention (footwear, foot orthoses, foot exercises, advice, and self-management) or advice and self-management alone. Outcome measures will be obtained at baseline, 4, 8 and 12 weeks. The primary outcome is feasibility, which will be evaluated according to demand, acceptability, adherence, adverse events, and retention rate. Limited efficacy testing will be conducted on secondary outcome measures including foot pain (the Manchester-Oxford Foot Questionnaire), foot muscle strength (hand-held dynamometry), general health-related quality of life (the Short Form-12), use of cointerventions, and participants' perception of overall treatment effect. Biomechanical testing will be conducted at baseline to evaluate the immediate effects of the footwear/orthotic intervention on pressure beneath the foot and on the medial aspect of the first metatarsophalangeal joint and hallux.

DISCUSSION

This study will determine the feasibility of conducting a fully-powered randomised trial of footwear, foot orthoses, foot exercises, advice and self-management for relieving pain associated with hallux valgus and provide insights into potential mechanisms of effectiveness.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Registry ( ACTRN12621000645853 ).

The co-occurrence of calcaneal spur and hallux valgus: A radiological evaluation

BACKGROUND

Calcaneal spur and hallux valgus are common foot deformities and both conditions have been shown to disrupt foot biomechanics.

OBJECTIVES

This study aimed to investigate the association between calcaneal spur and hallux valgus using radiographic and demographic data.

METHODS

A total of 1375 patients (1083 women; mean age: 45.5 years) with standard ankle lateral and foot conventional anteroposterior radiographs were evaluated. The following data were obtained: age, gender, laterality, hallux valgus angle (HVA), intermetatarsal angle (IMA), and calcaneal spur. Patients with a HVA of 15∘ and above were considered to have hallux valgus. Patients with hallux valgus were classified into three different groups according to the HVA.

RESULTS

The prevalence of calcaneal spur was higher in older age and women (45.8%, 30.2%; p< 0.01, p< 0.01, respectively). Subjects with and without calcaneal spurs had similarities in terms of their laterality, having a HVA of ⩾ 15∘ and an IMA of ⩾ 11∘ (p> 0.05). Hallux valgus severity was not associated with calcaneal spur (p> 0.05). In addition, the hallux valgus prevalence was higher in patients who were over 50 years old (58.2%, p= 0.046).

CONCLUSIONS

The presence of calcaneal spurs does not affect the prevalence of hallux valgus. The severity of hallux valgus determined according to the HVA was similar in patients with and without calcaneal spurs. In addition, female gender and older age were identified as risk factors for calcaneal spurs, while only older age was a risk factor for hallux valgus.

The videos on YouTube® related to hallux valgus surgery have insufficient information

BACKGROUND

Previous studies have determined the videos on YouTube® have misleading information in medicine, however the assessment of the information for hallux valgus surgery is lacking.

METHODS

YouTube® was analyzed using two keywords as 'hallux valgus surgery' and 'bunion surgery'. Once redundancies were eliminated, each video was evaluated for the characteristic as following: duration, number of views, likes and dislikes, days since upload, view and like ratios and video power index (VPI). The quality of the information was evaluated using DISCERN, JAMA and hallux valgus score (HVS).

RESULTS

A total of 49 videos included. Fair or poor results for DISCERN and HVS (90% and 69% of videos, respectively) were found. No difference was found between video source and quality scores. Number of likes and VPI negatively correlated with all scores (p < 0.001).

CONCLUSIONS

YouTube® had poor quality of information for hallux valgus surgery.

The impact of hallux valgus on function and quality of life in females

BACKGROUND

The effect of hallux valgus (HV) on health-related quality of life (HRQOL) and the relationship between radiographic severity of deformity and patient reported outcome measures (PROMs) is poorly understood. The aim of this study was to compare the HRQOL of female patients with HV to the UK population. The secondary aim was to assess the correlation between PROMs, including HRQOL, with radiographic severity of deformity.

METHODS

Weight bearing radiographic data (hallux valgus (HVA) angle; intermetatarsal (IM) angle) were measured in consecutive female patients presenting with HV. Each patient prospectively completed the Euroqol EQ-5D-5L questionnaire (EQ-5D), Visual Analogue Scale for Pain (VAS-Pain) and Manchester Oxford Foot Questionnaire (MOXFQ). Data were stratified into age ranges and compared with an EQ-5D United Kingdom general population reference dataset. Pearson R correlation values were calculated for the PROMs and radiographic deformity.

RESULTS

Between July 2015 and March 2020, 425 consecutive female patients presented with HV for consideration for surgery. EQ-5D-5L data were prospectively collected for 396 of these patients (93.2%). Females less than 65 years with HV had a statistically significantly worse quality of life compared with females of the same age group in the general population. Above the age of 65, there was no statistically significant difference in EQ-5D-5L Index score between the two groups. Younger females reported higher VAS-Pain scores compared to older patients with 91% of patients reporting some degree of pain symptoms. There was a moderate correlation with MOXFQ Index score and EQ-5D-5L Index (R = -0.51, p < 0.001) and VAS-Pain scores (R = 0.54, p < 0.001). There was no correlation between radiographic HV deformity and HRQOL measures or MOXFQ scores although it was noted that there was a trend of increasing HVA/IMA with age.

CONCLUSION

Female patients presenting with HV deformity have a significantly reduced quality of life compared with the UK general population. The radiographic severity of deformity did not correlate with HRQOL measures or foot and ankle specific PROMs. Foot and ankle specific clinical PROMsmoderately correlate with HRQOL and may be a better marker of the negative effect of symptomatic hallux valgus deformity on quality of life.

LEVEL OF EVIDENCE

III.

Fancy shoes and painful feet: Hallux valgus and fracture risk in medieval Cambridge, England

OBJECTIVE

Hallux valgus, the lateral deviation of the great toe, can result in poor balance, impaired mobility and is an independent risk factor for falls. This research aims to compare the prevalence of hallux valgus in subpopulations of medieval Cambridge, England, and to examine the relationship between hallux valgus and fractures to examine the impact of impaired mobility and poor balance caused by this condition.

MATERIALS

177 adult individuals from four cemeteries located in Cambridge, England.

METHODS

Human remains were macroscopically and radiographically assessed.

RESULTS

Hallux valgus was identified in 18 % of individuals and was significantly more common during the 14th-15th centuries than the 11th-13th centuries. The highest prevalence was observed in the friary (43 %), followed by the Hospital (23 %), the rurban parish cemetery (10 %), and the rural parish cemetery (3%). Fractures from falls were significantly more common in those with hallux valgus than those without.

CONCLUSION

The increased prevalence of hallux valgus identified in individuals from the 14th to 15th centuries coincided with the adoption of new footwear with pointed toes. Those that adopted this fashion trend appear to have been more likely to develop balance and mobility problems that resulted in an increased risk of falls.

SIGNIFICANCE

This is the first study to explore the relationship between foot problems and functional ability by studying hallux valgus in archaeological assemblages.

LIMITATIONS

Falls are complex and determining the mechanism of injury in human skeletal remains is not always possible.

FURTHER RESEARCH

Fracture prevalence rates may have been affected by biological factors and underlying pathological conditions.

Relationship between lower limb muscle strength and hallux valgus severity in older people

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.

Identification of patterns of foot and ankle pain in the community: Cross-sectional findings from the clinical assessment study of the foot

OBJECTIVES

To investigate patterns of foot and ankle pain locations and symptoms, socio-demographic and comorbid characteristics to examine whether there are distinct foot and ankle pain phenotypes.

METHODS

Adults aged ≥50 years registered with four general practices in North Staffordshire were mailed a Health Survey questionnaire. Participants reporting foot pain in the last month indicated foot pain location on a foot manikin. Foot and ankle pain patterns were investigated by latent class analysis. Associations between the classes with foot pain symptoms, socio-demographic and comorbid characteristics were assessed.

RESULTS

Four thousand four hundred fifty-five participants with complete foot pain and manikin data were included in this analysis (mean age 65 years [SD 9.8], 49% male). Of those with foot and ankle pain (n = 1356), 90% had pain in more than one region. Six distinct classes of foot and ankle pain were identified: no pain (71%), bilateral forefoot/midfoot pain (4%), bilateral hindfoot pain (5%), left forefoot/midfoot pain (8%), right forefoot/midfoot pain (5%) and bilateral widespread foot and ankle pain (6%). People with bilateral widespread foot and ankle pain were more likely to be female, obese, depressed, anxious, have/had a manual occupation, have comorbidities, lower SF-12 scores and greater foot-specific disability. Age did not differ between classes.

CONCLUSIONS

Six distinct classes of foot and ankle pain locations were identified, and those with bilateral widespread foot and ankle pain had distinct characteristics. Further investigation of these individuals is required to determine if they have poorer outcomes over time and whether they would benefit from earlier identification and treatment.

Hallux valgus among sales promotion women wearing high heels in a department store

BACKGROUND

Wearing high heels for an extended period of time can cause several pathological conditions in women's feet, one of such is the hallux valgus (HV), as shown by a number of cross-sectional studies. This study aims to evaluate the incidence of HV among sales promotion women and to know the association of the high heel shoes with the severity of HV in that population.

METHOD

This study used comparative cross-sectional design between two groups, wearing high heel and flat shoes; sales promotion women who work for at least 1 year were recruited as subjects by means of purposive sampling and were given questionnaires, and then physical and radiological examination of the foot were performed to detect any HV and its severity.

RESULT

Incidence of HV is 25.25% (25 of 99) among subjects who were wearing high heel shoes and 10.87% (10 of 92) for those who were wearing flat shoes. Subjects wearing high heel shoes are 2.77 times (95% confidence interval (CI): 1.25-6.15; p = 0.01) more at risk for developing HV than those who wore flat shoes. The incidence of HV increases with age ( p < 0.05). Those who have been working for >4 years are 5.2 times (95% CI: 1.95-14.31) at more risk for developing HV than those who have been working for ≤4 years ( p < 0.001). The duration of wearing shoes per day, the type of toe box, and body mass index are not statistically significant with HV ( p > 0.05). The incidence of HV increased among overweight and obese subjects ( p > 0.05). The severity of HV in subjects was mostly mild to moderate.

CONCLUSION

The incidence of HV is higher among sales promotion women who wear high heel shoes than flat shoes. Age and working experience are also related to the development of HV. Factors that affect the severity of HV cannot be shown in this study.

Footprint Curvature in Spanish Women: Implications for Footwear Fit

The incorrect adjustment of footwear produces alterations in the foot that affect quality of life. The usual measurements for shoe design are lengths, widths and girths, but these measures are insufficient. The foot presents an angle between the forefoot and the rearfoot in the transverse plane, which is associated with foot pronation, hallux valgus and metatarsus adductus. Here, we aimed at identifying the groups formed by the angulations between the forefoot and rearfoot using a sample of footprints from 102 Spanish women. The angle between the forefoot and rearfoot was measured according to the method described by Bunch. A cluster analysis was performed using the K-means algorithm. Footprints were grouped into three types: curved, semi-curved and straight, according to the degrees of angulation between the forefoot and rearfoot. There is great variability in the morphology of the foot. Based on our findings, to achieve a better footwear fit, we propose the manufacture of three types of lasts with different curvatures.

Distal oblique metatarsal osteotomy technique in hallux valgus deformity: Clinical and radiological results

Objectives

This study aims to evaluate the radiological and functional outcomes of hallux valgus patients treated with distal oblique metatarsal osteotomy technique.

Patients and methods

Twenty-six feet of 22 patients (4 males, 18 females; mean age 46.2±18 years; range, 16 to 70 years) who were diagnosed as hallux valgus between March 2013 and April 2016 and who underwent distal oblique metatarsal osteotomy were included in this retrospective study. American Orthopedic Foot and Ankle Society/Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS/HMIS) was used for clinical and functional evaluation. The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, first metatarsal length and forefoot bone and soft tissue width were measured for radiological evaluation.

Results

The mean follow-up time was 33.1±9.8 months. The AOFAS/HMIS score increased significantly postoperatively (p=0.001). In the footwear section of the AOFAS/HMIS, the median preoperative score of 5 (range, 0-5) increased to 10 (range, 5-10) at the postoperative period (p=0.001). Hallux valgus angle, IMA, DMAA, and first metatarsal length significantly decreased when compared to preoperative measurements. Forefoot bone width also decreased significantly from 9.3 cm (range, 7.5-11.5 cm) to 8.8 cm (6.8-10.3 cm) (p=0.001).

Conclusion

Distal oblique metatarsal osteotomy is a safe method for hallux valgus deformity. Forefoot width reduction, decrease of soft tissue tension, sesamoid reduction, and plantar fascia relaxation are the crucial benefits of this method.

Non-vehicle commuting in Italy: need for ergonomic action for women's lower limbs?

INTRODUCTION

The aim of this paper is to examine gender differences in the occurrence of accidents among workers while walking to or from their workplace (non-vehicle commuting accidents). We have previously found that the lower limb is more often injured at work among women, compared to men, so the paper concentrates on lower limb injuries.

METHODS

Using the records of the National Institute for Insurance against Injuries at Work (INAIL), we focused on the non-vehicle commuting accidents of women and men recognized as work-related for the period 2013-2017. In particular, we examined the gender difference by work sector and type of trauma suffered with particular attention to lower limb injuries.

RESULTS

The rate of non-vehicle commuting accidents (n. 60,936) among women was significantly higher than for men (1.29‰ vs 0.40‰ men, p < 0.001) for the period studied. Lower limb injuries (50.5% for women and 43.7% for men, p < 0.001) constituted the large majority of these injuries. In particular, dislocation of the ankle (78% for women vs 65.5% for men, p < 0.001), bruise of the knee (71.2% for women vs 54.9% for men, p < 0.001) and fracture of the foot (41% for women vs 33.6% for men, p < 0.001) were all significantly higher among women. The work sectors with higher injury rates were: Transport and Warehouse, Public Administration, Health and care services and Wholesale and retail trade. This result may be due to wear and tear from conditions at work. The women injured were on the average, a decade older than men (50-59 vs 40-49 years old).

CONCLUSIONS

Non-vehicle commuting represents an important, albeight neglected, preventable risk for women workers, causing lower limb trauma particularly at the ankle, the foot and the knee. These areas may be particularly injure-prone among women in specific sectors, due to the work environment. Effective prevention of these injuries requires gender-oriented ergonomic actions at work and in the commuting environment.

Development of a quantitative measurement system for three-dimensional analysis of foot morphology using a smartphone

Existing techniques for measuring foot morphology are invasive or cumbersome. A new technique was developed using a smartphone, which can measure foot morphology to within 1 mm. This is shown to be applicable to the prediction of hallux valgus, which allows for early intervention.

The influence of obesity and gender on outcome after reversed L-shaped osteotomy for hallux valgus

BACKGROUND

Hallux valgus deformity (HV) affects around every fourth individual, and surgical treatment is performed in every thousandth person. There is an ongoing quest for the best surgical management and reduction of undesirable outcomes. The aim was to explore associations of obesity and gender with radiological and clinical outcome after reversed L-shaped osteotomy (ReveL) for HV.

MATERIALS AND METHODS

This study was carried out in a retrospective cohort design at a single University Hospital in Switzerland between January 2004 and December 2013. It included adult patients treated with ReveL for HV. The primary exposure was body mass index (BMI) at the time of ReveL. The secondary exposure was gender. The primary outcome was radiological relapse of HV (HV angle [HVA] > 15 degrees [°]) at the last follow-up. Secondary outcomes were improvable patient satisfaction, complication, redo surgery, and optional hardware removal. Logistic regression analysis adjusted for confounders.

RESULTS

The median weight, height, and BMI were 66.0 (interquartile range [IQR] 57.0-76.0) kilograms (kg), 1.65 (IQR 1.60-1.71) metres (m), and 24.0 (IQR 21.3-27.8) kg/m². Logistic regression analysis did not show associations of relapse with BMI, independent of age, gender, additional technique, and preoperative HVA (adjusted odds ratio [OR_adjusted] = 1.10 [95% (%) confidence interval (CI) = 0.70-1.45], p = 0.675). Relapse was 91% more likely in males (OR_adjusted = 1.91 [95% CI = 1.19-3.06], p = 0.007). Improvable satisfaction was 79% more likely in males (OR_adjusted = 1.79 [CI = 1.04-3.06], p = 0.035). Hardware removal was 47% less likely in males (OR_adjusted = 0.53 [95% CI 0.30-0.94], p = 0.029).

CONCLUSIONS

In this study, obesity was not associated with unsatisfactory outcomes after ReveL for HV. This challenges the previous recommendation that preoperative weight loss may be necessary for a successful surgical treatment outcome. Males may be informed about potentially higher associations with unfavourable outcomes. Due to the risk of selection bias and lack of causality, findings may need to be confirmed with clinical trials.

Effect of foot care interventions for older adults using day care services

AIM

This study explored the prevalence of foot problems among older adults and the effectiveness of foot care interventions for improving toe-gap force and foot flexibility. Foot problems are very common among people aged 65 years and older. However, the effects of foot care interventions on components underlying these issues (i.e., toe-gap force and foot flexibility) are unclear.

DESIGN

This was a quasi-experimental study.

METHODS

Eighteen older adults were divided into three groups: medical foot care intervention, combined intervention and control group. The combined intervention group received medical foot care, foot hygiene and five-toed socks. Toe-gap force and foot flexibility were measured.

RESULTS

The most common foot problems were hallux valgus, toe deformities, nail discoloration and thickness and dryness. Significant differences in right foot toe-gap force were observed between the combined intervention and control groups. There were no significant differences in foot flexibility between groups.

Shoe design for older adults: Evidence from a systematic review on the elements of optimal footwear

Due to changes in foot morphology and the occurrence of foot deformities and foot pain with ageing, older people frequently wear ill-fitting shoes. This can lead to discomfort and reduced mobility. A review of the literature was performed in Medline, Scopus and Embase with three aims: (a) to evaluate the effects of shoes or shoe elements on the comfort and mobility of older adults, (b) to summarise the evidence-based elements of a safe and comfortable shoe for older adults, and (c) from that, to compile those elements into design recommendations for a safe and comfortable shoe for older adults. Safe elements of footwear include proper anatomical fit, a well-fitting toe box, limited heel height, a broad enough heel, a firm insole and midsole, an outsole with sufficient tread, bevelled heel, firm heel counter with snug fit, and an easy and effective closing mechanism. We conclude that there is a need for shoe design specifically aimed at the foot morphology and demands of older people. The shoe market should increase the availability of well-fitting shoes designed for the older foot and person.

Plantar heel pain in middle-aged and older adults: population prevalence, associations with health status and lifestyle factors, and frequency of healthcare use

Background

The objectives of this study were to estimate the population prevalence and distribution of plantar heel pain in mid-to-older age groups, examine associations with selected health status and lifestyle factors, and report the frequency of healthcare use.

Methods

Adults aged ≥50 years registered with four general practices were mailed a health survey (n = 5109 responders). Plantar heel pain in the last month was defined by self-reported shading on a foot manikin, and was defined as disabling if at least one of the function items of the Manchester Foot Pain and Disability Index were also reported. Population prevalence estimates and associations between plantar heel pain and demographic characteristics, health status measures and lifestyle factors were estimated using multiple imputation and weighted logistic regression. Healthcare professional consultation was summarised as the 12-month period prevalence of foot pain-related consultation.

Results

The population prevalence of plantar heel pain was 9.6% (95% CI: 8.8, 10.5) and 7.9% (7.1, 8.7) for disabling plantar heel pain. Occurrence was slightly higher in females, comparable across age-groups, and significantly higher in those with intermediate/routine and manual occupations. Plantar heel pain was associated with physical and mental impairment, more anxiety and depression, being overweight, a low previous use of high-heeled footwear, and lower levels of physical activity and participation. The 12-month period prevalence of foot pain-related consultation with a general practitioner, physiotherapist or podiatrist/chiropodist was 43.0, 15.1 and 32.8%, respectively.

Conclusions

Plantar heel pain is a common, disabling symptom among adults aged 50 years and over. Observed patterns of association indicate that in addition to focused foot-specific management, primary care interventions should also target more general physical and psychological factors that could potentially act as barriers to treatment adherence and recovery.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2718-6) contains supplementary material, which is available to authorized users.

Everyday footwear: An overview of what we know and what we should know on ill-fitting footwear and associated pain and pathology

Footwear has been used to protect feet for millennia with socially exclusive population adopting stylish and fashionable shoes with expensive materials. In terms of historic timeline, only more recently footwear has been worn by all classes in the western world as an integral part of their apparel. Traditionally, footwear has been constructed from natural materials, mainly leather, but has recently benefitted from the flexibility that technology has provided with a plethora materials and new design innovations. Although it has expanded the availability for a variety of consumers, the choice and fit continue to be problematic with many individuals wearing shoes that are ill-fitting. Provision of specific footwear advice for problem feet is poorly evidenced and is heavily practitioner dependant limiting its efficacy. There is limited understanding as to the changes that can occur from regularly wearing footwear that is unsuitable in shape, style and construction which is referred to as ill-fitting. Current research on the effect that everyday footwear has on foot function and pain focuses mainly on women's shoes, particularly high heels. Defining what is a good fitting shoe, that does not damage the foot or mechanics of walking, may need to be individualised, but best fit is based on loose historical parameters rather than research evidence. The aim of this overview is to highlight aspects of current research, establishing what is known about the effect's shoes have on the feet as well as exploring the mythology around footwear fit and advice that is often historical in nature.

Hallux Valgus

Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics. The precise biomechanical etiology remains under debate. Predisposing factors include female sex, age, constricting footwear, and family history. Metatarsus adductus, equinus contracture, hammertoe deformity, and pes planus often coexist with hallux valgus. Nonoperative treatment involves patient education, shoe modifications, toe pads and positioning devices, and activity modifications. Surgery is considered in patients who fail nonoperative treatment with the goal of pain relief, correction of the deformity, improved first ray stability, and improved quality of life. More than 100 different procedures have been described to treat hallux valgus; they include combinations of soft tissue balancing, metatarsal osteotomies, and fusion of either the metatarsophalangeal (MTP) or tarsometatarsal (TMT) joint. The choice of procedures depends on the severity and location of the deformity as well as surgeon preference. Recent advances in operative techniques include minimally invasive surgery and correction of rotational deformity.

Plantar pressures in identical and non-identical twins

Identifying environmental risk factors for musculoskeletal disorders is challenging due to the number of potential confounders. Twins are of particular interest for researchers interested in studying these types of problems due to their inherent control for the influence of genetic factors. In twin studies, this population can allow environmental risk factors to be more easily identified, and this type of study design may allow the role of biomechanics in injury and disease to be further explored. At present, it is unclear if foot function displays more similarity between certain types of twins. In this study, we hypothesized that the plantar pressures of monozygotic (identical) twins would be more similar between pairs than dizygotic (non-identical) twins. We measured static and dynamic plantar pressures from five pairs of each twin type. Statistical parametric modeling was used to compare pressure distributions at the sensor level. For >80% of stance phase, the pixel level analysis indicated that monozygotic twins had less variation in plantar pressure between pairs. The average z-statistic across the entire trial was 0.88 for the monozygotic group and 1.13 for the dizygotic group. In this study we provide evidence of greater similarity of plantar pressures in monozygotic twin pairs compared to dizygotic twins. This finding supports the use of co-twin studies investigating potentially modifiable environmental and biomechanical risk factors for musculoskeletal conditions that affect the foot and ankle.

Heel Height as an Etiology of Hallux Abductus Valgus Development: An electromagnetic Static and Dynamic First Metatarsophalangeal Joint Study

Background: Hallux abductus valgus (HAV) is a forefoot condition produced by extrinsic and intrinsic factors. Shoes with a high heel height and a typical narrow tip toe box can induce deviations in both the proximal phalanx of the hallux (PPH) and the first metatarsal (IMTT) bones. Nevertheless, the isolated role of heel height remains unclear in the development of HAV pathology. Objectives: The goal was to determine if the heel height increase of shoes without a narrow box toe could augment the PPH and IMTT deviation in frontal, sagittal, and transverse planes toward the first metatarsophalangeal joint (MPJ) and the first metatarsocuneiform joint (MCJ), respectively, during static and dynamic conditions in relation to precursor movements of HAV. Methods: Women with an average age of 25.10 ± 4.67 years were recruited in this cross-sectional study to assess the three planes of motion of PPH and IMTT while wearing high heels with heights at 3, 6, 9 cm and unshod conditions via sandals. The measurements used an electromagnetic goniometer device with sensors placed on medial aspects of the PPH and IMTT bones under static and dynamic conditions. Results: Wearing shoes with a 6 cm heel in dynamic condition may increase the PPH valgus and abduction deviation from 3.15 ± 0.10° to 3.46 ± 0.05° (p < 0.05) and from 1.35 ± 0.28° to 1.69 ± 0.30° (p < 0.001), respectively. In addition, a PPH abduction increase from 1.01 ± 0.36° to 1.31 ± 0.46° (p < 0.05) after wearing shoes with a 6 cm heel height was observed under static conditions. Conclusions: Wearing shoes with a heel height of 6 cm without a narrow box toe interference may produce PPH abduction and valgus deviations related to HAV formation.

Ultrasonographic Evaluation of the Femoral Cartilage, Achilles Tendon, and Plantar Fascia in Young Women Wearing High-Heeled Shoes

BACKGROUND

Specific attention on the musculoskeletal impact of wearing high-heeled shoes (HHS) has mainly focused on knee osteoarthritis and the literature is limited to biomechanical changes. The distal femoral cartilage has not been morphologically studied. Additionally, although heel elevation is coupled with a shear stress at the heel and overloaded calf muscles, Achilles tendon (AT) and plantar fascia (PF) thicknesses have not been assessed either.

OBJECTIVE

To investigate whether the distal femoral cartilage, AT, and PF were different in women wearing HHS and flat-heeled shoes (FHS) and specifically, different in terms of AT/PF and distal femoral cartilage thicknesses.

DESIGN

Cross-sectional observational study.

SETTING

Tertiary care center.

PARTICIPANTS

There were 34 women (mean age; 31.1 ± 6.4, body mass index [BMI]; 21.6 ± 2.4 kg/m² ) in the HHS group and 54 women (mean age; 29.5 ± 7.2 years, BMI 22.5 ± 2.9 kg/m² ) in the FHS group (P = .271, P = .102, respectively). Women wearing shoes with a heel height of >5 cm were enrolled in the HHS group, and those wearing shoes with a heel height of <1.4 cm were included in the FHS group.

MAIN OUTCOME MEASUREMENTS

Distal femoral cartilage from the lateral condyle, intercondylar area and medial condyle (MFC), AT and PF thicknesses, and any abnormalities were evaluated bilaterally by ultrasound.

RESULTS

Within-group comparisons yielded thicker right MFC (P = .022) and left AT (P = .028) only in the HHS group. Between-group comparisons yielded thicker left AT in the HHS group (P = .040). PF thicknesses were similar both within and between group comparisons (all P > .05). Right AT thickness was positively correlated with right (r = .469, P = .005) and left (r = .402, P = .018) PF thicknesses only within the HHS group. Only calcaneal irregularity/spur was found to be common in the HHS group (P = .038).

CONCLUSIONS

We found thickening of the right MFC and left AT in those wearing HHS, whereas PF thickness was not significantly different between those wearing HHS and those wearing FHS.

LEVEL OF EVIDENCE

III.

Factors associated with wearing inadequate outdoor footwear in populations at risk of foot ulceration: A cross-sectional study

BACKGROUND

Few studies have investigated if people at risk of foot ulceration actually wear the footwear recommended by best practice guidelines to prevent foot ulceration. This study aimed to investigate the prevalence of, and factors associated with, wearing inadequate outdoor footwear in those with diabetes or peripheral neuropathy in an inpatient population.

METHODS

This was a secondary analysis of a multi-site cross-sectional study investigating foot conditions in a large representative inpatient population admitted into hospital for any medical reason on one day. A range of explanatory variables were collected from all participants including sociodemographic, medical and foot condition factors. The outcome variable for this study was the self-reported outdoor footwear type worn most by participants outside the house in the year prior to hospitalisation. The self-reported footwear type was then categorised into adequate and inadequate according to footwear features recommended in guidelines for populations at risk of foot ulceration. Logistic regression identified factors independently associated with inadequate footwear in all inpatient participants, and diabetes and neuropathy subgroups.

RESULTS

Overall, 47% of a total of 726 inpatients wore inadequate outdoor footwear; 49% of the 171 in the diabetes subgroup and 43% of 159 in the neuropathy subgroup. Wearing inadequate outdoor footwear was independently associated (Odds Ratio (95% Confidence Interval)) with being female in the diabetes (2.7 (1.4-5.2)) and neuropathy subgroups (3.7 (1.8-7.9)) and being female (5.1 (3.7-7.1)), having critical peripheral arterial disease (2.5 (1.1-5.9)) and an amputation (0.3 (0.1-0.7)) in all inpatients (all, p<0.05).

CONCLUSIONS

Almost half of all inpatients at risk of foot ulceration reported wearing outdoor footwear most of the time that did not meet recommendations for prevention. We found women were much more likely to wear inadequate footwear. More work needs to be done to increase the uptake of footwear recommendations in these populations to prevent foot ulceration.

Nonradiographic Measurement of Hallux Valgus Angle Using Self-photography

BACKGROUND

Radiographs of the feet are the reference standard for measuring the hallux valgus angle. However, the availability and use of radiographs are constrained due to cost and radiation exposure. Less invasive, nonradiographic assessments have been proposed, although measurement using self-photography has not been reported.

OBJECTIVES

To determine (1) reliability of photographic hallux valgus angle (pHVA) measurement using the same photographs of the feet, (2) reliability of repeated self-photography trials, and (3) measurement error when the radiographic hallux valgus angle (rHVA) is estimated using the pHVA.

METHODS

In this reliability study, participants took photographs of their own feet using a digital camera. The intrarater and interrater reliability of pHVA measurements were then assessed using the intraclass correlation coefficient (ICC) and 95% minimum detectable change (MDC). The participants took photographs twice, and the reliability of repeated self-photography trials was examined. Participants also received radiographs of their feet, from which the rHVA was measured. The measurement error was assessed using the mean difference and 95% limits of agreement.

RESULTS

The intrarater and interrater ICC of pHVA measurement was 0.99, with MDCs less than 2°. The ICC of pHVA measurement for repeated self-photography was 0.96, and the MDC was 6.9°. The pHVA was systematically lower than the rHVA, by 5.3°.

CONCLUSION

Measurement of the pHVA using self-photography was reproducible, although pHVA measurement underestimated the rHVA. The pHVA can be a useful nonradiographic method to quantify hallux valgus deformity. J Orthop Sports Phys Ther 2019;49(2):80-86. Epub 12 Sep 2018. doi: 10.2519/jospt.2019.8280.

Radiological and Clinical Outcome After Reversed L-Shaped Osteotomy: A Large Retrospective Swiss Cohort Study

The objective was to report radiological and clinical outcomes after reversed L-shaped osteotomy (ReveL) for hallux valgus (HV). A retrospective cohort study was performed between January 2004 and December 2013. The primary outcome was radiological recurrence of HV (HV angle [HVA] >15°). There were various exposure and secondary outcome variables. The results showed a median follow-up of 12.0 months (N = 827). Radiological recurrence, limited patient satisfaction, complication, revision surgery, and elective hardware removal were found in 25.0%, 15.3%, 4.6%, 2.5%, and 26.7%. Median pre- to postoperative changes were highest for HVA (delta = -16.7°). Recurrence was more likely in cases with preoperative HVA ≥40° (adjusted odds ratio [OR_adjusted]) 3.63, p < .001). Revisions were more likely with concomitant diseases and bilateral surgery (OR_adjusted 12.53, p = .010; OR_adjusted 3.35, p = .030). Hardware removal was less likely in patients ≥50 years (OR_adjusted 0.67, p = .014). In conclusion, ReveL was a good surgical option for HV because of the relatively low rates of unfavorable outcomes.

Early initiation of zoledronic acid does not impact bone healing or clinical outcomes of hallux valgus orthomorphia

Objective

This prospective randomized controlled study was performed to determine whether early drug use for osteoporosis impacts bone healing after orthomorphic surgery for hallux valgus (HV) in menopausal patients with osteoporosis.

Methods

This study included 113 consecutive patients with osteoporosis who underwent a combination of Lapidus arthrodesis and Akin osteotomy for treatment of HV. The patients were randomly divided into a zoledronic acid (ZOL) group (5-mg intravenous injection of ZOL, n = 56) and a placebo group (n = 57); both ZOL and placebo were administered 1 week postoperatively. Radiographs were taken preoperatively and at 1, 6, 8, 10, and 12 weeks postoperatively to record the time of the first tarsometatarsal joint (FTJ) fusion and Akin osteotomy site healing. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scoring system 24 weeks after surgery.

Results

There were no statistically significant differences in the FTJ fusion time after Lapidus arthrodesis, healing time after Akin osteotomy, or postoperative AOFAS scores between the two groups.

Conclusion

Early initiation of ZOL does not impact the bone healing or clinical outcomes of orthomorphic surgery for HV in postmenopausal women diagnosed with osteoporosis after a combination of Lapidus arthrodesis and Akin osteotomy.

Importance of Footwear for Preventing Xerosis and Hyperkeratosis in Older People with Psychiatric Disorders Living in an Institution

Few studies have focused on the relation between the use and characteristics of footwear and the presence of foot lesions in people with psychiatric disorders. This work analyzes the influence of different footwear habits on the presence of deformities and ungueal and dermal pathologies of the foot of institutionalized people with psychiatric disorders compared to people without these disorders. A transversal and observational study was conducted on 107 participants, divided into two groups who have used different types of shoes throughout their lives. The control group comprised 63 autonomous people who mainly use leather footwear and a study group of 44 institutionalized people with intellectual disabilities and psychiatric disorders who mainly use textile footwear. There were significant differences between populations. The group with psychiatric disorders presented more xerosis and hyperkeratosis. Footwear with inappropriate characteristics is a possible causal agent of skin alterations. Wearing footwear with quality textile uppers, e.g., fabric or felt, could influence the appearance of these alterations. Leather footwear is recommended for institutionalized people to reduce symptoms of xerosis and improve their quality of life.

An Imaged-Based Three-Dimensional Study of First Metatarsal Protrusion Distance in Women with and Without Hallux Valgus

BACKGROUND

First metatarsal protrusion distance (MPD) has been commonly studied as a characteristic of hallux valgus deformity. To date, the majority of investigations have used radiographic methods, with most reporting first metatarsal (ray) protrusion to be associated with deformity. As an alternative, this study used a three-dimensional (3-D) image acquisition and data analysis method to quantify MPD.

METHODS

Magnetic resonance images were acquired in weightbearing on 29 women (19 with hallux valgus; 10 controls). After the 3-D images were reconstructed into virtual bone models, two examiners measured MPD in relation to the navicular. In addition to a reliability analysis, a t test assessed for group differences in demographics, foot posture (hallux valgus, intermetatarsal angles), and MPD.

RESULTS

Group demographics were not different, while measures of hallux valgus and intermetatarsal angles were different ( P < 0.01) between groups. The measurement of MPD was highly reliable (ICC [Formula: see text] 0.99; SEM [Formula: see text] 0.78 mm). Metatarsal protrusion averaged approximately -2.0 mm in both groups. There was no statistical group difference ( P = 0.89) in MPD.

CONCLUSIONS

The reconstructed image datasets captured the 3-D spatial relationship of the anatomy. Measurements of MPD were reliable. The first ray measured 2 mm shorter than the second ray in both the hallux valgus and control groups. Though unexpected, this result may prompt future study of the pathokinematics associated with hallux valgus that include the quantification of metatarsal protrusion with 3-D methods, instead of relying solely on single-plane radiograph reports.

Hallux valgus in a random population in Spain and its impact on quality of life and functionality

The aim of this study was to determine the prevalence of Hallux valgus (HV) and the association between the presence thereof and quality of life, dependence for basic and instrumental activities of daily living and foot function. Prevalence study was carried out in a random population sample (n = 1837) (α = 0.05; Precision = ±2.2%). Informed consent and ethical review board were obtained (code 2008/264). We studied anthropometric variables, Charlson Comorbidity Index, function and state of foot [Foot Function index (FFI), Foot Health Status Questionnaire (FHSQ)], quality of life (SF-36), and dependence for activities of daily living (Barthel and Lawton index). Degree of HV was determined using Manchester scale. Descriptive and multivariate logistic regression analyses were performed. Hence, the prevalence of HV is 39%. Patients with HV are significantly older (64.6 ± 11.7 vs 60.1 ± 12.6 years old). HV prevalence is greater in females (48.1 vs. 28.3%), subjects with flat foot (48.1 vs. 36.1%) or hammer toes (48.2 vs. 30.9%). Moreover, with regard to the presence or not of HV, statistically significant differences were neither noted in the SF-36 questionnaire nor in the Barthel and Lawton Index. For FHSQ and FFI questionnaires, significant differences were observed between patients who presented HV and those who did not. HV is associated with age, gender, flat foot and hammer toes. The SF-36 and Barthel and Lawton questionnaires remained unaltered by the presence of HV. The presence of Hallux valgus was associated with reduced quality of life and increases foot pain, disability and functional limitation.