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Kawakami W, Iwamoto Y, Ota M, Ishii Y, Takahashi M. Individuals with asymptomatic hallux valgus exhibit altered foot kinematics during gait regardless of their foot posture. Clin Biomech (Bristol, Avon) 2024; 118:106319. [PMID: 39106589 DOI: 10.1016/j.clinbiomech.2024.106319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/08/2024] [Accepted: 07/30/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND A flatfoot has been believed to be closely associated with the development of hallux valgus; however, the association is still controversial. Abnormal foot kinematics has been identified as a possible risk factor for the development of hallux valgus, but it remains unclear whether foot posture contributes to abnormal foot kinematics. This is the first study to investigate the differences in foot kinematics during gait between individuals with and without hallux valgus, while controlling for foot posture. METHODS Twenty-five females with hallux valgus and 25 healthy females aged 18 to 22 were recruited. Foot posture was measured using normalized navicular height truncated and the leg-heel angle. Foot kinematic and kinetic data during gait were recorded by a three-dimensional motion capture system. To investigate the characteristics of foot kinematics in individuals with hallux valgus while controlling for foot posture, we used a propensity score matching method. The matching was obtained by using the 1:1 nearest-neighbor procedure and a caliper width of 0.2. FINDINGS Twelve pairs were matched. Individuals with hallux valgus had significantly increased midfoot dorsiflexion from 56% to 80% during stance phase, rearfoot eversion from 53% to 71%, and forefoot abduction from 5% to 29% compared with control. INTERPRETATION Individuals with hallux valgus have a flexible foot that cannot suppress the dynamic deformation of the rearfoot and midfoot during gait. To suppress the development of hallux valgus, interventions that aim to prevent dynamic deformations of the rearfoot and midfoot during gait may be necessary, regardless of their static foot posture.
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Affiliation(s)
- Wataru Kawakami
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshitaka Iwamoto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Center for Advanced Practice and Research of Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuhiro Ota
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Ishii
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Center for Advanced Practice and Research of Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Makoto Takahashi
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Center for Advanced Practice and Research of Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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Ishihara H, Maeda N, Komiya M, Tashiro T, Tsutsumi S, Arima S, Kawai M, Tamura Y, Ikuta Y, Urabe Y. The vertical mobility of the first tarsometatarsal joint during demi-plié with forced turnout in ballet dancers. Sci Rep 2024; 14:15321. [PMID: 38961097 PMCID: PMC11222447 DOI: 10.1038/s41598-024-64304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 06/06/2024] [Indexed: 07/05/2024] Open
Abstract
The forced turnout has a perceived risk of development of hallux valgus (HV) in ballet dancers. We determined how the forced turnout affects the sagittal mobility of the first tarsometatarsal (TMT) joint, which is one of the pathogenic factors of HV development. Seventeen female ballet dancers (body mass index: 18.2 ± 1.8 kg/m2) were included and performed demi-plié in control, functional turnout, and forced turnout conditions. Ultrasound imaging synchronized with a three-dimensional motion analysis system was used for measuring the vertical locations of the first metatarsal and medial cuneiform (MC) to evaluate the first TMT joint mobility. Plantar displacement of MC and the first TMT joint mobility in the forced turnout were the greatest among the 3 conditions. Multiple regression analysis indicated that the greater extent of the forcing angle might increase the displacement of MC and the first TMT joint mobility. Evaluating the sagittal mobility of the first TMT joint in the forced turnout can assist in understanding the association between inappropriate techniques including the forced turnout and HV development in ballet dancers. Since the excessive mobility of the first TMT joint is a factor in HV development, the acquirement of adequate active turnout may have the potential to prevent HV development in ballet dancers.
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Affiliation(s)
- Honoka Ishihara
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Makoto Komiya
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho, 1398, Kita-ku, Niigata City, Niigata, 950-3198, Japan
- Athlete Support Medical Center, Niigata University of Health and Welfare, Niigata, 950-3198, Japan
| | - Tsubasa Tashiro
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Shogo Tsutsumi
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Satoshi Arima
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan.
| | - Miki Kawai
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Yuki Tamura
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Yukio Urabe
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1‑2‑3 Kasumi, Minami‑ku, Hiroshima, 734‑8553, Japan.
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Colò G, Leigheb M, Surace MF, Fusini F. The efficacy of shoes modification and orthotics in hallux valgus deformity: a comprehensive review of literature. Musculoskelet Surg 2024:10.1007/s12306-024-00839-9. [PMID: 38922494 DOI: 10.1007/s12306-024-00839-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024]
Abstract
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.
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Affiliation(s)
- G Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy.
| | - M Leigheb
- Orthopaedics and Traumatology Unit, Department of Health Sciences, ''Maggiore Della Carità'' Hospital, University of Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - M F Surace
- Circolo Hospital, Macchi Foundation 'Insubria University', Viale Borri 57, 21100, Varese, Italy
| | - F Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, University of Turin, Via Zuretti 29, Turin, Italy
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Moulodi N, Sarrafzadeh J, Azadinia F, Shakourirad A, Jalali M. Additional effect of neuromuscular electrical stimulation in a conservative intervention on morphology and strength of abductor hallucis muscle and correction of hallux valgus deformity: a randomized controlled trial. Physiother Theory Pract 2024:1-10. [PMID: 38391279 DOI: 10.1080/09593985.2024.2316309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND In hallux valgus, morphological changes and functional weakness of intrinsic foot muscles occur, especially in the abductor hallucis muscle. OBJECTIVES This study aimed to investigate how a conservative treatment with the addition of neuromuscular electrical stimulation affects the volume and strength of the muscle, the correction of deformity, passive range of motion, pain, and disability. METHODS Twenty-eight female participants (48 feet) were randomly assigned to two groups. The interventions included orthoses and exercise (Ortho) in both groups. One group received additional neuromuscular electrical stimulation of abductor hallucis muscle to activate it. Each group received the treatments for one month and was assessed two times, at baseline before starting and after one month of treatment. Mixed within-between ANOVA, analysis of covariance, and nonparametric tests were used for data analysis. RESULTS The muscle volume, abduction strength, goniometric angle, and passive hallux dorsi/plantar flexion showed significant changes in both groups (p < .001). Subscales of the foot and ankle ability questionnaire, significantly changed (p ≤ .05). Pain decreased significantly in the two groups (p < .001 and p = .02). Intermetatarsal angle did not significantly differ between the two groups (p = .86, partial eta effect size = 0.001). But, the hallux valgus angle mean (on MRI) in the Ortho group was less than that of the orthoNMES group (p = .007, partial eta effect size = 0.15). CONCLUSION Both groups showed nearly identical treatment effects in the primary volume and hallux valgus correction outcome measures. In this study, adding neuromuscular electrical stimulation did not have an additional effect compared to conservative in the treatment of hallux valgus. TRIAL REGISTRATION NUMBER The RCT Code is IRCT20200915048725N1.
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Affiliation(s)
- Nasrin Moulodi
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Sarrafzadeh
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Azadinia
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Shakourirad
- Sina Hospital, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Jalali
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Wu DY, Lam EKF. Are sesamoids and proximal phalanx of metatarsus primus varus deformity of hallux valgus feet displaced? A radiological study. J Orthop Surg (Hong Kong) 2024; 32:10225536241233474. [PMID: 38369475 DOI: 10.1177/10225536241233474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The hallux valgus deformity is made up of misaligned first metatarsal, hallux, and sesamoids. Their angular deformities are well-studied, but not their positional displacements. A few available reports claimed the proximal end of the proximal phalanx and sesamoids were not shifted medially along with the first metatarsal head. However, the general observation is otherwise. This study revisits the issue. METHODS A radiological study of 189 feet with and without the hallux valgus deformity was carried out to analyze the first metatarsal, hallux, and sesamoid positional changes in relation to the second metatarsal and among themselves. A total of 194 X-ray images with all relevant measurements that formed the raw database for this study were submitted for online viewing and reference. RESULTS There was a statistically significant change in the first metatarsal, hallux, and sesamoid positions of feet with hallux valgus deformity compared to normal feet. All have migrated medially but to different degrees. It was contrary to the past findings of no change in sesamoid and hallux positions. CONCLUSIONS We agree with past findings that the metatarsus primus varus deformity is directly related to the failed medial metatarsosesamoid ligament. We also believe in the failure of the deep 1-2 transverse metatarsal ligament responsible for the sesamoid migration.
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Affiliation(s)
| | - Eddy Kwok Fai Lam
- Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong, China
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Tang Z, Wu Y, Bao W, Chen X, Zhang D, Korotkov AN, Zheng W, Gu S. Finite Element Parametric Design of Hallux Valgus Orthosis Based on Orthogonal Analysis. Orthop Surg 2023; 15:2794-2804. [PMID: 37667965 PMCID: PMC10622271 DOI: 10.1111/os.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE To design appropriate orthosis for hallux valgus, a difficult foot condition that affects a quarter of the body's bones, we need to clarify the numerical biomechanical features, which have not been established in previous biomechanical studies. Therefore, we constructed a finite element model of the bunion foot to investigate the orthopaedic force compensation mechanism. METHODS A patient with moderate hallux valgus was recruited. CT imaging data in DICOM format were extracted for three-dimensional foot model reconstruction. In conjunction with the need for rapid design of bunion orthosis, a metatarsal force application sizing method based on an orthogonal test design was investigated. The orthogonal test design was used to obtain the hallux valgus angle (HVA) and the inter metatarsal angle (IMA) data for different force combinations. Based on the extreme difference analysis and analysis of variance of the test results, the influence of different force combinations on the bunion angle was quickly determined. RESULTS The results showed that the stress concentration occurred mainly in the first metatarsal bone. The distribution trend was in the medial and lateral middle of the bone and gradually decreased to the dorsal base of the bone body. The greatest stress occurs in the cartilage between the phalanges and metatarsals. In 25 groups of simulation experiments, HVA was reduced from 27.7° to 13°, and IMA was reduced from 12.5° to 7.3°. CONCLUSION Applying detailed orthopaedic force collocation to the first metatarsal column can effectively restore the mechanics and kinematics of hallux valgus, and provide a reference for the treatment of bunion valgus and the design of orthopaedic devices.
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Affiliation(s)
- Zhi Tang
- College of Mechanical EngineeringDonghua UniversityShanghaiChina
| | - Yifei Wu
- College of Mechanical EngineeringDonghua UniversityShanghaiChina
| | - Wenlan Bao
- College of Mechanical EngineeringDonghua UniversityShanghaiChina
| | - Xiaoyan Chen
- College of Mechanical EngineeringDonghua UniversityShanghaiChina
| | - Die Zhang
- College of Mechanical EngineeringDonghua UniversityShanghaiChina
| | - Alexander Nikolaevich Korotkov
- Institute of IT, Mechanical Engineering and Motor VehiclesT.F. Gorbachev Kuzbass State Technical UniversityKemerovoRussia
| | - Weiming Zheng
- Institute of IT, Mechanical Engineering and Motor VehiclesT.F. Gorbachev Kuzbass State Technical UniversityKemerovoRussia
| | - Song Gu
- Trauma Center, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Wong DWC, Cheung JCW, Zhao JG, Ni M, Yang ZY. Forefoot Function after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis on Plantar Load Measurement. J Clin Med 2023; 12:jcm12041384. [PMID: 36835920 PMCID: PMC9965975 DOI: 10.3390/jcm12041384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
While hallux valgus (HV) surgeries are useful for correcting skeletal alignment problems, their effects on plantar load, which reflects forefoot functions, are less understood. The objective of this study is to conduct a systematic review and meta-analysis on the plantar load change after HV surgeries. A systematic search of Web of Science, Scopus, PubMed, CENTRAL, EMBASE, and CINAHL was performed. Studies that assessed the pre- and post-operative plantar pressure of HV patients undergoing surgeries and reported load-related parameters over the hallux, medial metatarsal, and/or central metatarsal regions were included. Studies were appraised by using the modified NIH quality assessment tool for before-after study. Studies suitable for meta-analysis were pooled with the random-effects model, using the standardized mean difference of the before-after parameters as an effect measure. Twenty-six studies containing 857 HV patients and 973 feet were included for the systematic review. Meta-analysis was conducted on 20 of them, and most studies did not favor HV surgeries. Overall, HV surgeries reduced the plantar load over the hallux region (SMD -0.71, 95% CI, -1.15 to -0.26), indicating that forefoot function worsened after surgeries. For the other five outcomes, the overall estimates were not statistically significant, indicating that surgeries did not improve them either. There was substantial heterogeneity among the studies, which in most cases could not be resolved by pre-planned subgroup analyses by surgical classification, year of publication, median age of patients, and length of follow-up. Sensitivity analysis removing lower-quality studies showed that the load integrals (impulse) over the central metatarsal region significantly increased (SMD 0.27, 95% CI, 0 to 0.53), indicating that surgeries increased the risk of transfer metatarsalgia. There is no solid evidence that HV surgeries could improve forefoot functions from a biomechanical point perspective. Currently available evidence even suggests that surgeries might reduce the plantar load over the hallux and adversely affect push-off function. The reasons behind and the effectiveness of alternative surgical methods warrant further investigation.
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Affiliation(s)
- Duo Wai-Chi Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - James Chung-Wai Cheung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Jia-Guo Zhao
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Ming Ni
- Department of Science Development, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
- Department of Orthopaedics, Pudong New Area People’s Hospital, Shanghai 201299, China
| | - Zu-Yao Yang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Correspondence: ; Tel.: +852-2252-8739
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Dygut J, Piwowar M. Muscular Systems and Their Influence on Foot Arches and Toes Alignment-Towards the Proper Diagnosis and Treatment of Hallux Valgus. Diagnostics (Basel) 2022; 12:diagnostics12122945. [PMID: 36552952 PMCID: PMC9776458 DOI: 10.3390/diagnostics12122945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/12/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
(1) Background: Static foot deformities, including hallux valgus, are common deformities. The subject under consideration is the role of extrinsic and intrinsic muscles working within muscular systems that shape the arches of the foot and the alignment of the toes. (2) Methods: Based on a literature review, the muscle systems were analyzed. The systems under consideration were as follows: "tendon stirrup" (system I); muscles complementary to the tendon stirrup (system II); "foot lever" (system III); muscles complementary to system III (system IV); "reins of hallux" (system V), a muscular system having distal inserts on the hallux. The shape of the foot arches was analyzed in this context. (3) Results: The correct arch architecture of the foot stabilized mainly by the extrinsic muscle systems determining the function of the intrinsic muscle systems of the foot is described. The proper function of muscular systems shaping the arches of the foot is a prerequisite for the proper function of muscles directly responsible for the alignment of the big toe (hallux) and other foot toes. (4) Conclusion: The action of muscles should be considered in groups (systems) because the action of the group of muscles results in the creation of a new quality of movement. The analysis of individual muscle-pulling forces, especially the moments of force in the weight-bearing foot, may lead to extremely incorrect conclusions. In pathological cases, the restoration of the correct arches of the foot guarantees the recovery of the correct function of the pulling forces of the foot muscles responsible for the physiological alignment of the hallux. This is especially important concerning conservative and surgical treatment of hallux valgus.
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Selected hallmarks of hallux valgus in older women with symptomatic hallux valgus compared to middle-aged women with and without deformation of the forefoot. Sci Rep 2022; 12:18338. [PMID: 36316449 PMCID: PMC9622853 DOI: 10.1038/s41598-022-23113-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of the study was to compare the shape of the feet, the mobility of the metatarsophalangeal and interphalangeal joints and the flexibility of the calf muscles in older women with hallux valgus versus middle-aged women with and without this deformation to identify the presence of features which correlate particularly strongly with hallux valgus, and on which prophylaxis and conservative treatment should focus. The study involved 201 women: 92 aged 60-84 years with hallux valgus of both toes, 78 aged 38-59 with hallux valgus of both toes, and 31 aged 38-57 years with correctly shaped feet. The intensity of pain in the foot, the valgus angle of the big toe and fifth toe, the longitudinal and transverse arches of the foot, the symmetry of foot load with body weight, toe joint mobility and muscle flexibility were analysed. Both groups of women with hallux valgus differed from women with normal feet in the height of the transverse arch, the extent of dorsal extension in the first metatarsophalangeal joint and plantar flexion in the first interphalangeal joint. Older women were additionally characterised by reduced plantar flexion in the metatarsophalangeal joint of the big toe, limited flexibility of the soleus and gastrocnemius muscles as well as less pain in the toe area than in the foot itself. The most characteristic changes which were observed in older women with hallux valgus are a limited range of motion in the MTP and IP joints of the big toe, a reduced transverse arch and increased restriction of calf muscle flexibility.
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Maeda N, Ikuta Y, Tashiro T, Arima S, Morikawa M, Kaneda K, Ishihara H, Brand A, Nakasa T, Adachi N, Urabe Y. Quantitative evaluation of the vertical mobility of the first tarsometatarsal joint during stance phase of gait. Sci Rep 2022; 12:9246. [PMID: 35655091 PMCID: PMC9163033 DOI: 10.1038/s41598-022-13425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/24/2022] [Indexed: 11/09/2022] Open
Abstract
We determined how the in vivo mobility of the first tarsometatarsal (TMT) joint can be quantified during gait. Twenty-five healthy participants (12 females) with no history of foot disorders were included. Non-invasive ultrasound (US) with a three-dimensional motion analysis (MA) system was used to evaluate the kinematic characteristics of first TMT joint during stance phase of gait. US probe was positioned longitudinally above the first TMT joint and adjusted to its proximal dorsal prominence. Gait analysis was conducted by the MA system starting with the activation of B-mode US video at 80 frames per second and 60-mm depth for simultaneous capture. During stance phase, the first metatarsal was translated dorsally with respect to the medial cuneiform, returning to a neutral level at toe-off in all subjects. During middle stance phase, the medial cuneiform was stable in males but displaced in the plantar direction in females and was the primary contributor to the differences in sagittal mobility observed between groups. Quantitatively measuring sagittal mobility of the first TMT joint could be useful for the early detection of foot abnormalities. The dynamic characteristics of the medial cuneiform during gait in healthy females may be associated with a high prevalence of hallux valgus.
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Affiliation(s)
- Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan.
| | - Tsubasa Tashiro
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Satoshi Arima
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Masanori Morikawa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kazuki Kaneda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Honoka Ishihara
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Andreas Brand
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical Private University Salzburg, Salzburg, Austria
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Yukio Urabe
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
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Shah M, Stirling B, Jackson JB, Gonzalez T. Utilization of the Modified Lapidus Procedure for Correction of Moderate to Severe Hallux Valgus Deformity With Increased Distal Metatarsal Articular Angle. Foot Ankle Spec 2022:19386400221093859. [PMID: 35608239 DOI: 10.1177/19386400221093859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hallux valgus, a common deformity treated by orthopaedic foot and ankle surgeons, can frequently present with an increased distal metatarsal articular angle (DMAA), which may require correction in addition to the hallux valgus deformity. Thus, we investigated the efficacy of the modified Lapidus procedure, a triplanar correction, in correcting the DMAA in hallux valgus surgery. METHODS A retrospective chart review was performed on patients who underwent the hallux valgus reconstruction with a modified Lapidus procedure between April 26, 2018, and November 19, 2020. Exclusion criteria included patients with inadequate follow-up. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and DMAA were measured on preoperative weight-bearing, 2-week postoperative non-weight-bearing, and at final follow-up weight-bearing radiographs. RESULTS The study included a total of 99 cases of modified Lapidus procedure for hallux valgus on 85 subjects. On radiologic assessment, the average DMAA decreased from 17.72 ± 6.18 degrees preoperatively to 9.19 ± 5.19 degrees 2 weeks postoperatively (P < .0001) and 9.79 ± 4.62 degrees at the final follow-up (P < .0001). The average HVA decreased from 31.34 ± 10.39 degrees preoperatively to 13.34 ± 6.16 degrees 2 weeks postoperatively (P < .0001) and 15.05 ± 7.43 degrees at final follow-up (P < .0001). Last, the IMA decreased from 14.99 ± 3.82 degrees preoperatively (P < .0001) to 4.66 ± 2.59 degrees 2 weeks postoperatively and 6.62 ± 3.46 degrees at final follow-up (P < .0001). The recurrence rate was 3.03%. CONCLUSION The modified Lapidus procedure is an effective procedure in correcting the HVA, IMA, and DMAA in hallux valgus surgery without the need for additional distal or proximal metatarsal osteotomies. Surgeons should consider this technique in patients with moderate to severe hallux valgus deformity who may require correction of their DMAA. LEVEL OF EVIDENCE Level IV-Retrospective comparative study.
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Affiliation(s)
- Milaan Shah
- Department of Orthopaedics, Prisma Health/University of South Carolina School of Medicine, Columbia, South Carolina
| | - Brianna Stirling
- Department of Orthopaedics, Prisma Health/University of South Carolina School of Medicine, Columbia, South Carolina
| | - J Benjamin Jackson
- Department of Orthopaedics, Prisma Health/University of South Carolina School of Medicine, Columbia, South Carolina
| | - Tyler Gonzalez
- Department of Orthopaedics, Prisma Health/University of South Carolina School of Medicine, Columbia, South Carolina
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Moon KA, Kim YJ, Kim JH, Park JH, Jeon HS. Effect of the manual stretching maneuver for hallux valgus. Foot (Edinb) 2022; 51:101900. [PMID: 35255404 DOI: 10.1016/j.foot.2021.101900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Kyeong-Ah Moon
- Department of Physical Therapy, The Graduate School, Yonsei University, Republic of Korea
| | - Ye-Jin Kim
- Department of Physical Therapy, The Graduate School, Yonsei University, Republic of Korea
| | - Ji-Hyun Kim
- Department of Physical Therapy, The Graduate School, Yonsei University, Republic of Korea
| | - Joo-Hee Park
- Department of Physical Therapy, College of Health Science, Yonsei University, Republic of Korea
| | - Hye-Seon Jeon
- Department of Physical Therapy, College of Health Science, Yonsei University, Republic of Korea.
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Kukushliev VV, Burton AT, Shi GG, Law BC, Kraus JC. A Retrospective Study Characterizing the Radiographic Progression of Hallux Valgus. Cureus 2022; 14:e24607. [PMID: 35664376 PMCID: PMC9148677 DOI: 10.7759/cureus.24607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Hallux valgus deformity is the lateral deviation of the metatarsophalangeal (MTP) joint and is the most common pathology of the great toe, affecting 2%-4% of the population. It is commonly believed that the condition progresses over time both in the magnitude of deformity and development of arthritic changes. To our knowledge, there are rare studies describing the rate of deformity progression and the development of arthritic changes. Our aim is to quantify the progression of hallux valgus and associated arthritic changes in an adult population using radiographs. Methods: Patients who are 18 years of age and older (mean age: 61.7 years and range: 18.6-94.2) who presented to our institutions between January 1, 2004, and December 1, 2019, were included. Patients were included in the study if they had hallux valgus on weight-bearing radiographs and two such radiographs at least six months apart. Hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsophalangeal (MTP) arthritis, tarsometatarsal (TMT) osteoarthritis, Hardy-Clapham sesamoid position, and round sign were collected per patient in the initial and final radiographs. Included cases were first studied together in a whole group. Then, cases were separated into three groups based on the time between initial and final radiographs. Results: A total of 52 radiographic records for 43 patients were included. HVA and IMA progress with time; however, progression does not follow a direct relationship with the time elapsed between initial and final radiographs (p = 0.92 and p = 0.35, respectively). The progression of TMT osteoarthritis, sesamoid position, and round sign do not show a dependence on the time elapsed (p = 0.20, p = 0.11, and p = 0.42, respectively). An increase of one sesamoid unit position over baseline is associated with a 0.85-degree increase in IMA. A one-unit progression of sesamoid position at baseline raises the odds of MTP osteoarthritis progression at the follow-up visit by 2.14 (OR = 2.14, p = 0.0007, CI = [1.35, 3.83]). A HVA increase of one degree increases the odds of TMT osteoarthritis progression at follow-up by a factor of 1.17 (OR = 1.17, p = 0.0005, CI = [1.07, 1.34]). Patients with MTP arthritis at the initial visit have 3.77 times higher odds of round sign progression on their follow-up visit (OR = 3.77, p = 0.027, CI = [1.16, 13.13]). Discussion: Hallux valgus progression can be quantified. Upon their first visit, a patient’s hallux valgus parameters can be utilized to demonstrate expected progression. Progression of the deformity and arthritic changes is slow. Nonetheless, the results should be considered by surgeons and patients when developing a treatment plan with patients.
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Tay AYW, Goh GS, Thever Y, Yeo NEM, Koo K. Impact of pes planus on clinical outcomes of hallux valgus surgery. Foot Ankle Surg 2022; 28:331-337. [PMID: 33888397 DOI: 10.1016/j.fas.2021.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/24/2021] [Accepted: 04/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pes planus is associated with hallux valgus development. This study evaluated the impact of pes planus on clinical outcomes following hallux valgus surgery. METHODS 191 patients underwent Scarf osteotomy for hallux valgus. Pes planus angles including talonavicular coverage angle, lateral talus-first metatarsal angle (Meary's angle) and lateral talocalcaneal angle were measured. The cohort was stratified into control (0°-4.0°), mild (4.1°-14.9°), moderate (15.0°-30.0°) and severe (> 30.0°) pes planus groups according to Meary's angle. Clinical outcomes were compared at baseline, 6 months and 24 months. RESULTS There were 78 controls, 95 mild and 18 moderate cases of pes planus. Meary's angle was independently associated with preoperative hallux valgus angle. Pes planus angles were not associated with pain, AOFAS, SF-36 physical or mental scores. All three groups had similar clinical outcomes and patient satisfaction. CONCLUSION Compared to patients with neutral foot arches, those with pes planus presented with more severe hallux valgus deformity but had similar clinical outcomes following surgical correction.
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Affiliation(s)
- Adriel You Wei Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Yogen Thever
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore; The Bone and Joint Centre, Mount Elizabeth Hospital, Singapore
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15
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Xiang L, Mei Q, Wang A, Shim V, Fernandez J, Gu Y. Evaluating function in the hallux valgus foot following a 12-week minimalist footwear intervention: A pilot computational analysis. J Biomech 2022; 132:110941. [DOI: 10.1016/j.jbiomech.2022.110941] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/11/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
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16
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Dissaneewate T, Na Rungsri T, Cheunchokasan P, Leelasamran W. Comparison between the plantar pressure effects of toe separators and insoles in patients with hallux valgus at a one-month follow-up. Foot Ankle Surg 2022; 28:93-99. [PMID: 33612377 DOI: 10.1016/j.fas.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/23/2021] [Accepted: 02/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Various designs of foot orthoses for hallux valgus have been developed to reduce foot pain. The plantar pressure assessment can determine the better intervention. This study aimed to compare the effectiveness of plantar pressure distribution in patients with hallux valgus during walking with toe separator and insole. METHOD Patients with hallux valgus were randomized into one of two interventions: prefabricated toe separator or customized insole. The plantar pressure distribution of the participants was measured during walking with the devices after use for one month with an in-shoe measurement system. RESULTS Twenty-three participants were analyzed. After 1-month, significant peak pressures and pressure-time integral reductions were observed during walking in the middle forefoot (64.28 kPa and 28.97 kPa s, respectively) and lateral forefoot regions (54.03 kPa and 22.30 kPa s, respectively) after insole use compared with a toe separator. CONCLUSIONS After one month of use, the customized insole was more effective in plantar pressure reduction than the toe separator for a hallux deformity.
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Affiliation(s)
- Tulaya Dissaneewate
- Department of Rehabilitation Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Tuanjit Na Rungsri
- Department of Rehabilitation Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Phakatip Cheunchokasan
- Department of Rehabilitation Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Wipawan Leelasamran
- Department of Rehabilitation Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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17
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Jor A, Rahman A. Prototype Development of a Combined Padded Metatarsal Cup for High Heeled Footwear to Enhance Female Foot Musculoskeletal Safety. Kurume Med J 2021; 66:185-193. [PMID: 34690204 DOI: 10.2739/kurumemedj.ms664003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study investigated the feasibility of combined padded metatarsal cup on plantar pressures and stress distribution in the bone alignment of female foot with high heeled footwear during balanced standing. The aim of this study is to redistribute the plantar pressure away from the medial side of the forefoot. A combined padded metatarsal cup (CPMC) was developed from medium soft ethylene vinyl acetate (MSEVA) and very soft ethylene propylene diene monomer (VSEPDM) neoprene sponge. The participants of three categories were selected for the study. The peak plantar pressure and a radiographic assessment of foot musculoskeletal alignment were carried out. The results showed that the magnitude of load on medial forefoot area could be effectively reduced by inserting joint of soft materials on metatarsal region. Hence load on hallux could also be reduced satisfactorily which could resist the hallux valgus deformity. A comparison of conventional system and jointing materials separately with the developed prototype was made and found that the developed prototype of CPMC provides more relaxation of plantar pressure and musculoskeletal safety and confirms more comfort on hypothesis test. The concept of combined padded metatarsal cup should therefore be considered to help in designing musculoskeletal safety footwear.
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Affiliation(s)
- Abu Jor
- Department of Leather Engineering, Khulna University of Engineering & Technology
| | - Azizur Rahman
- Department of Industrial Engineering and Management, Khulna University of Engineering & Technology
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18
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Dittmar JM, Mitchell PD, Cessford C, Inskip SA, Robb JE. Fancy shoes and painful feet: Hallux valgus and fracture risk in medieval Cambridge, England. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 35:90-100. [PMID: 34120868 PMCID: PMC8631459 DOI: 10.1016/j.ijpp.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/21/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Jenna M Dittmar
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK; Department of Archaeology, University of Aberdeen, Aberdeen, UK.
| | - Piers D Mitchell
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Craig Cessford
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK; Cambridge Archaeological Unit, Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Sarah A Inskip
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK; School of Archaeology and Ancient History, University of Leicester, Leicester, UK
| | - John E Robb
- Department of Archaeology, University of Cambridge, Cambridge, UK
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19
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González-Elena ML, Castro-Méndez A, Coheña-Jiménez M, Córdoba-Fernández A. Relationship of the Use of Short Footwear with the Development of Hallux Valgus in a Sample of Andalusian Schoolchildren. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111244. [PMID: 34769761 PMCID: PMC8583135 DOI: 10.3390/ijerph182111244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022]
Abstract
Background: Several studies have shown the relationship between poor footwear fit and the risk of feet deformities. The available evidence seems to show that the development of hallux valgus deformity in the feet of schoolchildren may be related to the use of shoes that are poorly fitting in length. The objective of this cross-sectional study was to analyze the relationship between poor footwear fit in length and risk of developing hallux valgus. Methods: Using an instrument that was designed and calibrated for this purpose, maximum foot length was obtained and compared to the inner length of the shoe in 187 schoolchildren. Hallux valgus angle (HVA) was measured on weight-bearing podogram image obtained from the longest foot in 188 schoolchildren. Results: By default, the footwear was poorly fitting in length (too short or close-fitting) in 38.5% of the schoolchildren, with boys having the worst footwear fit; though no significant differences stood out. (p = 0.276). Regarding the HVA, no significant differences were recorded according to age or gender (p = 0.573). A strong correlation was observed between too-short footwear and the increase in HVA in 10-year-old boys (r = 0.817; p = 0.025) and in 9-year-old girls (r = 0.705; p = 0.005). Conclusions: Inadequate footwear fit in length may be a predisposing extrinsic risk factor for the development of hallux valgus in schoolchildren of both sexes. Results of the present study demonstrate the need to adapt the sizes of footwear to the rapid increase in foot-length that occur at puberty to avoid the risk of developing hallux valgus, especially at the ages of onset pubertal foot growth.
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20
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A comparison of the effectiveness of splinting, exercise and electrotherapy in women patients with hallux valgus: A randomized clinical trial. Foot (Edinb) 2021; 48:101828. [PMID: 34388424 DOI: 10.1016/j.foot.2021.101828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/22/2021] [Accepted: 05/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus (HV) is a very common foot deformity involving lateral deviation of the hallux and medial deviation of the first metatarsal head. OBJECTIVES To investigate the effects of HV night splinting, exercise and electrotherapy on the HV angle, and foot-specific health-related quality of life. METHODS Sixty women (120 feet) with bilateral HV deformity were randomly assigned to one of three groups - an HV night splint (SP) group, an exercise (EX) group, and a high-voltage galvanic stimulation (HVPGS) (EL) group. The patients in SP group used the HV night splints while resting or sleeping for at least 8 h a day and the patients in the EX group performed exercises 3-4 times a day with 10 repetitions for the duration of the one-month treatment period. Twenty-minute HVPGS was applied in total over three weekly sessions for four weeks in EL group. Angular degrees (hallux interphalangeal angle (HIPA), HV angle (HVA), and intermetatarsal angle (IMA)) were determined before (t0) and three months after treatment (t2). Foot-specific quality of life was assessed using the Manchester-Oxford Foot Questionnaire (MOFQ) at t0, after one month (t1), and at t2. RESULTS All groups exhibited significant changes in the HIPA, HVA, and IMA angles and outcome measures (p ≤ 0.001). Decreases in the HIPA and IMA angles, and MOFQ-Pain subscale scores, were higher in the SP group than in the other two groups (p < 0.05). IMA angle at t2, MOFQ-Walking score at t1 and t2 and MOFQ-Pain subscale score at t1 were lower in the SP group (p < 0.05). CONCLUSION The SP group exhibited more positive effects in the parameters measured than the other two groups. A combination of these conservative treatment approaches may be more beneficial to improve HV symptoms with longer follow-up periods. CLINICALTRIALS. GOV IDENTIFIER NCT04393545.
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21
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Multiplanar instability of the first tarsometatarsal joint in hallux valgus and hallux rigidus patients: a case-control study. INTERNATIONAL ORTHOPAEDICS 2021; 46:255-263. [PMID: 34468786 DOI: 10.1007/s00264-021-05198-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hypermobility of the first ray has been considered associated with various forefoot diseases including hallux valgus (HV) and hallux rigidus (HR). Weightbearing CT scan can be a reliable method for analysis of the first tarsometatarsal (TMT) joint in axial, sagittal, and coronal planes. Our objective was to comparatively investigate signs of instability of the first TMT joint on weightbearing CT between three groups (control, HV, and HR). METHODS In this single-centre, retrospective, case-control study, 27 HV patients (30 feet; mean age 54.2 years), 26 HR patients (30 feet; mean age 56.6 years), and 30 controls (30 feet; mean age; 43 years) were enrolled. Measurements of signs of instability were performed in multiplanes including first TMT angle, dorsal translation of the first metatarsal (M1) at the first TMT joint, plantar distance between the medial cuneiform (C1) and M1 in sagittal plane, hallux valgus angle (HVA), intermetatarsal angle (IMA) in axial plane, rotational profiles of C1 and M1 in coronal plane. Analysis of variance (ANOVA) test and chi-square test were performed to compare each parameter between the three groups. Interobserver reliabilities were assessed using interclass correlation coefficients (ICCs). RESULTS The HV group had significantly increased first TMT angle (0.23° in controls, 1.15° in HV, 0.19° in HR, p < 0.001), HVA (7.52°, 33.50°, 11.21°, p < 0.001), IMA (9.46°, 16.98°, 11.87°, p < 0.001), C1-M1 angle (22.44°, 29.46°, 23.74°, p < 0.001), and rotational profile of the distal M1 (7.06°, 17.88°, 9.85°, p < 0.001) compared with the control and HR groups. Dorsal translation of M1 (23% in controls, 63% in HV, 70% in HR, p < 0.001) was frequently found in the HV and HR groups with significantly increased plantar distance (0.37 mm, 1.14 mm, 1.46 mm, p < 0.001) compared with controls. CONCLUSIONS Multiplanar instability of the first TMT joint was confirmed using weightbearing CT in HV and HR groups compared with controls. HV group demonstrated instability mainly in sagittal and axial planes; HR group had sagittal instability predominantly. Our measurement of rotational instability at the first TMT joint was not able to detect differences between groups. A surgical correction of the instability at the first TMT joint can be an option to address HV and HR. CLINICAL RELEVANCE First ray hypermobility at the first TMT joint is an important consideration when addressing HV and HR, a surgical correction of the instability at the first TMT joint should be taken in consideration as an option.
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Feng Y, Shen S, Song Y. Ultrasound Comparison of the Abductor Hallucis Muscle Between Normal and Hallux Valgus Feet After Long-Distance Running: A Pilot Study. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: Previous research has indicated that the structure and function of abductor hallucis muscle (AbdH) would be adversely affected by hallux valgus (HV). However, the influence of long-distance running on AbdH in HV feet has not been explored. Therefore, this pilot study
aimed to compare the imaging differences of AbdH between normal and HV feet after long-distance running. Methods: A total of 14 male adults were divided into two groups (Normal Foot Group (NFG), Hallux Valgus Group (HVG)) based on their foot morphology. A B-mode ultrasonic scanner was
utilized for measuring AbdH thickness, cross-sectional area, and pennation angle before and after 5-km running test. Perceived soreness was monitored simultaneously using the visual analogue scale. Results: AbdH showed significantly differences between groups before and after the running
test. Compared with NFG, HVG exhibited smaller value before the test while greater changes in all parameters although pennation angle failed to reach the significant level. Conclusions: These results further confirmed that HV could lead to the morphological alterations of AbdH. Also,
AbdH of people with HV would endure more fatigue and soreness when performed the same long-distance running test with normal counterparts. Nevertheless, more studies are much needed for further verification.
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Affiliation(s)
- Yong Feng
- Department of Physical Education, Ningbo University of Finance and Economics, Ningbo, 315211, China
| | - Siqin Shen
- Faculty of Engineering, University of Pannonia, Veszprem, 8200, Hungary
| | - Yang Song
- Doctoral School of Safety and Security Sciences, Obuda University, Budapest, 1034, Hungary
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YILDIZ Kİ, ARICAN M. Halluks Valgus Deformitesinin Tanımlanmasında Tripod İndeksin Etkinliği : Retrospektif Bir Çalışma. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2021. [DOI: 10.33631/duzcesbed.840867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Farzadi M, Sanjari MA, Jalali M, Saeedi H, Kamali M, Movahedi Yeganeh M. Foot structural factors and ground reaction force in hallux valgus grades. Foot (Edinb) 2020; 45:101689. [PMID: 33059213 DOI: 10.1016/j.foot.2020.101689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Little attention has been paid to foot structural factors and ground reaction force in hallux valgus. Investigating the structural factors in detail and determining their biomechanical effects can help to better manage hallux valgus. METHODS In this case-control study, 120 females, 90 hallux valgus and 30 healthy, were recruited. Hallux valgus grades (mild, moderate, severe), first metatarsal mobility, foot pronation, hallux rotation, and pain were assessed by clinical tests. Ground reaction forces were measured in barefoot and shod conditions for both feet and analyzed using mixed within-between MANOVA. The association between structural factors and pain with force was analyzed using Spearman correlation coefficient. RESULTS The frequency of foot structural factors and pain severity were reported in hallux valgus grades. A significant difference was seen in the force values between groups (P<0.001). Bonferroni post hoc test indicated that the mean of the first peak for the severe group was significantly higher than the mild group (P=0.013) and the mean of second peak for the moderate group was higher than that of the healthy group (P=0.009). The force values were affected by wearing shoe (P<0.001) but not by foot side (P=0.086). There was a medium, positive correlation between the hallux rotation and force in the moderate group (r=0.39, P=0.03) and also between the pronation and force in the severe group (r=0.36, P=0.04). CONCLUSION Foot structural factors, pain, and force were different in each hallux valgus grads. Similar force in both feet, and increased force by wearing shoe were seen. The relationship between the pronation and hallux rotation with force revealed the importance of these factors from the biomechanical viewpoint.
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Affiliation(s)
- Maede Farzadi
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sanjari
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Basic Rehabilitation Sciences, School of Rehabilitation Sciences, and Biomechanics Lab., Iran University of Medical Sciences, Tehran, Iran.
| | - Maryam Jalali
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Saeedi
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kamali
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Wong DWC, Wang Y, Chen TLW, Yan F, Peng Y, Tan Q, Ni M, Leung AKL, Zhang M. Finite Element Analysis of Generalized Ligament Laxity on the Deterioration of Hallux Valgus Deformity (Bunion). Front Bioeng Biotechnol 2020; 8:571192. [PMID: 33015022 PMCID: PMC7505935 DOI: 10.3389/fbioe.2020.571192] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Hallux valgus is a common foot problem affecting nearly one in every four adults. Generalized ligament laxity was proposed as the intrinsic cause or risk factor toward the development of the deformity which was difficult to be investigated by cohort clinical trials. Herein, we aimed to evaluate the isolated influence of generalized ligament laxity on the deterioration using computer simulation (finite element analysis). We reconstructed a computational foot model from a mild hallux valgus participant and conducted a gait analysis to drive the simulation of walking. Through parametric analysis, the stiffness of the ligaments was impoverished at different degrees to resemble different levels of generalized ligament laxity. Our simulation study reported that generalized ligament laxity deteriorated hallux valgus by impairing the load-bearing capacity of the first metatarsal, inducing higher deforming force, moment and malalignment at the first metatarsophalangeal joint. Besides, the deforming moment formed a deteriorating vicious cycle between hallux valgus and forefoot abduction and may result in secondary foot problems, such as flatfoot. However, the metatarsocuneiform joint did not show a worsening trend possibly due to the overriding forefoot abduction. Controlling the deforming load shall be prioritized over the correction of angles to mitigate deterioration or recurrence after surgery.
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Affiliation(s)
- Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fei Yan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yinghu Peng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Qitao Tan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples’ Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Aaron Kam-Lun Leung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
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26
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Seki H, Miura A, Sato N, Yuda J, Shimauchi T. Correlation between degree of hallux valgus and kinematics in classical ballet: A pilot study. PLoS One 2020; 15:e0231015. [PMID: 32251429 PMCID: PMC7135216 DOI: 10.1371/journal.pone.0231015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/14/2020] [Indexed: 11/18/2022] Open
Abstract
Hallux valgus is a serious medical concern for classical ballet dancers. Although it is well-known that progression of hallux valgus is related to inappropriate movement techniques in classical ballet, the kinematic relationship between the degree of hallux valgus and ballet techniques has not been substantiated. To develop proper training methods that prevent progression of hallux valgus, this study aimed to investigate the relationship between the degree of hallux valgus and movement techniques in classical ballet. Seventeen female classical ballet dancers at the advanced college-level participated in this study. Kinematic analysis of standing and plié in the first position was conducted via video capture technique. The Pearson product-moment correlation analysis was performed to examine the degree of hallux valgus and the following three kinematic variables: (1) the extent to which turnout is forced by other joints in the lower extremity than the hip joint, (2) the direction difference between the knee and toe in the transverse plane, and (3) the pelvis obliquity angle. Among these kinematic variables, we found a significant correlation between the hallux valgus angle and the pelvis obliquity angle during plié (P = .045). The greater the hallux valgus angle, the greater the retroversion of the pelvis, a result which was contrary to our prediction. We present the first evidence that the degree of hallux valgus correlates with kinematics in a very basic technique of classical ballet.
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Affiliation(s)
- Haruka Seki
- Japan Ballet Educational Association, Tokyo, Japan
- Department of Movement Sciences, Japan Women’s College of Physical Education, Tokyo, Japan
| | - Akito Miura
- Faculty of Human Sciences, Waseda University, Saitama, Japan
- * E-mail:
| | - Nahoko Sato
- Department of Physical Therapy, Faculty of Rehabilitation Science, Nagoya Gakuin University, Aichi, Japan
| | - Jun Yuda
- Department of Movement Sciences, Japan Women’s College of Physical Education, Tokyo, Japan
| | - Toshiko Shimauchi
- Department of Movement Sciences, Japan Women’s College of Physical Education, Tokyo, Japan
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Moulodi N, Kamyab M, Farzadi M. A comparison of the hallux valgus angle, range of motion, and patient satisfaction after use of dynamic and static orthoses. Foot (Edinb) 2019; 41:6-11. [PMID: 31675599 DOI: 10.1016/j.foot.2019.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/30/2019] [Accepted: 06/22/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Conservative treatment is recommended for mild and moderate hallux valgus. The treatment may include two different types of orthoses: a dynamic orthosis and a static orthosis. The aim of this study was to compare the hallux valgus angle, hallux valgus range of motion, and patient satisfaction after the use of a dynamic and a static orthosis for the treatment of hallux valgus. METHODS Twenty-four participants contributed to this cross-over study. Participants were randomly allocated to orthotic treatments at the start. The hallux valgus angle and range of motion were measured using a goniometer. Pain, signs and symptoms, function in activities of daily living (ADL), function in sport and recreation, and foot and ankle-related quality of life (QOL) were measured using the Foot and Ankle Outcome Score (FAOS) questionnaire. The participants then switched to using the other orthosis. A one-way repeated measure ANOVA was conducted to compare the measured variables in subjects at 4 conditions before and after of using each orthosis. RESULTS There was a significant difference in the hallux valgus angle (p=0.001). The Bonferroni test indicated that both static and dynamic orthoses significantly decrease the angle of hallux valgus, respectively before static, after static (mean difference=-2.67, p=0.001) and before dynamic, after dynamic conditions (mean difference=-2.13, p=0.02). There was also a significant difference in subjects range of motion by using a dynamic orthosis in before dynamic, after dynamic conditions (mean difference=9.77, p=0.01). There was no significant difference in total FAOS score within the conditions (p=0.067). CONCLUSION The use of both static and dynamic orthoses for 1 month can reduce the hallux valgus angle up to 2-3°. To achieve better results, it is suggested to wear orthoses for longer time. The dynamic orthosis also increases the passive range of motion of the first metatarsophalangeal joint and it seems to be effective during walking.
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Affiliation(s)
- Nasrin Moulodi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, 13487-15459, Iran.
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, 13487-15459, Iran.
| | - Maede Farzadi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, 13487-15459, Iran.
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Choi JY, Ahn HC, Baek HS, Park JH, Suh JS. Factors influencing medial sesamoid arthritis in patients with hallux valgus deformity: Magnetic resonance imaging evaluation. Foot Ankle Surg 2019; 25:612-617. [PMID: 30321940 DOI: 10.1016/j.fas.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 06/10/2018] [Accepted: 06/13/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The importance of preoperative evaluation of the position and degree of arthritic changes of the medial sesamoid bone before hallux valgus correction is emerging. This is an observational study to evaluate the magnetic resonance imaging (MRI) findings of hallux valgus deformity, and assess the severity of and identify the factors that influence the arthritic changes in medial sesamoid-metatarsal (mSM) joints. METHODS We reviewed weight-bearing anteroposterior radiographs, forefoot axial radiographs and MR images of 514 feet of 405 patients who underwent hallux valgus correction. On MRI, the degrees of the arthritic changes in the first metatarsophalangeal (MTP) and mSM joints were categorized into 5 classes. Binary logistic regression analysis was performed to identify the factors affecting the arthritic changes. RESULTS The binary logistic regression analysis showed that advanced age, more lateralized position of medial sesamoid bone on forefoot axial radiograph, and higher MRI grade of arthritic change of the 1st MTP joint were significant factors contributing to medial sesamoid arthritis (P<0.001, 0.001. 0.006, respectively). CONCLUSIONS Medial sesamoid arthritis can be assessed using MRI. The position of medial sesamoid bone on forefoot axial radiographs can strongly help predict the possibility of mSM joint arthritis. LEVEL OF EVIDENCE III, observational study.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Hee Chan Ahn
- W Institute for Foot and Ankle Disease and Trauma, W Hospital, Daegu, South Korea
| | | | - Jong Hun Park
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea.
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Glasoe WM, Michaud TC. Measurement of Dorsal First Ray Mobility: A Topical Historical Review and Commentary. Foot Ankle Int 2019; 40:603-610. [PMID: 30902026 DOI: 10.1177/1071100719839692] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Despite evidence that instability of the first ray (first metatarsal and medial cuneiform) alters the loading mechanics of the foot, surprisingly few studies have linked the condition with disorders of the foot. A factor limiting this research is the difficulty associated with measuring first ray mobility (FRM). To quantify dorsal FRM, clinicians and researchers have devised a variety of methods that impose a dorsally directed load, and record displacement. The methods include manual examination, radiographs, mechanical devices, and handheld rulers. Since different methods yield different results; each of these methods is worthy of scrutiny. This article reviews the methods used to quantify dorsal FRM and offers commentary on how the testing procedures could be standardized. The measurement of dorsal FRM informs surgical decisions, orthotic prescriptions, and research design strategies mostly as it pertains to the identification and treatment of first ray hypermobility. This review found sufficient support to recommend continued use of radiographs and mechanical devices for quantifying dorsal displacement, whereas measurements acquired with handheld rulers are prone to the same subjective error attributed to manual examination procedures. Since measures made with radiographs and existing mechanical devices have their own drawbacks, the commentary recommends ideas for standardizing the testing procedure and calls for the development of a next-generation device to measure dorsal FRM. This future device could be modeled after arthrometers that exist and are used to quantify stability at the knee and ankle. Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Ward M Glasoe
- 1 Division in Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
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30
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Nakagawa R, Yamaguchi S, Kimura S, Sadamasu A, Yamamoto Y, Muramatsu Y, Sato Y, Akagi R, Sasho T, Ohtori S. Efficacy of foot orthoses as nonoperative treatment for hallux valgus: A 2-year follow-up study. J Orthop Sci 2019; 24:526-531. [PMID: 30509733 DOI: 10.1016/j.jos.2018.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/15/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The purpose of this study was to clarify the 2-year clinical and radiological outcomes of nonoperative treatment using foot orthosis for hallux valgus patients. METHODS Patients who underwent nonoperative treatment using foot orthosis were surveyed prospectively. Foot orthoses were made by one certified orthotist using the standardized method. Pain and quality of life were evaluated using subjective and objective assessment measures at 3, 6, 12, 18, and 24 months. Furthermore, radiological outcomes, patient satisfaction, and adherence to treatment were surveyed. RESULTS A total of 53 patients (50 women and 3 men; median age, 63 years) were included for analysis. The pain visual analogue scale score significantly decreased over time, with the lowest score observed at 12 months. The treatment effect was maintained over 24 months (median score, 52, 21, and 27 points at baseline, 12 months, and 24 months, respectively; P < .001). The Japanese Society for Surgery of the Foot hallux scale, American Academy of Orthopaedic Surgeons Foot and Ankle Scale, and 36-Item Short-Form Health Survey bodily pain subscale also improved, although the treatment effects were maximal at 6 months and decreased thereafter. At 24 months, 43 (81%) patients continued to use the orthosis, with the median visual analogue scale score for patient satisfaction of 76 points. The hallux valgus angle and intermetatarsal angle did not change during the 24-month period. CONCLUSION Nonoperative treatment using foot orthoses decreased pain in patients with hallux valgus. The effect of treatment was maintained up to 2 years with a relatively high degree of patient satisfaction. However, treating physicians should inform patients to set realistic expectations and be aware that a limited degree of pain reduction is expected.
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Affiliation(s)
- Ryosuke Nakagawa
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan; Collage of Liberal Arts and Sciences, Chiba University, Japan.
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Aya Sadamasu
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Yohei Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Yuta Muramatsu
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Yasunori Sato
- Chiba University Hospital Clinical Research Center, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan; Center for Preventive Medical Sciences, Chiba University, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
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Coordination Among Shank, Rearfoot, Midfoot and Forefoot Kinematic Movement During Gait in Individuals With Hallux Valgus. J Appl Biomech 2019; 35:44–51. [PMID: 30207203 DOI: 10.1123/jab.2017-0319] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
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.
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Xiang L, Mei Q, Fernandez J, Gu Y. Minimalist shoes running intervention can alter the plantar loading distribution and deformation of hallux valgus: A pilot study. Gait Posture 2018; 65:65-71. [PMID: 30558948 DOI: 10.1016/j.gaitpost.2018.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/18/2018] [Accepted: 07/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hallux valgus (HV) is one common deformity of the human foot. Metatarsal pain, gait deviation and foot function disorder may occur when HV is severe. RESEARCH QUESTION It was hypothesized that a 12-week minimalist shoes running intervention among mild and moderate hallux valgus males may alter foot morphology and plantar pressure distribution during walking and running. METHODS The foot morphology and plantar pressure data, in this study, were collected from eleven participants using the Easy-Foot-Scan (EFS) and Novel EMED force plate. RESULTS Compared to pre-intervention sessions, the hallux abductus angle and forefoot width decreased significantly with increased metatarsal waist girth in the post-intervention session. The peak pressure, maximum force and force time integral in the first metatarsal reduced significantly due to the distribution of plantar pressure to the central foot regions. SIGNIFICANCE The findings suggest that minimalist shoes may deform forefoot morphology and neutralize loading concentration for mild and moderate hallux valgus.
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Affiliation(s)
| | - Qichang Mei
- Faculty of Sports Science, Ningbo University, Ningbo, China; Research Academy of Grand Health, Ningbo University, Ningbo, China; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Research Academy of Grand Health, Ningbo University, Ningbo, China; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China; Research Academy of Grand Health, Ningbo University, Ningbo, China; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
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Zhang Y, Awrejcewicz J, Szymanowska O, Shen S, Zhao X, Baker JS, Gu Y. Effects of severe hallux valgus on metatarsal stress and the metatarsophalangeal loading during balanced standing: A finite element analysis. Comput Biol Med 2018; 97:1-7. [DOI: 10.1016/j.compbiomed.2018.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/14/2018] [Accepted: 04/14/2018] [Indexed: 11/26/2022]
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Bac A, Bogacz G, Ogrodzka-Ciechanowicz K, Kulis A, Szaporów T, Woźniacka R, Radlińska N. Characteristics of Selected Anthropometric Foot Indicators in Physically Active Students. J Am Podiatr Med Assoc 2018; 108:236-244. [PMID: 29932755 DOI: 10.7547/15-157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of this study was to determine the type of medial longitudinal arch (MLA) in students of Krakow universities, investigate the relationship between physical activity and the shaping of the feet, and examine the relationship between hallux valgus angle and the type of footwear chosen most often. METHODS The study group consisted of 120 students, of which 56 respondents were students of the University School of Physical Education in Krakow, whereas the remaining 64 respondents were students of the Pedagogical University of Krakow. To evaluate the MLA, a podoscope was used, which allowed us to determine the length and width of the foot, and calculation of the Clarke angle, heel angle γ, and the angle of hallux valgus. All students were also subjected to a measurement of body weight and height. RESULTS There was a statistically significant relationship between physical activity and the Clarke angle in the group of women studying at the University School of Physical Education. There was no correlation between the hallux valgus angle and the type of footwear chosen most often in the research groups. CONCLUSIONS The most frequently diagnosed type of longitudinal and transverse arch foot in the research group was normal MLA. There was no relationship between physical activity and transverse arch foot in any of the research groups.
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Affiliation(s)
- Aneta Bac
- Department of Occupational Therapy, Faculty of Motor Rehabilitation, University School of Physical Education, Krakow, Poland
| | - Gabriela Bogacz
- Department of Occupational Therapy, Faculty of Motor Rehabilitation, University School of Physical Education, Krakow, Poland
| | - Katarzyna Ogrodzka-Ciechanowicz
- Department of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University School of Physical Education, Krakow, Poland
| | - Aleksandra Kulis
- Department of Occupational Therapy, Faculty of Motor Rehabilitation, University School of Physical Education, Krakow, Poland
| | - Tomasz Szaporów
- Department of Occupational Therapy, Faculty of Motor Rehabilitation, University School of Physical Education, Krakow, Poland
| | - Renata Woźniacka
- Department of Physiotherapy, Faculty of Motor Rehabilitation, University School of Physical Education, Krakow, Poland
| | - Natalia Radlińska
- Department of Occupational Therapy, Faculty of Motor Rehabilitation, University School of Physical Education, Krakow, Poland
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Comparison of plantar pressure distribution in CAD-CAM and prefabricated foot orthoses in patients with flexible flatfeet. Foot (Edinb) 2017; 33:76-80. [PMID: 29128666 DOI: 10.1016/j.foot.2017.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/22/2017] [Accepted: 07/06/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUNDS The effect of foot orthoses on plantar pressure distribution has been proven by researchers but there are some controversies about advantages of custom-made foot orthoses to less expensive prefabricated foot orthoses. METHODS Nineteen flatfeet adults between 18 and 45 participated in this study. CAD-CAM foot orthoses were made for these patients according to their foot scan. Prefabricated foot orthoses were prepared according to their foot size. Plantar pressure, force and contact area were measured using pedar®-x in-shoe system wearing shoe alone, wearing CAD-CAM foot orthoses and wearing prefabricated foot orthoses. Repeated measures ANOVA model with post-hoc, Bonferroni comparison were used to test differences. RESULTS CAD-CAM and prefabricated foot orthoses both decreased pressure and force under 2nd, 3-5 metatarsal and heel regions comparing to shoe alone condition. CAD-CAM foot orthosis increased pressure under lateral toe region in comparison to shoe alone and prefabricated foot orthosis. Both foot orthoses increased pressure and contact area in medial midfoot region comparing to shoe alone condition. Increased forces were seen at hallux and lateral toes by prefabricated foot orthoses in comparison with CAD-CAM foot orthoses and control condition, respectively. CONCLUSION According to the results, both foot orthoses could decrease the pressure under heel and metatarsal area. It seems that the special design of CAD-CAM foot orthoses could not make great differences in plantar pressure distribution in this sample. Further research is required to determine whether these results are associated with different scan systems or design software.
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Balsdon MER, Bushey KM, Dombroski CE, LeBel ME, Jenkyn TR. Medial Longitudinal Arch Angle Presents Significant Differences Between Foot Types: A Biplane Fluoroscopy Study. J Biomech Eng 2017; 138:2546138. [PMID: 27548905 DOI: 10.1115/1.4034463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Indexed: 11/08/2022]
Abstract
The structure of the medial longitudinal arch (MLA) affects the foot's overall function and its ability to dissipate plantar pressure forces. Previous research on the MLA includes measuring the calcaneal-first metatarsal angle using a static sagittal plane radiograph, a dynamic height-to-length ratio using marker clusters with a multisegment foot model, and a contained angle using single point markers with a multisegment foot model. The objective of this study was to use biplane fluoroscopy to measure a contained MLA angle between foot types: pes planus (low arch), pes cavus (high arch), and normal arch. Fifteen participants completed the study, five from each foot type. Markerless fluoroscopic radiostereometric analysis (fRSA) was used with a three-dimensional model of the foot bones and manually matching those bones to a pair of two-dimensional radiographic images during midstance of gait. Statistically significant differences were found between barefoot arch angles of the normal and pes cavus foot types (p = 0.036), as well as between the pes cavus and pes planus foot types (p = 0.004). Dynamic walking also resulted in a statistically significant finding compared to the static standing trials (p = 0.014). These results support the classification of individuals following a physical assessment by a foot specialist for those with pes cavus and planus foot types. The differences between static and dynamic kinematic measurements were also supported using this novel method.
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Rodriguez MW, Pioske KE, Glasoe WM. An Imaged-Based Three-Dimensional Study of First Metatarsal Protrusion Distance in Women with and Without Hallux Valgus. J Am Podiatr Med Assoc 2017; 107:531-537. [PMID: 28768118 DOI: 10.7547/16-104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
| | - Kara E. Pioske
- Division in Physical Therapy, University of Minnesota, Minneapolis, Minnesota
| | - Ward M. Glasoe
- Division in Physical Therapy, University of Minnesota, Minneapolis, Minnesota
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An Investigation of Structure, Flexibility, and Function Variables that Discriminate Asymptomatic Foot Types. J Appl Biomech 2017; 33:203-210. [DOI: 10.1123/jab.2016-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It has been suggested that foot type considers not only foot structure (high, normal, low arch), but also function (overpronation, normal, oversupination) and flexibility (reduced, normal, excessive). Therefore, this study used canonical regression analyses to assess which variables of foot structure, function, and flexibility can accurately discriminate between clinical foot type classifications. The feet of 61 asymptomatic, healthy adults (18–77 years) were classified as cavus (N = 24), rectus (N = 54), or planus (N = 44) using standard clinical measures. Custom jigs assessed foot structure and flexibility. Foot function was assessed using an emed-x plantar pressure measuring device. Canonical regression analyses were applied separately to extract essential structure, flexibility, and function variables. A third canonical regression analysis was performed on the extracted variables to identify a combined model. The initial combined model included 30 extracted variables; however 5 terminal variables (malleolar valgus index, arch height index while sitting, first metatarsophalangeal joint laxity while standing, pressure-time integral and maximum contact area of medial arch) were able to correctly predict 80.7% of foot types. These remaining variables focused on specific foot characteristics (hindfoot alignment, arch height, midfoot mechanics, Windlass mechanism) that could be essential to discriminating foot type.
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Watanabe K, Ikeda Y, Suzuki D, Teramoto A, Kobayashi T, Suzuki T, Yamashita T. Three-dimensional analysis of tarsal bone response to axial loading in patients with hallux valgus and normal feet. Clin Biomech (Bristol, Avon) 2017; 42:65-69. [PMID: 28110242 DOI: 10.1016/j.clinbiomech.2017.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with hallux valgus present a variety of symptoms that may be related to the type of deformity. Weightbearing affects the deformities, and the evaluation of the load response of tarsal bones has been mainly performed using two-dimensional plane radiography. The purpose of this study was to investigate and compare structural changes in the medial foot arch between patients with hallux valgus and normal controls using a computer image analysis technique and weightbearing computed tomography data. METHODS Eleven patients with hallux valgus and eleven normal controls were included. Computed tomograms were obtained with and without simulated weightbearing using a compression device. Computed tomography data were transferred into a personal computer, and a three-dimensional bone model was created using image analysis software. The load responses of each tarsal bone in the medial foot arch were measured three-dimensionally and statistically compared between the two groups. FINDINGS Displacement of each tarsal bone under two weightbearing conditions was visually observed by creating three-dimensional bone models. At the first metatarsophalangeal joint, the proximal phalanges of the hallux valgus group showed significantly different displacements in multiple directions. Moreover, opposite responses to axial loading were also observed in both translation and rotation between the two groups. INTERPRETATION Weightbearing caused deterioration of the hallux valgus deformity three-dimensionally at the first metatarsophalangeal joint. Information from the computer image analysis was useful for understanding details of the pathology of foot disorders related to the deformities or instability and may contribute to the development of effective conservative and surgical treatments.
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Affiliation(s)
- Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Japan.
| | - Yasutoshi Ikeda
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Daisuke Suzuki
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Takuma Kobayashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
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Palomo-López P, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, Calvo-Lobo C, López-López D. Impact of Hallux Valgus related of quality of life in Women. Int Wound J 2016; 14:782-785. [PMID: 27928895 DOI: 10.1111/iwj.12695] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 10/26/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study is to analyse and compare the impact of hallux valgus (HV) in a sample of adult women with varying degrees of HV scores obtained with regard to foot health and health in general. A total 100 female patients of mean age 43·04 ± 16·84 years who attended a podiatric clinic were asked to answer a questionnaire. The degree of deformity, HV, was determined on both feet of the patients using the Manchester Scale tool and the scores from the Foot Health Status Questionnaire were compared. Participants with varying degrees of HV recorded lower scores in Section 1 for the footwear and general foot health and higher scores for foot pain and foot function. In Section 2, they obtained lower scores in physical activity and social capacity and higher scores in vigour and general health. Differences between the four groups were evaluated by means of a t-test for independent samples, showing statistical significance (P < 0·001). This study has detected measurable differences of association between varying degrees of HV with impaired quality of life related to foot health in women.
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Affiliation(s)
| | | | | | - David Rodríguez-Sanz
- Department, Faculty of Health, Exercise and Sport, European University of Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
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Yu J, Wong DWC, Zhang H, Luo ZP, Zhang M. The influence of high-heeled shoes on strain and tension force of the anterior talofibular ligament and plantar fascia during balanced standing and walking. Med Eng Phys 2016; 38:1152-6. [DOI: 10.1016/j.medengphy.2016.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 07/20/2016] [Accepted: 07/27/2016] [Indexed: 11/15/2022]
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Ginés-Cespedosa A, Pérez-Prieto D, Muñetón D, González-Lucena G, Millán A, de Zabala S, Busquets R. Influence of Hindfoot Malalignment on Hallux Valgus Operative Outcomes. Foot Ankle Int 2016; 37:842-7. [PMID: 27103656 DOI: 10.1177/1071100716645403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hindfoot deformity has been described as a risk factor for poor hallux valgus (HV) surgery outcomes. However, there has been no study that demonstrates it. The purpose of this investigation was to evaluate the influence of hindfoot misalignment in HV surgery results. METHODS All patients operated on for HV during 2010 and 2011 at 3 university hospitals were included. The preoperative and 2-year postoperative radiologic data included the HV and the intermetatarsal (IM) angles, the naviculocuboid overlap (NC), the talonavicular coverage (TN) angle, the talus-first metatarsal (T-1MT) angle, as well as the calcaneal pitch (CP) angle. Additionally, the Short Form-36 questionnaire version 2.0 (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) score, satisfaction and recurrence were also analyzed. A total of 207 met the inclusion criteria. There were 26 patients (12.6%) who could not be assessed at the 2-year follow-up. Patients were allocated to a varus, normal, or a valgus hindfoot tertile using the values for the CP, NC, TN, and T-1MT angles. RESULTS No significant differences (P > .05) were found between the groups when the HV or IM angles, AOFAS, SF-36 Mental Composite Scale, SF-36 Physical Composite Scale, or satisfaction were compared. Similarly, no significant and strong correlations were observed (P > .05, ρ < 0.3) between any of the mentioned hindfoot measures and the outcomes scales. CONCLUSION No influence of hindfoot misalignment on HV surgery outcomes was found in the present study in terms of correction, pain, function, satisfaction, or quality of life. Patients with hindfoot misalignment did not obtain worse outcomes in HV surgery. LEVEL OF EVIDENCE Level II, prognostic, comparative study.
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Affiliation(s)
| | - Daniel Pérez-Prieto
- Orthopedic Department, Hospital del Mar. Universitat Autónoma de Barcelona, Spain
| | - David Muñetón
- Orthopedic Department, Hospital Vall d'Hebron. Barcelona, Spain
| | | | - Angelica Millán
- Orthopedic Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Santiago de Zabala
- Orthopedic Department, Hospital del Mar. Universitat Autónoma de Barcelona, Spain
| | - Rosa Busquets
- Orthopedic Department, Hospital Vall d'Hebron. Barcelona, Spain
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Treatment of Progressive First Metatarsophalangeal Hallux Valgus Deformity: A Biomechanically Based Muscle-Strengthening Approach. J Orthop Sports Phys Ther 2016; 46:596-605. [PMID: 27266887 DOI: 10.2519/jospt.2016.6704] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Hallux valgus is a progressive deformity of the first metatarsophalangeal joint that changes the anatomy and biomechanics of the foot. To date, surgery is the only treatment to correct this deformity, though the recurrence rate is as high as 15%. This clinical commentary provides instruction in a strengthening approach for treatment of hallux valgus deformity, by addressing the moment actions of 5 muscles identified as having the ability to counter the hallux valgus process. Unlike surgery, muscle strengthening does not correct the deformity, but, instead, reduces the pain and associated gait impairments that affect the mobility of people who live with the disorder. This review is organized in 4 parts. Part 1 defines the terms of foot motion and posture. Part 2 details the anatomy and biomechanics, and describes how the foot is changed with deformity. Part 3 details the muscles targeted for strengthening; the intrinsics being the abductor hallucis, adductor hallucis, and the flexor hallucis brevis; the extrinsics being the tibialis posterior and fibularis longus. Part 4 instructs the exercise and reviews the related literature. Instructions are given for the short-foot, the toe-spread-out, and the heel-raise exercises. The routine may be performed by almost anyone at home and may be adopted into physical therapist practice, with intent to strengthen the foot muscles as an adjunct to almost any protocol of care, but especially for the treatment of hallux valgus deformity. J Orthop Sports Phys Ther 2016;46(7):596-605. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6704.
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Hurn SE, Vicenzino BT, Smith MD. Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists. J Foot Ankle Res 2016; 9:16. [PMID: 27148407 PMCID: PMC4855349 DOI: 10.1186/s13047-016-0146-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/26/2016] [Indexed: 12/03/2022] Open
Abstract
Background Patients with hallux valgus (HV) frequently present to podiatrists for non-surgical management, with a wide range of concerns including pain, footwear difficulty and quality of life impacts. There is little research evidence guiding podiatrists’ clinical decisions surrounding non-surgical management of HV. Thus practitioners rely largely upon clinical experience and expert opinion. This survey was conducted to determine whether a consensus exists among Australian podiatrists regarding non-surgical treatment of HV, and secondly to explore common presenting concerns and physical examination findings associated with HV. Methods An online survey was distributed to Australian podiatrists in mid-2013 via the professional association in each state (approximately 1900 members). Podiatrists indicated common treatments recommended, presenting problems and physical examination findings associated with HV in juveniles, adults and older adults. Proportions were calculated to determine the most common responses, and Chi-squared tests were used to examine differences in treatment recommendations according to HV patient age group and podiatrist demographics. Results Of 210 survey respondents, 65 % (136) were female and 80 % (168) were private practitioners. Complete survey responses were received from 159 podiatrists for juvenile HV, 146 for adults and 141 for older adults. Seven different non-surgical treatment options were commonly recommended (by >50 % podiatrists), although recommendations differed between adult, older adult and juvenile HV. Common treatments included footwear advice or modification, custom and prefabricated orthotic devices, addition of padding, and muscle strengthening/retraining exercises. Padding was more likely to be utilised in older adults, while exercises were more likely to be prescribed for juveniles. A diverse range of presenting problems and physical examination findings were reported to be associated with HV. Conclusions Despite the lack of empirical evidence in this area, there appears to be a consensus among Australian podiatrists regarding non-surgical management of HV, and these recommendations are largely aligned with available clinical consensus documents. Presenting concerns and physical examination findings associated with HV are diverse and have implications for treatment decisions. Management strategies differ across patient age groups, thus any updated clinical guidelines should differentiate between adult and juvenile HV. This study provides useful data to inform clinical practice, education, policy and future research. Electronic supplementary material The online version of this article (doi:10.1186/s13047-016-0146-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheree E Hurn
- Queensland University of Technology, School of Clinical Sciences, Kelvin Grove, QLD 4059 Australia ; Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD 4059 Australia
| | - Bill T Vicenzino
- Division of Physiotherapy, University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD 4072 Australia
| | - Michelle D Smith
- Division of Physiotherapy, University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD 4072 Australia
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Doty JF, Alvarez RG, Ervin TB, Heard A, Gilbreath J, Richardson NS. Biomechanical Evaluation of Custom Foot Orthoses for Hallux Valgus Deformity. J Foot Ankle Surg 2015; 54:852-5. [PMID: 26058818 DOI: 10.1053/j.jfas.2015.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Indexed: 02/03/2023]
Abstract
The purpose of the present study was to compare the hallux valgus deformity pressure parameters seen in standard footwear (no orthosis) versus the pressure observed in the same footwear with the addition of 3 different length orthoses. The forefoot pressure at a hallux valgus deformity was recorded with pressure sensors placed on the plantar, medial, and dorsal surface of the first metatarsal head. The participants performed walking trials without an orthosis and with orthoses of 3 different lengths. The average pressure and maximum pressure of each area was recorded for each orthosis, and comparisons were made across the groups. The plantar pressures were decreased in the full length and 3/4 length orthoses, and the dorsal pressures were increased with the use of the full-length and sulcus-length orthoses. Significant changes in medial pressure were not seen with the addition of any orthosis compared with standard footwear alone. However, a trend toward increased medial pressures was seen with the full- and sulcus-length orthoses, and the 3/4-length orthoses exhibited a trend toward decreased medial pressures. We were unable to demonstrate that the use of a custom foot orthosis significantly decreases the medial pressures on the first metatarsal head in patients with hallux valgus deformity. The 3/4-length orthosis was less likely to negatively affect the dorsal or medial pressures, which were noted to increase with the sulcus- and full-length orthoses. Our data suggest that if a clinician uses this treatment option, a 3/4-length orthosis might be a better choice than a sulcus- or full-length orthosis.
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Affiliation(s)
- Jesse F Doty
- Clinical Instructor, Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, TN.
| | - Richard G Alvarez
- Professor and Chairman, Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, TN
| | - Timothy B Ervin
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, TN
| | - Ashley Heard
- Center for Orthotic and Prosthetic Care, Duke University, Durham, NC
| | | | - Nicholas S Richardson
- Orthopaedic Resident, Department of Orthopaedic Surgery, University of Tennessee College of Medicine, Chattanooga, TN
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Farzadi M, Safaeepour Z, Mousavi ME, Saeedi H. Effect of medial arch support foot orthosis on plantar pressure distribution in females with mild-to-moderate hallux valgus after one month of follow-up. Prosthet Orthot Int 2015; 39:134-9. [PMID: 24515981 DOI: 10.1177/0309364613518229] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Higher plantar pressures at the medial forefoot are reported in hallux valgus. Foot orthoses with medial arch support are considered as an intervention in this pathology. However, little is known about the effect of foot orthoses on plantar pressure distribution in hallux valgus. OBJECTIVES To investigate the effect of a foot orthosis with medial arch support on pressure distribution in females with mild-to-moderate hallux valgus. STUDY DESIGN Quasi-experimental. METHODS Sixteen female volunteers with mild-to-moderate hallux valgus participated in this study and used a medial arch support foot orthosis for 4 weeks. Plantar pressure for each participant was assessed using the Pedar-X(®) in-shoe system in four conditions including shoe-only and foot orthosis before and after the intervention. RESULTS The use of the foot orthosis for 1 month led to a decrease in peak pressure and maximum force under the hallux, first metatarsal, and metatarsals 3-5 (p < 0.05). In the medial midfoot region, peak pressure, maximum force, and contact area were significantly higher with the foot orthosis than shoe-only before and after the intervention (p = 0.00). CONCLUSION A foot orthosis with medial arch support could reduce pressure beneath the hallux and the first metatarsal head by transferring the load to the other regions. It would appear that this type of foot orthosis can be an effective method of intervention in this pathology. CLINICAL RELEVANCE Findings of this study will improve the clinical knowledge about the effect of the medial arch support foot orthosis used on plantar pressure distribution in hallux valgus pathology.
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Affiliation(s)
- Maede Farzadi
- Department of Prosthetics and Orthotics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Zahra Safaeepour
- Department of Prosthetics and Orthotics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad E Mousavi
- Department of Prosthetics and Orthotics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Hassan Saeedi
- Department of Prosthetics and Orthotics, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Augat P, Robioneck PB, Abdulazim A, Wipf F, Lips KS, Alt V, Schnettler R, Heiss C. Fixation performance of an ultrasonically fused, bioresorbable osteosynthesis implant: A biomechanical and biocompatibility study. J Biomed Mater Res B Appl Biomater 2015; 104:170-9. [DOI: 10.1002/jbm.b.33382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/10/2014] [Accepted: 01/09/2015] [Indexed: 11/06/2022]
Affiliation(s)
- P. Augat
- Institute of Biomechanics, Trauma Center Murnau; Murnau Germany
- Institute of Biomechanics, Paracelsus Medical University; Salzburg Austria
| | - P. B. Robioneck
- Research and Development Department; Stryker Trauma GmbH; Schönkirchen Germany
| | - A. Abdulazim
- Institute of Biomechanics, Trauma Center Murnau; Murnau Germany
| | - F. Wipf
- Research and Development Department; Stryker Trauma AG; Selzach Switzerland
| | - K. S. Lips
- Laboratory of Experimental Trauma Surgery; Justus-Liebig-University of Giessen; Giessen Germany
| | - V. Alt
- Laboratory of Experimental Trauma Surgery; Justus-Liebig-University of Giessen; Giessen Germany
- Department of Trauma Surgery; University Hospital of Giessen-Marburg; Giessen Germany
| | - R. Schnettler
- Laboratory of Experimental Trauma Surgery; Justus-Liebig-University of Giessen; Giessen Germany
- Department of Trauma Surgery; University Hospital of Giessen-Marburg; Giessen Germany
| | - C. Heiss
- Laboratory of Experimental Trauma Surgery; Justus-Liebig-University of Giessen; Giessen Germany
- Department of Trauma Surgery; University Hospital of Giessen-Marburg; Giessen Germany
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Koller U, Willegger M, Windhager R, Wanivenhaus A, Trnka HJ, Schuh R. Plantar pressure characteristics in hallux valgus feet. J Orthop Res 2014; 32:1688-93. [PMID: 25130961 DOI: 10.1002/jor.22707] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/03/2014] [Indexed: 02/04/2023]
Abstract
Due to the pathoanatomical changes in hallux valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the hallux is decreased during push-off. We assessed loading parameters in hallux valgus feet. Based on dorsal-plantar weight bearing radiographs of 61 feet, the intermetatarsal-, hallux valgus-, distal metatarsal articulation-angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed® system during level walking. We found negative correlations between hallux valgus angle and peak pressure in the great toe (r=-0.301, p<0.023), the maximum force of the hallux (r=-0.481, p<0.001), and contact time of the great toe (r=-0.448, p<0.001), and positive correlations for force time integral (r=0.348, p<0.001), contact area (r=0.307, p<0.020), maximum force (r=0.430, p<0.001), and peak pressure (r=0.361, p<0.006) of the fifth metatarsal head. A positive correlation between the sesamoid and the metatarsal subluxation regarding maximum force (r=0.294, p<0.034), and a negative correlation between the contact area of the hallux (r=-0.232, p<0.020) was shown. Depending on the severity, hallux valgus angle, and sesamoid subluxation, load shows significant lateral transmission in hallux valgus feet.
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Affiliation(s)
- Ulrich Koller
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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Siekmann W, Watson TS, Roggelin M. Correction of moderate to severe hallux valgus with isometric first metatarsal double osteotomy. Foot Ankle Int 2014; 35:1122-30. [PMID: 25056384 DOI: 10.1177/1071100714544520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The operative treatment for the moderate to severe bunion continues to present challenges. The indications for a single, double, or triple first ray osteotomy remain controversial. In addition, it is not clear whether an opening wedge osteotomy leads to clinically relevant arthritis at the first metatarsophalangeal joint. However, it is this theoretical concern that has led the authors to develop an isometric correction of the first ray. METHODS Thirty-two patients underwent operative correction of hallux valgus with a double osteotomy of the first metatarsal using an opening wedge proximally and a closing wedge distally. The mean follow-up period was 59.3 months with a range of 55 to 65 months. RESULTS The 1-2 intermetatarsal angle preoperatively was a mean of 18.9 degrees (range 17-23), correcting postoperatively to a mean angle of 8.6 degrees (range 5-12), for an average correction of 10.4 degrees (range 6-16). The postoperative AOFAS scores were 39.4 out of 40 points for pain, 42.4 out of 45 points for function, and 15 points for alignment. The total score was excellent with 94.2 out of 100 possible points. Radiographic union occurred in all cases. There was one case of painful edema of the foot and two cases of early avascular necrosis (AVN) diagnosed by residual pain at the hallux metatarsophalangeal joint and transient osteopenia of the metatarsal head on radiographs. No late sequelae associated with AVN such as arthritis or metatarsal head collapse were noted with long-term follow-up. These healed within months without specific treatment. CONCLUSION A double osteotomy of the first metatarsal with a nonlocking, low-profile plate was an effective procedure for correcting severe hallux valgus that carried a low complication rate and high patient satisfaction. It has clear advantages over isolated opening wedge procedures, including potentially better correction especially in those bunions associated with an increased distal metatarsal articular angle. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Wong DWC, Zhang M, Yu J, Leung AKL. Biomechanics of first ray hypermobility: An investigation on joint force during walking using finite element analysis. Med Eng Phys 2014; 36:1388-93. [PMID: 24726375 DOI: 10.1016/j.medengphy.2014.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/22/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
Hypermobility of the first ray is suggested to contribute to hallux valgus. The investigation of first ray hypermobility focused on the mobility and range of motion that based on manual examination. The load transfer mechanism of the first ray is important to understand the development and pathomechanism of hallux valgus. In this study, we investigated the immediate effect of the joint hypermobility on the metatarsocuneiform and metatarsophalangeal joint loading through a reduction of the stiffness of the foot ligaments. A three-dimensional foot model was constructed from a female aged 28 via MRI. All foot and ankle bones, including two sesamoids and the encapsulated bulk tissue were modeled as 3D solid parts, linking with ligaments of shell elements and muscles connectors. The stance phase of walking was simulated by the boundary and loading conditions obtained from gait analysis of the same subject. Compared with the normal foot, the hypermobile foot had higher resultant metatarsocuneiform and metatarsophalangeal joint forces. The increases accounted for 18.6% and 3.9% body weight. There was also an abrupt change of metatarsocuneiform joint force in the medial-lateral direction. The predicted results represented possible risk of joint problems and metatarsus primus varus.
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