The effect of hallux valgus on the anatomy of the nerves around the first metatarsal bone

OBJECTIVE

To identify the variations in the location of the nerves that may be at risk in hallux valgus (HV) surgery, and to reveal whether these nerves are affected by the anatomical changes associated with HV.

METHOD

In the formalin fixed, 46 lower extremities (19 female, 27 male) (9 normal, 14 mild HV, 21 moderate/severe HV), extensor hallucis longus tendon (EHL), deep plantar artery, medial dorsal cutaneous (MDCN), deep fibular (DFN), common plantar digital (CPDN) and proper plantar digital (PPDN) nerves were examined. The branches of MDCN extending to the medial side of foot were recorded in three segments. The positional topography of nerves according to EHL were analyzed on 360° circle and clock models.

RESULTS

Sex-related differences observed in some parameters in direct measurements were not found in the clock model comparisons. In advanced HV angles (> 20°), DFN was closer to EHL in the distal part of the metatarsal bone, while there was no difference in the proximal. The intersection of the medial branch of the MDCN with the EHL was more proximal in HV cases than in normal feet. The location of the nerves in the clock pattern did not change in HV. Of the nerve branches reaching the medial side of the foot, 65.2% were in Part I, 71.7% in Part II, and 4.3% in Part III.

CONCLUSION

Sex differences in the distance of the nerves to the EHL disappeared when the size effect of the cross-section of the first metatarsal bone region was eliminated with the clock model. Only in advanced HVA (>20°) (not in mild HV), the DFN being closer to the EHL distally and the intersection of the medial branch of the MDCN with the EHL in HV being more proximal than in normal can be interpreted as specific reflections of HV progress. The variations we revealed in the number of branches reaching the inside of the foot may explain the diversity of neuromas or nerve injuries associated with HV surgery.

First tarsometatarsal joint mobility in hallux valgus during gait: A synchronized ultrasound and three-dimensional motion capture analysis

PURPOSE

To quantify the vertical translation between the first metatarsal and medial cuneiform during the stance phase of gait in young individuals with and without hallux valgus.

DESIGN

This cross-sectional observational study included 34 young adults (male, n = 4; female, n = 30) who were divided into three groups according to the hallux valgus angle: control (< 20°, n = 13), mild hallux valgus (≥ 20° to < 30°, n = 12), and moderate hallux valgus (≥ 30°, n = 9). The mobility of the first tarsometatarsal joint was evaluated during the stance phase using B-mode ultrasound synchronized with a motion analysis system.

RESULTS

The medial cuneiform shifted more plantar during the early phase in mild hallux valgus and during the middle and terminal phases in moderate hallux valgus than in control. The severity of the hallux valgus was correlated with a trend toward plantar shift of the medial cuneiform. The first metatarsal was located more dorsal than the medial cuneiform; however, there was no significant variation. No significant differences in the peak ankle plantarflexion angle and moment were noted between the groups.

CONCLUSION

The hypermobility of the first tarsometatarsal joint, especially plantar displacement of the medial cuneiform in the sagittal plane, was found in young individuals with hallux valgus during the stance phase of gait, and the mobility increased with the severity of hallux valgus. Our findings suggest the significance of preventing hallux valgus deformity early in life.

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

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.

Comparison of foot function and physical performance between women with and without bilateral painful hallux valgus

BACKGROUND

We aimed to investigate whether foot function and physical performance differ between women with and without bilateral painful hallux valgus (HV).

METHODS

Forty-four women with bilateral painful HV and forty-three controls were included. The Foot Function Index, American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joints Scale, and Manchester-Oxford Foot Questionnaire were used. The time while walking 10 m-walkway at maximum speed and ascending and descending ten stairs as fast as possible also single-limb stance time were measured.

RESULTS

All self-reported and performance-based measures showed that women with HV had poorer foot function and physical performance than controls (p < 0.05). Women with mild HV had better self-reported foot function than those with moderate HV or severe HV (p < 0.05), but physical performance did not differ (p > 0.05).

CONCLUSIONS

Women with bilateral painful HV exhibited poorer self-reported foot function and performance-based physical function than those without HV.

LEVELS OF EVIDENCE

Level III.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Registry (ACTRN12621000645853).

Association between forefoot pain and sesamoid rotation angle determined using a weight-bearing plantar ultrasound imaging device

Forefoot pain is a common symptom for several foot problems. This study aimed to determine whether parameters of forefoot structure (hallux valgus angle (HVA), transverse arch height (TAH) and sesamoid rotation angle (SRA)) are associated with forefoot pain. 547 feet of adult women were divided into two groups: without pain (n = 472) and with pain (n = 75). HVA was measured with a goniometer, TAH and SRA were measured using a weight bearing plantar ultrasound imaging device.Associations between forefoot pain and parameters of forefoot structure were analyzed using the Mann-Whitney U test and univariate and multivariate logistic regression analyses. The intra-rater and inter-rater reliability of the ultrasound images were also tested. SRA was significantly greater in the group with pain compared to the group without pain (p = 0.031) but not HVA (p = 0.057) nor TAH (p = 0.117). The association between forefoot pain and SRA was significant (univariate: p = 0.015 and multivariate p = 0.015), but not between HVA nor TAH. The intra-rater and inter-rater reliability were almost perfect (SRA: ICC1,1 = 0.94, ICC2,1 = 0.91 and TAH: ICC1,1 = 0.88, ICC2,1 = 0.81). We conclude that a higher SRA is related to forefoot pain and should be taken into consideration for assessment of patients with forefoot pain.

Relationship between foot morphology, muscle strength, and physical performance test in women aged 65 years and older: a cross-sectional study

Background

Hallux valgus is a foot deformity that may affect gait, thus increasing the risk of falls among older people. We investigated the relationship between foot morphology, muscle strength, and physical performance.

Methods

In this study, community-dwelling older people aged ≥65 years were included. A three-dimensional footprint automatic measurement apparatus was used to measure the hallux valgus angle, arch height ratio, and heel-floor angle. Furthermore, the toe flexor strength and ankle plantar flexion strength were measured. Physical performance tests included the five-repetition sit-to-stand test, one-leg standing time, maximal step length, functional reach test, and 5-m fastest walking time (walking time). The relationship between the hallux valgus angle and foot morphology and muscle strength was examined. In addition, factors affecting physical performance testing were assessed. Two-group comparisons, correlation, and multiple comparisons were used for statistical analyses.

Results

Of the 133 women (age 77.7 ± 6.2 years), 57 had hallux valgus and 76 had no hallux valgus. There was a significant difference in the arch height ratio and heel-floor angle between women with and without hallux valgus (p < 0.001). A correlation was found between the hallux valgus angle and the heel-floor angle (r = 0.468, p < 0.001) and arch height ratio (r = − 0.337, p < 0.001), respectively. Multiple regression analysis showed that the hallux valgus angle was related to functional reach (β = − 0.162, p = 0.042), and toe flexor strength was related to five-repetition sit-to-stand (β = − 0.182, p = 0.036), maximal step length (β = 0.328, p < 0.001), and walking time (β = − 0.219, p = 0.006).

Conclusions

A relationship was found between the hallux valgus angle, arch height rate, and inward inclination angle of the calcaneus. Functional reach was predicted based on the hallux valgus angle, whereas the five-repetition sit-to-stand, maximal step length, and walking time were predicted based on toe flexor strength. Hallux valgus predicted not only the forefoot but also the foot morphology and was related to physical performance. From the perspective of motor function and fall prevention, efforts should be made to better understand and prevent the onset and progression of hallux valgus.

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

Background

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

Methods

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

Discussion

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

Trial registration

Australian and New Zealand Clinical Trial Registry (ACTRN12621000645853).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-022-00553-4.

Effects of global postural reeducation on postural control, dynamic balance, and ankle range of motion in patients with hallux abducto valgus. A randomized controlled trial

Hallux abducto valgus (HAV) is a common musculoskeletal disorder that has been addressed surgically. Nevertheless, the manual therapy approach may play an important role in the management of this condition. The present study aimed to determine the effectiveness of global postural reeducation (GPR) in subjects with symptomatic mild to moderate HAV in static postural control, dynamic stability, and ankle dorsiflexion range of motion (DFROM). A total of 80 patients with mild to moderate symptomatic HAV were allocated to the intervention group (GPR) or control group (CG) (no treatment) for 8 weeks. Outcome measures were assessed at baseline at 4 and 8 weeks including static postural control (Romberg test), dynamic balance (Star Excursion Balance Test [SEBT]), and ankle DFROM (Weight-Bearing Lunge Test [WBLT]). No improvements were observed at 4 weeks, but there were improvements at 8 weeks in: static postural control mediolateral displacement (X) of center of pressure (CoP) in both eyes open (EO) and eyes closed (EC): XEO (t(36) = 2.892, p = .006, d = 0.67); XEC (t(68) = 2.280, p = .026, d = 054); and velocity (V) of CoP displacement: VEO (t(68) = 2.380, p = .020, d = 0.57); VEC (t(36) = 2.057, p = .047, d = 0.37). It were also improvements in: WBLT (t(36) = -2.869, p = .007, d = 0.54) and SEBT at three directions (anterior, ANT; posteromedial, PM; and posterolateral, PL): SEBT.ANT (t(36) = -2.292, p = .028, d = 0.23); SEBT.PM (t(36) = -4.075, p < .001, d = 0.43); SEBT.PL (t(62) = -3.506, p = .001, d = 0.34). The present study showed that GPR compared to the CG might be effective in enhancing ankle function including postural control, dynamic balance, and DFROM.

Transverse laxity of the forefoot

BACKGROUND

Splay of the forefoot reflects the loss of tension in the soft tissues and indicates failure of the biomechanics of the tie-bar system. By identifying and quantifying the soft tissue structures involved in the destruction of forefoot stability we could increase the understanding of forefoot pathologies.

METHODS

We investigated the transverse forefoot laxity on healthy feet, feet with forefoot pathology and cadaveric feet undergoing sequential dissection.

RESULTS

Statistical difference in transverse laxity was seen between healthy feet (n = 160) and feet with symptomatic forefoot pathology requiring surgery (n = 29). Presence of lesser ray pathology is associated with increased transverse laxity. For the dissected cadaveric feet (n = 9) sequential sectioning the plantar plate causes a progressive evolution of transverse laxity. The repair of plantar plates greatly improves transverse stability.

CONCLUSIONS

Forefoot pathology causes increased transverse laxity. In case of a major transverse laxity of the forefoot a plantar plate lesion should be suspected.

Are foot deformity and plantar sensitivity impairment associated with physical function of community-dwelling older adults?

BACKGROUND

Foot deformities are highly prevalent in older adults and negatively impact their mobility and quality of life. However, the association between foot problems and physical function is still unclear.

OBJECTIVE

To investigate whether structural foot deformities and plantar tactile sensitivity are associated with lower extremity physical function impairment in community-dwelling older adults.

METHODS

We included 200 men and women aged 60 years and older from a community-based program. The foot assessment included toe deformities and calluses inspection and evaluation of plantar tactile sensitivity using monofilaments. The Short Physical Performance Battery (SPPB) was used to assess lower extremity physical function. We conducted a multivariate logistic regression analysis to investigate the association between foot problems and lower extremity physical function.

RESULTS

Hallux valgus was the most prevalent deformity among older adults. Those participants with reduced plantar tactile sensitivity (OR= 2.77; 95% CI: 1.38, 5.55) and a hallux valgus (OR= 2.23; 95% CI: 1.10, 4.52) were more likely to present poor lower extremity physical function.

CONCLUSION

Hallux valgus and impaired plantar sensitivity were associated with reduced lower extremity physical function in older adults. Further studies are necessary to identify this causality and to what extent management of these foot problems can improve general mobility and quality of life of older adults.

Health-related quality-of-life improvement after hallux valgus corrective surgery

BACKGROUND

Hallux valgus is a common forefoot deformity that affects function of foot and quality of life (QoL). This study aims to identify factors associated with clinically important improvements in QoL after hallux valgus corrective surgery.

METHODS

A retrospective analysis on 591 cases of hallux valgus corrective surgery performed between 2007 and 2013 was conducted. Patients' preoperative and 2-year postoperative Physical Component Score (PCS) and Mental Component Score (MCS) were compared to identify the presence of clinically significant improvements in patient-reported QoL. A multiple logistic regression model was developed through a stepwise variable-selection model building approach. Age, BMI, preoperative patient reported outcome score, PCS, MCS, pain score, gender, side of surgery, type of surgery, and presence of lesser toe deformities or metatarsalgia were considered.

RESULTS

Median PCS significantly improved from 49 to 53 (p < 0.001), and median MCS remained at 56 (p = 0.724). Age, preoperative MCS and PCS were independent predictors for significant improvements of PCS at 2-year postoperatively.

CONCLUSION

Three groups of patients were more likely to have significant QoL improvements after hallux valgus corrective surgery. These were the younger patients, those with better preoperative mental health or those with poorer preoperative physical health.

LEVEL OF EVIDENCE

III.

Using Manchester Scale classification of Hallux Valgus as a valuable tool in determining appropriate risk categorization during initial diabetic foot screening in primary health care settings

Limitations have been identified in the current state of primary care practises with regards to identifying and correctly categorizing foot deformity and its associated risk of developing foot ulcers in patients with diabetes. This study aims to bridge these gaps through the implementation of additional categorization tools to be made available for primary care professionals. This study thus analysed the relationship between foot pressure distribution and amount in patients with diabetes with Hallux Valgus foot deformity, and its different stages, in order to better understand the clinical applications of the Manchester Scale. Statistically significant data in pressure distribution (P < 0.05) was found in all three severity groups identified by the Manchester Scale (Mild, Moderate and Severe) when compared to a No deformity group. However, only the Severe Hallux Valgus group crossed the threshold over 500 kPa in the area of first metatarsal bone. Further research should aim to analyse pressure distribution and amount in patients with both diabetes and diabetic neuropathy of all stages of Hallux Valgus.

Hallux valgus deformity and postural sway: a cross-sectional study

Background

Hallux valgus deformity has been reported to be associated with increased postural sway. However, the direction and magnitude of postural sway associated with hallux valgus remain inconclusive. We assessed the association between hallux valgus deformity and postural sway using a force plate.

Methods

The subjects were 169 healthy volunteers, > 40 years old (63 males, 106 females, average age: 66.0 ± 12.4 years old), who took part in an annual medical examination. We investigated the photographic hallux valgus angle (°), total trajectory length of the gravity center fluctuation (mm), area of the center of pressure (mm²), mediolateral and anteroposterior postural sway (mm) in a standing position with 2-legged stance and eyes open, hallux pain (Numerical Rating Scale), trunk and lower limb muscle mass (kg). We classified the subjects into a hallux valgus group (n = 44, photographic hallux valgus angle of 1 or both feet ≥ 20°) and a no hallux valgus group (n = 125, photographic hallux valgus angle of both feet < 20°) and analyzed the relationship between hallux valgus and postural sway.

Results

The anteroposterior postural sway in the hallux valgus group (6.5 ± 2.8) was significantly greater than in the no hallux valgus group (5.4 ± 2.2, p = 0.014), and the lower limb muscle mass in the hallux valgus group (12.4 ± 2.2) was significantly smaller than in the no hallux valgus group (13.5 ± 3.2, p = 0.016). The total value of the photographic hallux valgus angle on both feet was positively correlated with the anteroposterior postural sway (p = 0.021) and negatively correlated with the lower limb muscle mass (p = 0.038). The presence of hallux valgus (p = 0.024) and photographic hallux valgus angle (p = 0.008) were independently related to the magnitude of anteroposterior postural sway.

Conclusions

Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway.

Trial registration

2017 − 135. Registered 22 August 2017.

A comparison of foot posture and walking performance in patients with mild, moderate, and severe adolescent idiopathic scoliosis

Background

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. However, the underlying mechanisms linking spinal curvature in AIS to foot characteristics and walking performance remain unclear.

Objective

This study aimed to compare walking performance between adolescents with mild, moderate, and severe scoliosis and matched healthy peers with foot posture as covariates.

Methods

This cross-sectional study of 96 adolescents was conducted between April 2020 to October 2020 in China, with 32 healthy peers in the control group and 64 patients in the AIS group. Foot posture and morphology, plantar pressure distribution, and gait characteristics were analyzed. One-way analysis of variance with Bonferroni correction and a post hoc comparison of the mean differences between the different groups was performed. Multiple analyses of covariance adjusted for age, sex, body mass index, foot posture index (FPI), arch index (AI), and walking speed were performed.

Results

Of the 64 adolescents with scoliosis, 18 had mild AIS, 32 had moderate AIS, and 14 had severe AIS. The AI and FPI were much higher in the moderate and severe AIS groups (p = 0.018) and the severe AIS group (p<0.001), respectively, than in the control group. The severe AIS group had advanced and longer midstance (p = 0.014) and delayed propulsion phase (p = 0.013) than the control group. Patients with moderate and severe AIS had asymmetrical gait periods in the left and right limbs (p<0.05). Significant differences in the center-of-pressure excursion index (CPEI) were found between the moderate and severe AIS and control groups (p = 0.003).

Conclusion

Moderate and severe AIS significantly influenced walking performance; however, no significant differences were observed between adolescents with mild AIS and healthy controls. Thus, early intervention could target the prevention of specific functional deficits and prevent it from progressing to a severe state.

Effectiveness of non-surgical interventions for hallux valgus: a systematic review and meta-analysis

OBJECTIVE

To conduct a systematic review and meta-analysis investigating the effectiveness of non-surgical interventions for hallux valgus (HV).

METHODS

The review protocol was registered with PROSPERO (CRD42019111711). Medline, CINAHL, Embase, and the Cochrane Library were searched to April 2020, including parallel-group and crossover studies investigating non-surgical interventions for HV. Two reviewers independently screened articles for inclusion, extracted data, performed risk of bias and GRADE assessments. Risk of bias was assessed using version 2 of the Cochrane risk of bias tool. Effect sizes (mean differences or risk ratios, and 95% confidence intervals) were calculated and pooled where possible for the primary outcomes, foot pain and HV angle.

RESULTS

Eighteen included studies investigated a wide range of non-surgical interventions for HV. Most studies had small sample sizes and concerns regarding risk of bias. Five separate meta-analyses for foot orthoses, splints, manual therapy, and taping added to foot exercises showed no significant effects on primary outcomes. However, results from eight studies showed a significant pain reduction with the use of foot orthoses, night splints, dynamic splints, manual therapy, taping added to foot exercises, multifaceted physical therapy program and Botox injections. Four studies reported a clinically significant reduction in HV angle with night splints, foot exercises, multifaceted physical therapy and Botox injections.

CONCLUSION

There is a low level of certainty surrounding the effectiveness of non-surgical interventions for HV, however a reduction in pain appears more likely than improvement in HV angle.

Differences in toe flexor strength and foot morphology between wheelchair dependent and ambulant older people in long-term care: a cross-sectional study

BACKGROUND

Hallux valgus, lesser toe deformity, and muscle weakness of the toe flexors contribute to falls in older people. This study aimed to examine the differences in toe flexor strength and foot morphology in older people requiring long-term care due to changes in the way they mobilize in everyday life.

METHODS

This study included 84 people aged ≥70 years without motor paralysis who underwent rehabilitation. They were divided into those who could mobilize without a wheelchair (walking group, n = 54) and those who used a wheelchair to mobilize (wheelchair group, n = 30). The presence or absence of diseases was confirmed, and hand grip strength, toe flexor strength, and foot morphology using the foot printer were measured. The presence of diseases, hand grip strength, toe flexor strength, and foot morphology were compared between the two groups. Multiple logistic analysis was performed with wheelchair dependence as the dichotomous outcome variable, and the percentages of each strength measure observed in the wheelchair group to the average hand grip and toe flexor strength measures in the walking group were compared.

RESULTS

No significant between-group difference in foot morphology was found. The factors related to the differences in ways of ambulating in daily life were history of fracture, heart disease, and toe flexor strength. After comparing the muscle strength of the wheelchair group with the mean values of the walking group, we found that the toe flexor strength was significantly lower than the hand grip strength.

CONCLUSIONS

Older people who used a wheelchair to mobilize have significantly less toe flexor strength than those who do not despite no significant difference in foot morphology. Use of a wheelchair is associated with a reduction in toe flexor strength.

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

OBJECTIVE

To examine differences in lower limb muscle strength between older people with varying degrees of hallux valgus deformity.

METHODS

Muscle strength was measured at the knee, ankle and foot using hand-held dynamometry and a clinical test of toe strength (the paper grip test) in 157 older people (99 women and 58 men) aged 65 to 91 (mean 74.1, SD 5.9) years. Hallux valgus severity was documented as none, mild, moderate or severe using validated photographs. Differences in muscle strength according to hallux valgus severity were evaluated using analysis of variance, adjusting for age. Paper grip test performance was compared across the hallux valgus severity groups using the chi-square (χ²) statistic.

RESULTS

Knee extension, ankle joint dorsiflexion, ankle joint plantar flexion, ankle joint inversion, ankle joint eversion and lesser toe plantarflexion strength were not significantly different across the four hallux valgus severity groups. However, there was a significant, dose-response reduction in hallux plantarflexion strength with increasing severity of hallux valgus. This persisted after adjustment for age (F₃ = 5.5, p = 0.001) with a medium effect size (partial η² = 0.10). The number of participants who could successfully complete the paper grip test of the hallux significantly reduced across the four hallux valgus categories (χ² = 18.5, p < 0.001).

CONCLUSIONS

There is a specific and progressive reduction in hallux plantarflexion strength with increasing severity of hallux valgus in older people. This finding has potential implications for both the aetiology and treatment of this common and disabling condition.

Ground reaction force complexity in hallux valgus

BACKGROUND

Investigating the complexity of movement systems can be insightful in clinical decision making. The study conducted to evaluate whether complexity of ground reaction force is affected by hallux valgus grades and footwear or foot side conditions.

METHODS

A sample of 120 females including 30 participants in each group of healthy and mild, moderate, and severe hallux valgus were recruited in this case-control study. Hallux valgus grades were assessed using Manchester scale. Ground reaction force were measured in bare foot and shod conditions for both feet and weighted permutation entropy was used to calculate the complexity. Nonparametric tests were employed for statistical inference.

FINDINGS

The first important result was that hallux valgus caused loss of complexity of ground reaction force with a medium to large effect size. However, we did not find any difference between three grades of hallux valgus entropy. The second finding was that entropy of healthy group decreased from barefoot to shod condition with a large effect size and the third finding was that ground reaction force entropy were similar in both feet.

INTERPRETATION

The findings are aligned with the theory that loss of complexity appears when the biological systems become functionally impaired. As soon as hallux valgus initiates, all potential risks related to the reduction of complexity appear. So, we suggest to administer conservative treatments in the early stages of hallux valgus. The study outcomes can be used for evaluation of foot function, classification of the foot types, or footwear selection.

The functional capacity and morphological characteristics of the intrinsic foot muscles in subjects with Hallux Valgus deformity: A systematic review

BACKGROUND

The intrinsic foot muscles are vital for maintaining normal foot function. This study was conducted to systematically review the literature on the functional capacity and morphological characteristics of the intrinsic foot muscles in subjects with Hallux Valgus (HV) deformity.

METHODS

A search was carried out in all available electronic databases, including Pub Med, Scopus, Embase and Web of Science, for identifying any relevant studies published from 1990 to October 2018.

RESULTS

Three studies had investigated intrinsic foot muscle size using ultrasound imaging; two had reported electromyography parameters and four had measured the muscle force capacity. The results of the present review suggested that the functional capacity and morphological characteristics of intrinsic foot muscles are different in subjects with HV compared to those without this deformity.

CONCLUSION

This review found scientific evidence on muscle performance impairment in the abductor hallucis and flexor hallucis brevis in subjects with HV deformity.

Correlation between functional ability, toe flexor strength, and plantar pressure of hallux valgus in young female adults: a cross-sectional study

Background

The prevalence of hallux valgus (HV) increases with age in females. Several studies have investigated the relationship between foot problems, including HV, and falls in older individuals. This study aimed to examine whether HV causes a decline in functional activity in young females and also evaluate the relationship between HV angle, functional activity, toe flexor strength, and plantar pressure.

Methods

We assessed 94 females (mean age, 19.6 ± 1.3 years; mean body mass index, 21.2 ± 2.0 kg/m²) not currently receiving treatment for lower limb disease. HV angle was determined using their footprint. Functional reach (FR) and maximum step length (MSL), toe flexor strength, and plantar pressure were measured. Plantar pressure was measured during walking. We also calculated FR and the pressure in eight regions (first toe, second through fifth toes, first metatarsal, second through fourth metatarsals, fifth metatarsal, midfoot, medial heel, and lateral heel).

Results

There were 39 and 55 participants in the HV and no HV groups, respectively. FR and MSL did not differ significantly between the HV and no HV groups. Toe flexor strength was significantly different between the HV and no HV groups (26.69 ± 9.68 vs. 32.19 ± 8.55, respectively) (p = 0.002, β = 0.206). During walking, plantar pressure was significantly lower in the second through fifth toes in the HV group (p = 0.005, β = 0.187). During FR, plantar pressure was significantly greater in the first metatarsal in the HV group (p = 0.016, β = 0.338). HV angle was negatively correlated with toe flexor strength (r = − 0.315, p = 0.002, β = 0.121) and plantar pressure during walking in the second through fifth toes (r = − 0.362, p < 0.001, β = 0.047), and positively correlated with plantar pressure during FR in the first metatarsal (r = 0.308, p = 0.002, β = 0.137). Toe flexor strength was negatively correlated with plantar pressure during FR in the second through fourth metatarsals (r = − 0.318, p = 0.002, β = 0.115), and there was a positive correlation with MSL (r = 0.330, p = 0.001, β = 0.092).

Conclusions

This study confirmed that HV reduces toe flexor strength and affects forefoot pressure during walking and FR in young females. Moreover, the toe flexor strength affects MSL. Efforts to prevent the onset and deterioration of HV from a young age might help reduce the risk of falling when older.

Feasibility of the Archercise biofeedback device to strengthen foot musculature

Background

Foot muscle weakness can produce foot deformity, pain and disability. Toe flexor and foot arch exercises focused on intrinsic foot muscle strength and functional control may mitigate the progression of foot deformity and disability. Ensuring correct exercise technique is challenging due to the specificity of muscle activation required to complete some foot exercises. Biofeedback has been used to improve adherence, muscle activity and movement patterns. We investigated the feasibility of using a novel medical device, known as “Archercise”, to provide real-time biofeedback of correct arch movement via pressure change in an inflatable bladder, and foot location adherence via sensors embedded in a footplate during four-foot exercises.

Methods

Thirty adults (63% female, aged 23–68 years) performed four-foot exercises twice on the Archercise sensor footplate alone and then with biofeedback. One-way repeated measures ANOVA with pairwise comparisons were computed to assess the consistency of the exercise protocol between trial 1 and trial 2 (prior to biofeedback), and the effectiveness of the Archercise biofeedback device between trial 2 and trial 3 (with biofeedback). Outcome measures were: Arch movement exercises of arch elevation and lowering speed, controlled arch elevation, controlled arch lowering, endurance of arch elevation; Foot location adherence was determined by percentage of time the great toe, fifth toe and heel contacted footplate sensors during testing and were analysed with paired sample t-tests. Participant survey comments on the use of Archercise with biofeedback were reported thematically.

Results

Seventeen (89%) arch movement and foot location variables were collected consistently with Archercise during the foot exercises. Archercise with biofeedback improved foot location adherence for all exercises (p = 0.003–0.008), coefficient of determination for controlled arch elevation (p < 0.0001) and endurance area ratio (p = 0.001). Twenty-nine (97%) participants reported Archercise with biofeedback, helped correct exercise performance.

Conclusions

Archercise is a feasible biofeedback device to assist healthy participants without foot pathologies perform foot doming exercises.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR): 12616001559404. Registered 11 November 2016, http://www.ANZCTR.org.au/ACTRN12616001559404p.aspx

The effects of hallux valgus and walking speed on dynamic balance in older adults

BACKGROUND

Hallux valgus (HV) contributes to deficits in static balance and increased fall risk in older adults. Very limited research has examined dynamic balance deficits in walking in this population. These individuals generally walk slowly, as balance challenge is lesser at slow speeds.

RESEARCH QUESTION

How does the dynamic balance of older adults with HV differ from healthy controls at controlled slow and fast walking speeds?

METHODS

Nineteen older adults with HV and 13 healthy controls completed 5 continuous walking trials at 1.0 and 1.3 m·s^-1 as whole body marker position and ground reaction force data were captured. Dynamic balance was evaluated using whole body center of mass (COM) and center of pressure (COP) inclination angles (IA) and duration of double support.

RESULTS

There were no differences in measures of dynamic balance between older adults with and without HV at slow and fast speeds. At the faster speed, the peak sagittal plane COM-COP IA increased and the double support duration decreased, while the peak frontal plane COM-COP IA were not affected.

SIGNIFICANCE

Older adults with HV do not exhibit deficits in dynamic balance during continuous walking at comfortable speeds when compared to healthy older adults.

Detailed analysis of the transverse arch of hallux valgus feet with and without pain using weightbearing ultrasound imaging and precise force sensors

Background

Hallux valgus is the most common forefoot deformity and affects the transverse arch structure and its force loading patterns. This study aims to clarify the differences in the transverse arch structure and the force under the metatarsal heads individually, between normal feet and hallux valgus feet, and between hallux valgus feet with pain and without pain. We further test the association between the parameters of the transverse arch and hallux valgus angle and between the parameters and pain in hallux valgus.

Methods

Women’s feet (105 feet) were divided into normal group (NORM) and hallux valgus group (HVG); and further into subgroups: hallux valgus without pain (HV Pain (-)) and hallux valgus with pain (HV Pain (+)). Transverse arch height and metatarsal heads height were measured using weight-bearing ultrasound imaging. Force under the metatarsal heads was measured using force sensors attached directly on the skin surface of the metatarsal heads. The measurements were taken in three loading positions: sitting, quiet standing and 90% weight shift on the tested foot. Differences between the groups were compared using Student t-test and Wilcoxon Exact test. Multivariate logistic analysis with adjustment for physical characteristics was also conducted.

Results

Transverse arch height was significantly higher in HVG than in NORM in all positions; there were no significant differences between HV Pain (+) and HV pain (-). Lateral sesamoid was significantly higher in HVG and HV Pain (+) than in NORM and HV Pain (-) respectively when bearing 90% of the body weight unilaterally. There was a trend of higher forces under the medial forefoot without significant difference. Transverse arch height and lateral sesamoid height were associated with the hallux valgus angle, while lateral sesamoid height was associated with forefoot pain in hallux valgus deformity.

Conclusions

This study shows the differences in the transverse arch structure between normal feet and feet with hallux valgus, and between hallux valgus feet with and without pain. This finding is noteworthy when considering future treatments of painful feet, notably the height of the lateral sesamoid which seems to play a role in forefoot pain.

Mild-to-Moderate Hallux Valgus Does Not Decrease Ankle Muscle Strength in Middle-Aged Japanese Women: A Comparative Study

Extreme hallux valgus has been documented to be related to lower functional ability and health-related quality of life. It also has a negative effect on foot structure and biomechanical characteristics, which in turn may affect muscle strength in the foot and ankle. Thus, the purposes of this study were to determine whether there is a difference of ankle muscle strength in varied hallux valgus deformities and to investigate correlations between hallux valgus angles and ankle muscle strength. Hallux valgus angles and ankle muscle strength data were collected from 31 middle-aged Japanese women. The hallux valgus angle was measured with a 3-dimensional foot scanner; ankle muscle strength was measured with a dynamometer. Results showed no differences in ankle muscle strength between normal and mild-to-moderate hallux valgus at both 60º/second and 120º/second (p > .05). Unexpectedly, women with mild-to-moderate hallux valgus had a greater value for inversion peak torque per body weight and eversion-to-inversion ratio than those with normal hallux valgus (p = .019 and p = .022) at 120º/second. Furthermore, hallux valgus was correlated with inversion peak torque and peak torque per body weight (r = 0.47; p = .012 and r = 0.50; p = .007) and associated with eversion-to-inversion strength ratio (r = -0.47; p = .012). The findings indicated that mild-to-moderate hallux valgus did not result in a decrease in ankle muscle strength. Conversely, mild-to-moderate hallux valgus had greater ankle inversion strength in middle-aged Japanese women. Further studies are needed to investigate ankle muscle strength in severe hallux valgus deformities.

Nonradiographic Measurement of Hallux Valgus Angle Using Self-photography

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Foot Mobilization and Exercise Program Combined with Toe Separator Improves Outcomes in Women with Moderate Hallux Valgus at 1-Year Follow-up A Randomized Clinical Trial

BACKGROUND:

Few studies have documented the outcome of conservative treatment of hallux valgus deformities on pain and muscle strength. We sought to determine the effects of foot mobilization and exercise, combined with a toe separator, on symptomatic moderate hallux valgus in female patients.

METHODS:

As part of the randomized clinical trial, 56 women with moderate hallux valgus were randomly assigned to receive 36 sessions for 3 months or no intervention (waiting list). All patients in the treatment group had been treated with foot joint mobilization, strengthening exercises for hallux plantarflexion and abduction, toe grip strength, stretching for ankle dorsiflexion, plus use of a toe separator. Outcome measures were pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. Objective measurements included ankle range of motion, plantarflexion and abduction strength, toe grip strength, and radiographic angular measurements. Outcome measures were assessed by comparing pretreatment, posttreatment, and 1-year follow-up after the intervention. Mixed-model analyses of variance were used for statistical assessment.

RESULTS:

Patients who were treated with 3 months of foot mobilization and exercise combined with a toe separator experienced greater improvement in pain, AOFAS scores, ankle range of motion, hallux plantarflexion and abduction strength, toe grip strength, and radiographic angular measurements than those who did not receive an intervention 3 months and 1 year postintervention ( P < .001 for all comparisons).

CONCLUSIONS:

These results support the use of a multifaceted conservative intervention to treat moderate hallux valgus, although more research is needed to study which aspects of the intervention were most effective.

Foot problems as a risk factor for falls in community-dwelling older people: A systematic review and meta-analysis

BACKGROUND

Foot problems are common in older people. The objective of this systematic review was to determine whether foot problems increase the risk of falling in community-dwelling older people.

METHODS

Electronic databases were searched from inception to May 2018. To be eligible for inclusion, papers needed to (i) include community-dwelling older participants, (ii) document falls either retrospectively or prospectively, and (iii) document or assess the presence of foot problems. Screening and data extraction were performed by two independent assessors, with disagreements resolved by consensus.

RESULTS

A total of 146 papers were screened by title and abstract, and nine met the inclusion criteria. An additional six eligible papers were identified by searching the reference lists of included papers, resulting in a total of 15 papers. Quantitative synthesis indicated that older people who fell were more likely to have foot pain, hallux valgus, lesser toe deformity, plantar fasciitis, reduced ankle dorsiflexion range of motion, reduced toe plantarflexion strength, impaired tactile sensitivity and increased plantar pressures when walking. Meta-analysis indicated that fallers were more likely to have foot pain (pooled odds ratio [OR] 1.95, 95% CI 1.38-2.76, p < 0.001), hallux valgus (pooled OR 1.89, 95% CI 1.19-3.00, p = 0.007) and lesser toe deformity (pooled OR 1.67, 95% CI 1.07-2.59, p = 0.020).

CONCLUSION

Foot problems, particularly foot pain, hallux valgus and lesser toe deformity, are associated with falls in older people. Documentation of foot problems and referral to foot care specialists should therefore be a routine component of falls risk assessment and prevention.

Does hallux valgus impair physical function?

Background

The relationships between radiographic hallux valgus (HV) and various physical functions independent of knee osteoarthritis (KOA) were examined among residents of a mountain village in Japan.

Methods

Study participants were recruited from mountain village residents aged ≥50 years. Participants’ height, weight, and body mass index (BMI) were measured, and baseline data, including age, sex, and foot pain, were obtained using interviews and questionnaires. Radiography of the feet and knees was performed to assess the presence of HV (HV angle ≥20°) and KOA (Kellgren-Lawrence grade ≥ II). Grip strength, 6-m walk at usual and maximum speeds, single-leg stance time, and stand up from a chair time were evaluated as physical function performance tests. Plantar pressure patterns were also examined.

Results

Moderate-severe HV (HV angle ≥30 degrees), impaired grip strength and maximum walking speed, and painful HV reduced usual and maximum walking speeds independent of KOA. Hallux plantar pressure decreased according to the HV angle. Hallux plantar pressure was significantly lower in painful HV than in the no HV feet or painless HV.

Conclusions

Moderate-severe HV deformity and HV-related pain impaired physical function independent of KOA. By controlling the pain and severe deformity of HV by treatments such as surgery, the physical function of HV patients might be improved.

Morphology of the Toe Flexor Muscles in Older Adults With Toe Deformities

OBJECTIVE

It has been suggested that atrophied or weak toe flexor muscles are associated with the formation of toe deformities, but there is little evidence to support this theory. This study aimed to determine whether the size of the toe flexor muscles differed in older adults with and without toe deformities.

METHODS

Forty-four older adults (>60 years) were recruited for the study. Each participant had their feet assessed for the presence of hallux valgus or lesser toe deformities. Intrinsic and extrinsic toe flexor muscles were imaged with an ultrasound system using a standardized protocol. Assessor-blinded measurements of muscle thickness and cross-sectional area were taken using Image J software.

RESULTS

Participants with lesser toe deformities (n = 20) were found to have significantly smaller quadratus plantae (P = 0.003), flexor digitorum brevis (P = 0.013), abductor hallucis (P = 0.004), and flexor hallucis brevis (P = 0.005) muscles than the participants without any toe deformities (n = 19). Female participants with hallux valgus (n = 10) were found to have significantly smaller abductor hallucis (P = 0.048) and flexor hallucis brevis (P = 0.013) muscles than the female participants without any toe deformities (n = 10; P < 0.05).

CONCLUSION

This is the first study to use ultrasound to investigate the size of the toe flexor muscles in older adults with hallux valgus and lesser toe deformities compared to otherwise healthy older adults. The sizes of the abductor hallucis and flexor hallucis brevis muscles were decreased in participants with hallux valgus, whereas the quadratus plantae, flexor digitorum brevis, abductor hallucis, and flexor hallucis brevis muscles were smaller in the participants with lesser toe deformities.

Study on the foot shape characteristics of the elderly in China

BACKGROUND

With aging, the feet of the elderly above 60 years old in China present degenerative changes, deformities, and diseases, which significantly affect their daily activities.

OBJECTIVES

The authors aimed to study the morphological characteristics of the feet and identify the foot type according to size (length and width) and defect characteristics of elderly feet in China.

METHODS

A convenient sample of 1000 subjects above 60 years old was recruited mainly in the regions of Shanghai, Shaanxi, Henan, Hebei, and Sichuan in China. Foot images were collected, and 800 (male 398, female 402) valid questionnaires were recovered. A total of 800 elderly subjects as the test group were invited to measure their foot sizes by means of a Footprint Collector (Tong Yuan Tang Health Management Limited, Qingdao in Shandong province). The foot type of the elderly was compared with that of the general adult Chinese population as the control group using the t-test for independent samples.

RESULTS

Hallux valgus (46.9%) and flat foot (50.0%) were the most common foot shape deformities. The most frequent foot diseases were foot scaling (91.2%) and calluses (96.3%). The medial width of the first metatarsal-toe joint of the elderly was significantly higher (elderly female, 44.95±4.86mm; elderly male, 48.55±4.94mm) than that of the general adult population (adult female, 40.18±3.43mm; adult male, 43.22±3.20mm) (p<0.01).

CONCLUSION

The foot length of the elderly was not significantly different from that of the general adult Chinese population. The width of the first metatarsal-toe joint in the forefoot of the elderly was significantly higher than that of the general adult Chinese population, which was consistent with the result that a high proportion of elderly subjects presented hallux valgus.

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

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

Clinical and Functional Characteristics of People With Chronic and Recent-Onset Plantar Heel Pain

BACKGROUND

Plantar heel pain is a common condition that reduces health-related quality of life. Recovery usually occurs within 12 months; however, up to 20% of people remain symptomatic beyond this time frame. The level of pain and function in this chronic heel pain group is not well described.

OBJECTIVE

To identify clinical and functional characteristics associated with chronic plantar heel pain compared with heel pain of recent onset.

DESIGN

Cross-sectional study.

SETTING

University research laboratory and private physiotherapy clinic.

PARTICIPANTS

A total of 71 people with plantar heel pain for longer than 12 months and 64 people with plantar heel pain for less than 6 months were recruited from the general public.

METHODS

Functional characteristics of participants in both heel pain groups were assessed with a variety of clinical measures and the Foot Health Status Questionnaire. Clinical measures included body mass index, foot and ankle muscle strength using hand-held dynamometry, as well as ankle and first metatarsophalangeal joint range of motion. The Foot Health Status Questionnaire was used to collect self-reported measures of foot pain severity, foot function and physical activity.

MAIN OUTCOME MEASUREMENTS

Univariate analyses of variance were performed to detect differences between the 2 groups for each of the variables measured.

RESULTS

The chronic heel pain group exhibited reduced ankle dorsiflexor and toe flexor strength yet better self-reported foot function. There was no difference between groups for body mass index, ankle and first metatarsophalangeal joint range of motion, inversion strength, eversion strength, calf endurance, self-reported foot pain, and physical activity.

CONCLUSIONS

Chronic plantar heel pain is associated with selective weakness of foot and ankle muscle groups but less affected foot function compared with heel pain of recent onset. Those with chronic symptoms may moderate or make adaptations to their daily activities, or simply accept their condition, enabling more effective coping. Strength deficits, although possibly a cause or consequence of chronic symptoms, suggest a need to include resistance exercise in the management of plantar heel pain.

LEVEL OF EVIDENCE

IV.

Relationship between foot pain, muscle strength and size: a systematic review

BACKGROUND

Foot pain is common and disabling and thought to be associated with muscle weakness. Understanding the relationship between pain and weakness may help identify effective treatment targets.

OBJECTIVES

To conduct a systematic review to evaluate the relationship between foot pain and foot muscle weakness, or muscle size as a proxy for weakness.

DATA SOURCES

Electronic databases and reference lists were searched for all years to April 2015.

ELIGIBILITY CRITERIA

Full-text articles were retrieved based on the question 'Does the study evaluate an association between foot pain and foot muscle weakness or size?'

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened eligible studies, extracted data and completed a methodological rating.

RESULTS

Eight studies were identified evaluating the relationship between foot pain and foot muscle strength (n=6) or size (n=2). Four studies reported a significant relationship between pain and toe flexor force. One study reported a significant relationship between heel pain and reduced forefoot muscle size. One study reported an inconsistent association depending on measurement technique. One study reported no association between pain and hindfoot muscle size. One study reported no association between low to moderate pain and toe flexion force.

LIMITATIONS

Due to data heterogeneity, no data were pooled for meta-analysis.

CONCLUSION

There is evidence of a significant association between foot pain and muscle weakness when foot pain is of high intensity and primarily measured by toe flexion force. However there is inconsistent evidence that lower intensity foot pain is associated with other measures of foot muscle weakness or size. Systematic Research Registry ID reviewregistry166.

Treatment of Progressive First Metatarsophalangeal Hallux Valgus Deformity: A Biomechanically Based Muscle-Strengthening Approach

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.

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

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