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Oztarsu MB, Oksuz S. Comparison of the effects of progressive supervised and home program exercise therapy in mild-moderate hallux valgus. J Comp Eff Res 2023; 12:e220091. [PMID: 36651612 PMCID: PMC10288957 DOI: 10.2217/cer-2022-0091] [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: 05/18/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023] Open
Abstract
Aim: To compare the effects of progressive exercise therapy, performed under the supervision of a physiotherapist and given as a home program in individuals with hallux valgus. Methods: Participants were randomly divided into two groups. While one group performed the exercises under the supervision of a physiotherapist, the other group did the same program at home. Results: The amount of decrease in foot adduction angle, pain level while walking, and right foot navicular height of individuals receiving treatment under the supervision of a physiotherapist were significantly higher. Conclusion: The exercise program applied under the supervision of a physiotherapist was more effective in reducing the first toe adduction angle, medial longitudinal arc height, and pain, improving dynamic balance and functional capacity.
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Affiliation(s)
- Merve Betul Oztarsu
- Department of Physiotherapy & Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, North Cyprus via Mersin 10, Famagusta, 99628, Turkey
| | - Sevim Oksuz
- Department of Physiotherapy & Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, North Cyprus via Mersin 10, Famagusta, 99628, Turkey
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Baravarian B, DiDomenico LA, Volteau M, Armstrong DG, Silva R. Exploring the Relationship Between Clinical Presentation in Hallux Valgus and Response to AbobotulinumtoxinA Treatment. J Foot Ankle Surg 2023; 62:556-562. [PMID: 36804286 DOI: 10.1053/j.jfas.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023]
Abstract
The relationship between pain/disability and angular deviation of the hallux valgus (HV), and the impact of orthotic use, laterality, and pain variability on treatment outcomes remain unclear. This was explored in post hoc analyses of a placebo-controlled trial of abobotulinumtoxinA (aboBoNT-A; Dysport®) for HV-associated pain (NCT03569098). The primary endpoint was not met in this study (change from baseline Numeric Pain Rating Scale [NPRS] score vs placebo at week 8); however, there was a greater reduction from baseline in mean NPRS score at week 12 with aboBoNT-A 500U versus placebo (p = .06). Adults with painful HV without surgery were randomized (1:1:1) to aboBoNT-A 300U, aboBoNT-A 500U, or placebo. NPRS was completed for 7 days before baseline and weeks 4, 8, and 12. Over-the-counter orthoses were permitted. Participants (N = 186) had a mean [standard deviation, SD] age of 48.2 [13.1] years, 18% (33/186) used orthotics, and 67% (124/186) had bilateral HV. No associations between baseline pain severity and angular deviation were identified. Participants with high pain variability at baseline (SD > 2) had a poorer response to aboBoNT-A treatment than those with less variability. In conclusion, no relationship between HV-related pain/disability and angular deviation was observed. PLAIN LANGUAGE SUMMARY: A bunion (medical term: hallux valgus) is a common adult foot problem in which the big toe points inward toward the other toes, and this can be painful. How much the big toe points inward (how deformed the foot is) has been linked to the amount of pain the patient experiences. A better understanding of this foot deformity and bunion pain will help doctors and patients to make the right treatment decisions. A study was completed looking at how injections of a type of botulinum toxin (abobotulinumtoxinA) into specific muscles in the foot may help to reduce bunion pain in patients without surgery. This subsequent analysis of the study data looked at the amount of foot deformity in patients, the bunion pain they experienced, and which factors affected how well abobotulinumtoxinA worked to reduce bunion pain. The results of this study showed that the amount of foot deformity was not linked to the level of bunion pain. When deciding the best treatment option to relieve bunion pain, it is important that doctors not only consider how deformed the foot is, but also other important factors such as foot pain levels.
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Affiliation(s)
| | | | | | - David G Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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3
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Wang C, Li C, Zhang R, Li Z, Zhang H, Zhang Y, Liu S, Chi X, Zhao R. Identification of radiographic characteristics associated with pain in hallux valgus patients: A preliminary machine learning study. Front Public Health 2022; 10:943026. [PMID: 36033742 PMCID: PMC9399654 DOI: 10.3389/fpubh.2022.943026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/22/2022] [Indexed: 01/21/2023] Open
Abstract
Objective To investigate the association between the structural deformity and foot pain in hallux valgus (HV) patients using a multi-variate pattern analysis (MVPA) approach. Methods Plain radiographic metrics were calculated from 36 painful and 36 pain-free HV feet. In analysis 1, univariate analyses were performed to investigate the clinical and radiographic differences between painful and pain-free HV. In analysis 2, we investigated the pattern differences for radiographic metrics between these two groups using a MVPA approach utilizing a support vector machine. In analysis 3, sequential backward selection and exhaustive search were performed as a feature-selection procedure to identify an optimal feature subtype. In analysis 4, hierarchical clustering analysis was used to identify the optimal radiographic HV subtype associated with pain in HV. Results We found that: (1) relative to feet with pain-free HV, the painful ones exhibited a higher hallux valgus angle, i.e., the magnitude of distal metatarsal and phalangeal deviation; (2) painful HV could be accurately differentiated from pain-free HV via MVPA. Using sequential backward selection and exhaustive search, a 5-feature subset was identified with optimal performance for classifying HV as either painful or pain-free; and (3) by applying hierarchical clustering analysis, a radiographic subtype with an 80% pain incidence was identified. Conclusion The pain in HV is multifactorial and associated with a radiographic pattern measured by various angles on plain radiographs. The combination of hallux valgus angle, inter-phalangeal angle, distal metatarsal articular angle, metatarsal cuneiform angle and metatarsal protrusion distance showed the optimal classification performance between painful and pain-free HV.
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Affiliation(s)
- ChenGuang Wang
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China,ChenGuang Wang
| | - Chao Li
- Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Rui Zhang
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - ZhiJun Li
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - HuaFeng Zhang
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Zhang
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Shen Liu
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - XiaoYue Chi
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China,*Correspondence: Rui Zhao
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Żłobiński T, Stolecka-Warzecha A, Hartman-Petrycka M, Błońska-Fajfrowska B. The Influence of Short-Term Kinesiology Taping on Foot Anthropometry and Pain in Patients Suffering from Hallux Valgus. ACTA ACUST UNITED AC 2021; 57:medicina57040313. [PMID: 33810238 PMCID: PMC8066713 DOI: 10.3390/medicina57040313] [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: 03/02/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Hallux valgus, one of the most common foot disorders, contributes to the formation of pain, changes foot proportions and hinders everyday functioning. In this study we wanted to verify if kinesiology taping improves hallux valgus and affects the position as well as reducing pain. Materials and Methods: Forty feet with hallux valgus were examined and the parameters were measured at three stages: before the kinesiology taping was applied, just after its application and after a month of use. Measurements were taken with a 3D scanner and a baropodometric platform. Results: When taping was applied, the hallux valgus angle decreased statistically significantly compared with pre-taping (p < 0.01). The use of taping for a month significantly reduced this angle compared with pre-taping (p < 0.05). Parameters such as foot length, the surface of the hindfoot and forefoot and hindfoot pressure on the ground changed. A change in the hallux position due to the taping produced significant changes in the perception of pain (p < 0.001). Conclusion: Kinesiology taping acts on the hallux valgus and foot position mechanically. This makes kinesiology taping an effective method of conservative treatment for patients who are not qualified for surgery.
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Iliou K, Paraskevas GK, Kanavaros P, Barbouti A, Kitsouli A, Gekas C, Kitsoulis P. Correlation of the Hallux Sesamoids' Orientation with Various Anatomical Parameters in Patients with Hallux Valgus Deformity. Cureus 2019; 11:e4643. [PMID: 31312569 PMCID: PMC6624160 DOI: 10.7759/cureus.4643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction An awareness of the anatomical parameters of the foot such as the position and orientation of the sesamoid bones can be of great value for the etiology and diagnostic approach to patients with hallux valgus (HV). The purpose of this study was to evaluate the basic anatomical features and measurements related to the characteristics of HV in cadaveric material. Materials and methods The study sample included 12 cadaveric limbs with HV and 10 cadaveric limbs without HV as a control group. We measured the HV angle (HVA), the first to second intermetatarsal angle (IMA), and the first to fifth IMAs of all samples. We also recorded the shape of the first metatarsal head and the position/orientation of the sesamoid bones. Results The mean values of the HVA (p = 0.000), the first to second IMA (p = 0.000), and the first to fifth IMA (p = 0.000) differed between the HV and non-HV group. The position of the sesamoid ossicles between the HV and the non-HV group was statistically significant (p = 0.001). While we noted the round shape of the first metatarsal head was predominant in HV samples, we found no statistically significant difference in the first metatarsal head shape between the test and control groups. Conclusion The HVA, the first to second IMA, the first to fifth IMA, and the orientation of the sesamoid ossicles differed significantly between cadaveric samples with HV and those without HV.
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Affiliation(s)
- Kalliopi Iliou
- Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | | | | | | | | - Christos Gekas
- Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Nakai K, Zeidan H, Suzuki Y, Kajiwara Y, Shimoura K, Tatsumi M, Nishida Y, Bitoh T, Yoshimi S, Aoyama T. Relationship between forefoot structure, including the transverse arch, and forefoot pain in patients with hallux valgus. J Phys Ther Sci 2019; 31:202-205. [PMID: 30858663 PMCID: PMC6382484 DOI: 10.1589/jpts.31.202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/19/2018] [Indexed: 12/19/2022] Open
Abstract
[Purpose] Hallux valgus occurs in the forefoot where the transverse arch is located and
may be a factor involved in forefoot pain. The relationship between forefoot pain and
forefoot structure is unknown. This study aimed to analyze the relationship between
forefoot pain and the transverse arch in patients with hallux valgus. [Participants and
Methods] In this study, 122 (197 feet) adult females (46 to 86 years old) with hallux
valgus were studied. By using questionnaires, the females were divided into two groups
depending on whether or not they had forefoot pain (a group with forefoot pain [P group]
and a group without forefoot pain [NP group]). The hallux valgus angle was measured using
a goniometer, and the transverse arch was measured using a weight-bearing plantar
ultrasonography imaging device. The transverse arch measurements included the transverse
arch height and length. [Results] Only the transverse arch length, even after adjustment,
was significantly greater in the P group. No significant difference was found between the
hallux valgus angle and the transverse arch height. [Conclusion] The greater transverse
arch length in the P group was possibly due to the collapsing transverse arch support
muscles. Increased width probably caused inadequate impact absorption which in turn led to
forefoot pain.
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Affiliation(s)
- Kengo Nakai
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hala Zeidan
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yusuke Suzuki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yuu Kajiwara
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kanako Shimoura
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masataka Tatsumi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yuichi Nishida
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tsubasa Bitoh
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Soyoka Yoshimi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University: 53 Kawahara-cho Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Martin KD, Van Buren JP, Wake J, Dawson L. Comparison of Visual Analog Pain Score Reported to Physician vs Nurse. Foot Ankle Int 2018; 39:300-303. [PMID: 29160755 DOI: 10.1177/1071100717740584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The visual analog scale (VAS) is considered a reliable and validated measure of patient-reported acute pain. Patient-reported outcome measures are becoming the standard of care throughout the orthopedic community, but interpretation and clinical applications are still under investigation. The aim of the current study was to compare preoperative patient-reported VAS scores reported at the same visit to nursing staff and the treating surgeon. Our hypothesis was that there would be no difference in the scores reported. METHODS This study is a retrospective cohort of 201 consecutive foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal VAS 0 to 10, from "no pain" to the "worst pain." Differences in reported pain values were analyzed. RESULTS The results demonstrate that patients reported higher pain scores to the surgeon in 81% of the encounters, nursing staff 8%, and equal 11%. On average, the VAS score reported to the surgeon was significantly ( P < .05) higher than that reported to the nursing staff. CONCLUSION The current study found a statistically significant higher patient-reported pain score to the treating surgeon compared to the nursing staff. While the exact cause is unclear, the discrepant pain scores call into question the validity of the VAS, considered a fifth vital sign and standard outcome measure in an outpatient clinic setting. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
| | - J Preston Van Buren
- 2 Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Jeffrey Wake
- 2 Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
| | - Laura Dawson
- 3 Keller Army Community Hospital, West Point, NY, USA
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Barnes A, Sullivan J, Pappas E, Adams R, Burns J. Clinical and Functional Characteristics of People With Chronic and Recent-Onset Plantar Heel Pain. PM R 2017; 9:1128-1134. [PMID: 28461226 DOI: 10.1016/j.pmrj.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 04/04/2017] [Accepted: 04/08/2017] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Allegra Barnes
- Physiotherapy Department, Royal North Shore Hospital, New South Wales, Australia(∗)
| | - Justin Sullivan
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia 1825(†).
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, New South Wales; Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, New South Wales, Australia(‡)
| | - Roger Adams
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, New South Wales, Australia(§)
| | - Joshua Burns
- Sydney Children's Hospitals Network (Randwick and Westmead), University of Sydney, New South Wales, Australia(¶)
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Lobo CC, Marín AG, Sanz DR, López DL, López PP, Morales CR, Corbalán IS. Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus: A case-control study. Medicine (Baltimore) 2016; 95:e5243. [PMID: 27828846 PMCID: PMC5106052 DOI: 10.1097/md.0000000000005243] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (α = 0.05). Consequently, statistically significant differences were observed between the groups (P < 0.05) for the AbH and FHB thickness, and CSA reduction, and also the plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (P ≥ 0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV.
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Affiliation(s)
- César Calvo Lobo
- Physiotherapy Department, Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid CARMASALUD Clinical and Research Center Physiotherapy Department, Faculty of Health, Exercise and Sport, European University of Madrid, Villaviciosa de Odón Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña Department of Podiatry, University Center of Plasencia, Universidad de Extremadura, Spain School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
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