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

The Effect of Short-Term Kinesiology Taping on Neuromuscular Controls in Hallux Valgus During Gait: A Study of Muscle and Kinematic Synergy

To investigate the biomechanical mechanisms underlying the pathogenesis and explore the effects of kinesiology taping (KT) on neuromuscular control in HV patients. The study population consisted of 16 young controls (YC group) and 15 patients with hallux valgus (HV group). All subjects underwent a natural velocity gait assessment. Additionally, 11 patients from the HV group received KT intervention over a period of one month, consisting of 15 sessions administered every other day. After the one-month intervention, these patients underwent a gait assessment and were included in the HV-KT group. The electromyography (EMG) and joint motion were evaluated using non-negative matrix factorization (NNMF) to compare the difference in muscle and kinematic synergy among the three groups. The center of plantar pressure (COP) and ground reaction force (GRF) were measured by the force platform. The number of synergies did not differ within the three groups, but the structure of muscle synergies and kinematic synergies differed in the HV group. The KT intervention (HV-KT group) altered the structure of synergies. The correlation between kinematic synergies and muscular synergies was lower in the HV group than in the YC group, whereas the correlation between the two increased after the KT intervention in the HV group. During gait, the HV group tended to activate more muscles around foot joints to maintain body stability. The visual analogue scale (VAS) scores, hallux valgus angle (HVA), and COP were significantly decreased after the intervention ( [Formula: see text]). HV patients exhibited altered kinematic and muscular synergies structures as well as muscle activation. Also, it weakened the balance and athletic ability of HV patients. KT intervention improved neuromuscular control to provide a better gait performance.

Biokinetic Evaluation of Hallux Valgus during Gait: A Systematic Review

BACKGROUND

Foot pathologies can affect the kinetic chain during gait, leading to altered loading at other joints that can lead to subsequent pathologies. Although hallux valgus is the most common foot disease, little has been discussed about the biokinetic effects of hallux valgus on the foot and lower limb. This systematic review evaluated the kinematic, kinetic, and pedobarographic changes of the hallux valgus foot compared to a healthy one.

METHODS

Several electronic databases were searched up to January 2022, including only cross-sectional studies with clearly defined isolated hallux valgus diseases and healthy groups. Two investigators independently rated studies for methodological quality using the NIH Study Quality Assessment Tool for cross-sectional studies. Kinetic data were extracted, including temporal data, kinematics of the foot joint, kinematics of the proximal lower limb, and pedobarography. We did meta-analyses tests with a random effects model using the metafor package in R.

RESULTS

Hallux valgus patients walk slower compared to a disease-free control group -0.16 m/s (95% CI -0.27, -0.05). Hallux valgus patients exhibited significantly reduced coronal plane motion of the hindfoot-shank during preswing 1.16 degrees (95% CI 0.31, 2.00). Hallux valgus patients generated less force in the hallux region 33.48 N (95% CI 8.62, 58.35) but similar peak pressures in the hallux compared to controls. Hallux valgus patients generated less peak pressure at the medial and lateral hindfoot as compared to controls: 8.28 kPa (95% CI 2.92, 13.64) and 8.54 kPa (95% CI 3.55, 13.52), respectively.

CONCLUSION

Although hallux valgus is a deformity of the forefoot, the kinematic changes due to the pathology are associated with significant changes in the range of motion at other joints, underscoring its importance in the kinetic chain. This is demonstrated again with the changes of peak pressure. Nevertheless, more high-quality studies are still needed to develop a fuller understanding of this pathology.

Establishment and Validation of a Predictive Nomogram for Hallux Valgus with Pain Under the Second Metatarsal

Objective

To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux valgus complicated with pain under the second metatarsal based on risk factors.

Methods

A total of 545 patients with hallux valgus who were admitted to our hospital were divided randomly into a training set and a validation set. The demographic characteristics, imaging indices and gait test indices of the patients were collected. The risk factors were identified by univariate and multivariate logistic regression analyses. A risk prediction model for hallux valgus with pain under the second metatarsal was established, and the area under the curve (AUC) of the receiver operating characteristic and a decision curve analysis were used for verification and identification. The value of the model was tested in the verification group.

Results

Second metatarsal length, second metatarsal peak pressure, hallux valgus angle (HVA), intermetatarsal angle 1–2 (IMA1–2) and weight were the risk factors for hallux valgus complicated with pain under the second metatarsal. Based on the weighting of these seven risk factors, a prediction model was established. The AUC of the prediction model was 0.84 (95% confidence interval [CI]: 0.802~0.898, P < 0.05), and the results of a Hosmer–Lemeshow test showed a good degree of calibration (χ² = 10.62, P > 0.05). The internal validation of the AUC was 0.83 (95% CI: 0.737–0.885, P < 0.05). The model had obvious net benefits when the threshold probability was 10%–70%.

Conclusion

Second metatarsal length, second metatarsal peak pressure, HVA, IMA1–2 and weight were the risk factors for hallux valgus combined with second metatarsal pain. The risk prediction model for hallux valgus complicated with pain under the second metatarsal based on these seven variables was proven effective.

Level of Evidence

Level III, retrospective comparative study.