Gait in hallux valgus

NewsBot · Jul 5, 2013

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An Image-Based Gait Simulation Study of Tarsal Kinematics in Women With Hallux Valgus.
Glasoe WM, Phadke V, Pena FA, Nuckley DJ, Ludewig PM.
Phys Ther. 2013 Jul 3

BACKGROUND:
Although not well-understood, foot kinematics are changed with hallux valgus.
OBJECTIVE:
The purpose of this study was to examine tarsal kinematics in females with hallux valgus deformity.
DESIGN:
A prospective, cross-sectional design was used.
METHODS:
Twenty females with (N = 10) and without (N = 10) deformity participated. Data were acquired using a magnetic resonance (MR) scanner. Subjects were posed standing to simulate gait, with images reconstructed into virtual bone datasets. Measures taken described foot posture (hallux angle, intermetatarsal angle, arch angle). Then, using additional computer processes, the image sequence was registered across gait conditions to compute relative tarsal position angles, first ray angles and helical axis parameters decomposed into X, Y, Z, components. An ANOVA model compared kinematics between groups and across conditions. Multiple regression analysis assessed the relationship of arch angle, navicular position, and inclination of the first ray axis.
RESULTS:
Both the hallux and intermetatarsal angles were larger (P < 0.01) with deformity; arch angle was not different between groups. The calcaneus was everted (P < 0.05) by ≥ 6.6°, and the first ray adducted (44.17, P < 0.001) by ≥ 9.3° across conditions with deformity. There was an interaction (F = 5.06, P = 0.037) for the first ray axis. Follow-up comparisons detected increased inclination of the first ray axis over middle stance compared to late stance in the group with deformity.
LIMITATIONS:
Gait was simulated; kinetics were not measured; sample size was small.
CONCLUSIONS:
There were group differences. Eversion of the calcaneus and adduction of the first ray were increased, and the first ray axis was inclined 24° over middle stance in females with deformity compared to 6° in controls. Results may identify risk factors of hallux valgus and inform non-operative treatment (orthoses; exercise) strategies.
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Admin2 · Jul 6, 2013

Related Threads:
Lower Extremity Alignment and Hallux Valgus
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NewsBot · Jun 7, 2014

Functional impairments characterising mild, moderate and severe hallux valgus.
Hurn SE, Vicenzino B, Smith MD.
Arthritis Care Res (Hoboken). 2014 Jun 6

Objective: Hallux valgus has been linked to functional disability and increased falls risk, but mechanisms underpinning functional disability are unclear. This study investigated functional performance, muscle strength and plantar pressures in adults with mild, moderate, and severe HV compared to controls, while considering the influence of foot pain.

Methods: Sixty adults with hallux valgus (classified as mild, moderate and severe on dorsalplantar radiographs) and 30 controls participated. Measures included: hallux plantarflexion and abduction strength, walking performance, postural sway and forefoot plantar pressures. Multiple analysis of covariance and pairwise comparisons (p<0.05, Bonferroni adjustment) were used to investigate differences between groups, adjusting for age, sex, body mass index and foot pain.

Results: Hallux plantarflexion and abduction strength was significantly reduced in those with moderate (mean differences: plantarflexion -45.8N, abduction -12.3N, p<0.001) and severe hallux valgus (plantarflexion -50.1N, p<0.001; abduction -11.2N, p=0.01) compared to controls. A significant reduction in hallux peak pressure and pressure-time integral was evident in moderate (peak pressure -90.8kPa, p<0.001) and severe hallux valgus (peak pressure -106.2kPa, p<0.001) compared to controls. Those with severe hallux valgus also demonstrated increased mediolateral postural sway in single leg stance compared to controls (3.5cm, p=0.01).

Conclusion: Moderate to severe hallux valgus is associated with reduced hallux plantar pressures and strength measures, while relatively normal function compared to controls was found in those with mild deformity. Greater understanding of specific functional deficits associated with different stages of hallux valgus will help inform clinical management and future research.
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NewsBot · Aug 16, 2014

Plantar pressure characteristics in hallux valgus feet
Ulrich Koller, Madeleine Willegger, Reinhard Windhager, Axel Wanivenhaus, Hans-Joerg Trnka andReinhard Schuh
Journal of Orthopaedic Research

Due to the pathoanatomical changes in hallux valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the hallux is decreased during push-off. We assessed loading parameters in hallux valgus feet. Based on dorsal-plantar weight bearing radiographs of 61 feet, the intermetatarsal-, hallux valgus-, distal metatarsal articulation-angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed® system during level walking. We found negative correlations between hallux valgus angle and peak pressure in the great toe (r = −0.301, p < 0.023), the maximum force of the hallux (r = −0.481, p < 0.001), and contact time of the great toe (r = −0.448, p < 0.001), and positive correlations for force time integral (r = 0.348, p < 0.001), contact area (r = 0.307, p < 0.020), maximum force (r = 0.430, p < 0.001), and peak pressure (r = 0.361, p < 0.006) of the fifth metatarsal head. A positive correlation between the sesamoid and the metatarsal subluxation regarding maximum force (r = 0.294, p < 0.034), and a negative correlation between the contact area of the hallux (r = −0.232, p < 0.020) was shown. Depending on the severity, hallux valgus angle, and sesamoid subluxation, load shows significant lateral transmission in hallux valgus feet
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NewsBot · Jan 25, 2015

Comparison of Static and Dynamic Balance in Female Athletes with and
without Hallux Valgus
Haniyeh Aryadoost, Mohammad Hosain Alizadeh
International Journal of Sport Studies. Vol., 4 (12), 1473-1478, 2014

Hallux valgus (HV) which is defined by the medial deviation of the first metatarsal
and the lateral deviation of the proximal phalanges is a common condition in
women that may lead to a considerable pain and disability. There is evidence that
HV may impair balance, though it is yet unknown how HV affects balance and big
toe pain in athletes. The purposes of this study were to compare static and dynamic
balance in female athletes with and without HV and examine the correlation
between the big toe pain and the level of deformity. Thirty female athlete students
from the Faculty of Physical Education and Sport Sciences of Tehran University
with average age 21.13±2. 01 years and average body mass index 21. 07±1. 71
were selected and categorized based on HV angle into two groups: group1
including 15 athletes with normal foot, with HV mean angle of 13. 26±1. 38 and
Group 2 including 15 athletes with HV mean angle of 20. 93±4. 47. For measuring
the samples’ HV angle a goniametre and a self-assessment tool called Manchester
scale were used. The unilateral forefoot balance test as the static test and the Y
balance test as the dynamic test were done in groups and the results were compared
by independent t-test. The visual analogue scale also was used to assess the
severity of pain in HV group. All the tests were done using the SPSS computer
package version 17.
Results: The results showed no significant difference in
dynamic and static balance between two groups (P>0.05), and no significant
correlation between big toe pain and the severity of the condition in athletes with
HV (P>0.05).
Conclusions: This study showed that HV does not affect static and
dynamic balance in female athletes and it does not cause the big toe pain
significantly.
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NewsBot · Mar 25, 2015

Relationship between pedographic analysis and the Manchester scale in hallux valgus.
Iliou K, Paraskevas G, Kanavaros P, Gekas C, Barbouti A, Kitsoulis P
Acta Orthop Traumatol Turc. 2015;49(1):75-79. doi: 10.3944/AOTT.2015.14.0012.

OBJECTIVE:
The aim of this study was to evaluate the correlation between the Manchester scale and foot pressure distribution in patients with hallux valgus deformity.
METHODS:
The study included 152 feet of 87 patients with hallux valgus and a control group of 391 feet of 241 individuals without hallux valgus deformity. The severity of hallux valgus was determined using the Manchester scale grading system. Plantar loading patterns in 10 foot areas were determined for all participants.
RESULTS:
According to the Manchester scale, 72% of the participants had no, 12.9% mild, 10.7% moderate and 4.4% severe deformity. The Manchester scale grade was highly correlated with both hallux valgus angle and first intermetatarsal angle (p=0.00). Significant differences between the four grades were present for mean pressure under the hallux and the first and second metatarsal heads only (p=0.00). The load distribution under these areas was higher as the hallux valgus progressed from mild to more severe. In all groups, the highest pressure was observed under the second metatarsal head.
CONCLUSION:
The Manchester scale was strongly associated with both the hallux valgus angle and the first intermetatarsal angle. The progression from mild to moderate and severe deformation is associated with peak pressure raise at the hallux, first and second metatarsal heads. The Manchester scale appears to be a useful tool to provide information for the degree of deformity and the pressure under painful foot areas.
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NewsBot · Mar 28, 2015

Characterization of gait in female patients with moderate to severe hallux valgus deformity
S. Chopra, K. Moerenhout, X. Crevoisier
Clinical Biomechanics; In Press

Highlights
•Halllux kinematic in moderate to severe hallux valgus
•Plantar pressure in moderate to severe hallux valgus deformity
•Altered inner stance events in moderate to severe hallux valgus
•Gait variability in moderate to severe hallux valgus deformity
•Nine gait parameters have potential to describe gait in hallux valgus deformity
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Background
: Hallux valgus is one of the most common forefoot problems in females. Studies have looked at gait alterations due to hallux valgus deformity, assessing temporal, kinematic or plantar pressure parameters individually. The present study, however, aims to assess all listed parameters at once and to isolate the most clinically relevant gait parameters for moderate to severe hallux valgus deformity with the intent of improving post-operative patient prognosis and rehabilitation.

Methods
: The study included 26 feet with moderate to severe hallux valgus deformity and 30 feet with no sign of hallux valgus in female participants. Initially, weight bearing radiographs and foot and ankle clinical scores were assessed. Gait assessment was then performed utilizing pressure insoles (PEDAR®) and inertial sensors (Physilog®) and the two groups were compared using a non-parameteric statistical hypothesis test (Wilcoxon rank sum, p<0.05). Furthermore, forward stepwise regression was used to reduce the number of gait parameters to the most clinically relevant and correlation of these parameters was assessed with the clinical score.

Findings
: Overall, the results showed clear deterioration in several gait parameters in the hallux valgus group compared to controls and 9 gait parameters (effect size between 1.03 – 1.76) were successfully isolated to best describe the altered gait in hallux valgus deformity (r2=0.71) as well as showed good correlation with clinical scores.

Interpretation
: Our results, and nine listed parameters, could serve as benchmark for characterization of hallux valgus and objective evaluation of treatment efficacy.
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NewsBot · Jul 16, 2015

Mild hallux valgus angle affects single-limb postural stability in asymptomatic subjects
Çinar-Medeni, Özge | Atalay Guzel, Nevin | Basar, Selda
Journal of Back and Musculoskeletal Rehabilitation, vol. Preprint, no. Preprint, 2015, pp. 1-5

BACKGROUND: Single-limb postural stability is a key component of lower extremity functional status. Factors affecting postural stability should be well defined to prevent injuries. OBJECTIVE: The aim of this study was to investigate the effect of the hallux valgus angle on postural stability in asymptomatic subjects. METHODS: A total of 19 subjects were included in the study. The hallux valgus angle and postural stability were assessed. Participants were assigned to two groups according to whether the hallux valgus angle was pathological or not. A hallux valgus angle greater than 15 degrees was accepted as pathological. The relationship between the hallux valgus angle and postural stability, and the differences in postural stability scores between the two groups were analyzed. Postural stability was assessed with a stabilometer. The test was performed with the eyes open. RESULTS: We found a significant correlation between the hallux valgus angle and mediolateral and overall stability index (r= 0.484, p= 0.036; r = 0.463, p= 0.046 respectively). Subjects with a pathological mild hallux valgus angle had greater stability index scores than normal subjects (p< 0.05). CONCLUSIONS: A mild hallux valgus angle has negative effects on postural stability as a forefoot deformity. This deformity should be taken into account for injury prevention strategies in pain-free younger adults.
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NewsBot · Oct 13, 2016

Gait Analysis of Patients Suffering From Hallux Valgus
Naoya Ito, MD et al
Foot & Ankle Orthopaedics September 2016 – December 2016 vol. 1 no. 1

Introduction/Purpose: Hallux valgus that is defined as HVA (hallux valgus angle) >20 is one of the most common forefoot problems and can lead to alterations of the plantar pressure pattern. In addition, it can cause clinically gait alterations. Hence, we investigated the plantar pressure pattern and the gait-related factors using the gait analyzer. The purpose of this study was to examine the relationship between gait alterations or motor function and hallux valgus deformity.
Methods: In 2009, we examined 309 inhabitants (male, 105; female, 204; age, >65 years) of Miyagawa village in Mie, Japan and compared the plantar pressure pattern between the subjects who has hallux valgus (HVA, >20; n=88) and those who does not have hallux valgus (HVA, < 20; n = 221). Furthermore, we compared gait-related factors among mild group (20< HVA < 30; n=88), moderate group (30< HVA < 40; n=24), and severe group (HVA, >40; n=9). If the right and left hallux valgus varied in severity, we selected severe side. The plantar pressure pattern and the gait-related factors such as stride, step width, foot angle (Figure 1), and gait speed were measured using the gait analyzer (Walk way MW 1000; Anima, Tokyo, Japan). Statistical analyses were performed using t-test, Chi-Square test, or logistic analysis adjusted age, gender and height. P < 0.05 was considered significant.
Results: The average weight and height of hallux valgus group were significantly lower, and age of hallux valgus group were significantly higher than those of normal group. About the plantar pressure pattern, ratio of the subjects in hallux valgus group who can use the hallux ball in toe off were significantly less than those of normal group. However, the gait-related factors were not significantly different between 2 groups. On the other hand, when we compared by severity, step width tended to increase with progression of hallux valgus. Moreover, stride, gait speed, and foot angle of severe group were the lowest among 4 groups (normal, mild, moderate, and severe). Especially stride of severe group was significantly lower than those of other 3 groups.
Conclusion: Mild hallux valgus can cause alterations of the plantar pressure pattern, but didn’t cause motor functional decline. However, when hallux valgus become severe, hallux valgus can cause not only gait alterations but also motor functional decline.
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HansMassage · Oct 18, 2016

I will share my unofficial observational study of many clients over a 20 year period.
When a postural disturbance alters the muscle firing sequence during gate the hallux may fail to exert a ground force against the medial rotation exerted by the plantaris on the heel during lock up of the knee at mid stride resulting in the external rotation of the forefoot at push off.
Conversely failure of the heal to maintain ground force during mid stride also results in the same placement.
My success has been in correcting posture distortion and patient training of maintaining proper ground force during the stride.

NewsBot · Sep 13, 2018

Coordination Among Shank, Rearfoot, Midfoot and Forefoot Kinematic Movement During Gait in Individuals With Hallux Valgus
Wataru Kawakami et al
Journal of Applied Biomechanics Volume: 0 Issue: 0 Pages: 1-23

An important step in the management of hallux valgus is the objective analysis of foot mechanics in dynamic conditions. However, the manner which hallux valgus affects the foot motion is poorly understood. Moreover, hallux valgus deformity may affect foot intersegmental coordination patterns. The purpose of this study was to investigate the relative motion and intersegmental foot coordination patterns, considering the midfoot, during gait in individuals with hallux valgus. Fifteen females with hallux valgus and 13 females without hallux valgus were recruited in this study. Three-dimensional positional data during gait were collected using a motion capture system and analyzed using a multisegment foot model and an analysis software. Intersegmental foot coordination patterns were assessed using a modified vector-coding technique. In individuals with hallux valgus, the rearfoot was significantly more everted throughout stance, and forefoot motion during late stance was significantly increased. In intersegmental coordination patterns, individuals with hallux valgus exhibited excessive mobility of the rearfoot relative to the midfoot segment during midstance and increased anti-phase motion between rearfoot and midfoot segments during late stance. Excessive rearfoot eversion and altered intersegmental coordination patterns between rearfoot and midfoot may decrease the proper rigidity of the foot and lead to forefoot hypermobility during late stance in individuals with hallux valgus.
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NewsBot · Oct 3, 2018

Analysis of Gait and Footprint in Patients with Hallux Valgus
Naoya Ito, MD, Akinobu Nishimura, MD, PhD
AOFAS Annual Meeting 2018 1

Introduction/Purpose: Hallux valgus (HV) is one of the most common forefoot problems. HV is defined as a hallux valgus angle
of more than twenty degrees. HV can lead to alterations of the plantar pressure pattern and clinical gait. This study examined the
relationship between gait alterations and HV deformities.
Methods: We examined 500 residents (161 men and 339 women; >50 years of age) of Miyagawa village in Mie, Japan in 2009,
2011 and 2013. They performed a 6-meter walk test at normal and maximum speed. We examined gait speed, the number of
steps, and footprint between patients with normal (HV angle <20; n=350) and HV (HV angle >20; n=150), and between normalto-mild
(HV angle <30; n=436) and moderate-to-severe (HV angle >30; n=64). Their plantar pressure patterns were measured
using a gait analyzer (Walk Way MW 1000; Anima, Tokyo, Japan, Figure.1). Statistical analyses were performed using the chisquare
test according to sex and use of the hallux ball; the t-test according to age, height, and weight; and logistic regression
analysis adjusted for age, sex, and height according to gait speed and the number of steps. P value less than 0.05 was considered
significant.
Results: With regard to the plantar pressure pattern, the percentage of subjects in the HV group who left a footprint of the
hallux ball was significantly lower than that in the normal group. The percentage of subjects in the moderate-to-severe group who
left a footprint of the hallux ball was even lower. Analysis of the footprint revealed that the HV group used the hallux ball
significantly less during toe-off than the normal group. At both normal and maximum speed, the number of steps and gait speed
did not differ significantly between the normal and HV groups. However, when we compared normal-to-mild and moderate-tosevere
groups, the number of steps in the moderate-to-severe group was significantly greater than in the normal-to-mild group at
maximum walking speed.
Conclusion: Analysis of the footprint revealed that the percentage of subjects in the HV group who was able to use the hallux
ball during toe-off was significantly less than that in the normal group. The percentage of subjects in the moderate-to-severe group
who could use the hallux ball in toe-off was even lower. HV can cause footprint alterations. Moderate-to-severe HV can cause not
only footprint alterations but also gait alterations, especially when walking at maximum speed.
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NewsBot · Mar 19, 2019

Lower Limb Loading Character of Hallux Valgus Group Based on Detailing Medical Imaging Control
Ge, Hui
Journal of Medical Imaging and Health Informatics, Volume 9, Number 3, March 2019, pp. 589-593(5)

The purpose of this study was to compare the kinematics and plantar pressure of the lower extremity joints between normal group and mild hallux valgus group based on detailing medical imaging control. 10 healthy females (control group, CO) and 10 females with mild hallux valgus (hallux valgus group, HV) were included in this study. Based on Computed Tomography (CT) imaging to measure the hallux valgus angle (HVA). The bone reconstruction was through Mimics software based on CT images. The hallux valgus group in this study was defined in this range of 15° < HVA < 20°, and the control group was defined in this range of HVA ≤ 15°. Compared to CO, the hip joint in the frontal plane was found less abduction in HV. The knee joint in the frontal plane was found adducted in HV while abducted in CO. In the transverse plane, hip joint was found external rotated in HV compared to internal rotated in CO. The ankle joint was found more abduction in HV at initial contact during gait cycle. The plantar pressure of HV group was found a lateral excursion in HV group. Which was reflected with higher plantar pressure in other toes, lateral metatarsal and lateral midfoot regions. With the pressure-bearing area of the hallux valgus group moved laterally, a unique foot-ground contact pattern is formed, that is, the lateral aspect of the foot becomes the main support area, and the support mode causes the ankle joint to be in an abducted pattern instantaneously.
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