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Hallux valgus and foot strengthening

Discussion in 'Biomechanics, Sports and Foot orthoses' started by scotfoot, Jul 2, 2022.

  1. scotfoot

    scotfoot Well-Known Member


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    Very encouraging to see this publication . The strengthening exercises being used are the ones that Mickle et al found to be effective for foot strengthening in older patients and include moving the toes around the MTPJ against progressive resistance.

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

    Abstract

    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.
     
  2. scotfoot

    scotfoot Well-Known Member

    Mickle et al 2016 looked at the strengthening effects of progressive resistance exercises on toe flexor strength verses a home exercise program.

    The progressive resistance exercises worked, the home exercises did not. Presumably that is why La Trobe have chosen Mickles progressive resistance exercises for their trial into Hallux Valgus.

    Here is a run down of the home exercises that Mickle found did NOT work for older subjects.

    "The home-exercise group (Home group) received a booklet containing a series of eight general foot exercises that had little or no resistance and did not progress in ACCEPTED MANUSCRIPT ACCEPTED MANUSCRIPT 8 amount of resistance. The warm-up consisted of ankle rotations, calf raises and toe raises, and the cool down consisted of rolling a golf ball underneath each foot for 2 minutes. They then performed a prescribed number of repetitions of toe squeezes, toe pulls, marble pickups and towel pulls as suggested by Frey 15 and the Short Foot exercise 11, three times per week. "

    Here is a YouTube video of the type of exercises that did work .


    .
     
  3. scotfoot

    scotfoot Well-Known Member

    Calf raises ; do they usefully strengthen the intrinsic foot muscles?

    Well, calf raises were used by Mickle et al 2016, as a warmup exercise 3 times a week for the duration of the trial period and these, along with "toe squeezes, toe pulls, marble pickups and towel pulls" ,did not significantly strengthen the feet .

    A recurring misconception amongst those studying and advising on the foot is that the toe flexor component of intrinsic toe flexors is not significant in foot biomechanics .This is just plain wrong.

    If you want to strengthen these muscles, flex the toes .
     
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