• 1

    Nugyen US, Hillstrom HJ, Li W, et al. Factors associated with hallux valgus in population-based study of older women and men: the Mobilize Boston Study. Osteoarthritis Cartilage 18: 41, 2010.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Coughlin MJ, Saltzman CI, Nunley JA II: Angular measurements in the evaluation of hallux valgus deformities: a report of the Ad Hoc Committee of the American Orthopedic Foot & Ankle Society on angular measurements. Foot Ankle Int 23: 68, 2002.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Coughlin MJ, Jones CP. Hallux valgus demographics, etiology, and radiographic assessment. Foot Ankle Int 28: 759, 2007.

  • 4

    Schneider W, Knahr K: Surgery for hallux valgus: the expectations of patients and surgeons. Int Orthop 6: 382, 2001.

  • 5

    Roddy E, Zhang W, Doherty M: Prevalence and associations of hallux valgus in a primary care population. Arthritis Care Res 34: 857, 2008.

  • 6

    Mann R, Coughlin M: Hallux valgus etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res 157: 31, 1981.

  • 7

    Myer AJ, Adams MI, Sheridan MJ, et al: Epidemiological aspects of the surgical correction of structural forefoot pathology. Foot Ankle Surg 48: 543, 2009.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Menz HB, Roddy E, Thomas E, Croft PR: Impact of hallux valgus severity on general and foot-specific health-related quality of life. Arthritis Care Res 63: 396, 2011.

    • Search Google Scholar
    • Export Citation
  • 9

    Sammarco GJ, Idusuyi CB: Complications after surgery of the hallux valgus. Clin Orthop Relat Res 391: 59, 2001.

  • 10

    Hoffmeyer P, Cox JN, Blanc Y, et al: Muscles in hallux valgus. Clin Orthop Relat Res 232: 112, 1988.

  • 11

    Teheraninasr A, Saeedi H, Forogh B, et al: Effects of insole with toe separator and night splint on patients with painful hallux valgus: a comparative study. Prosthet Orthot Int 32: 79, 2008.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Nix S, Smith M, Vicenzino B: Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res 27: 3, 2010.

    • Search Google Scholar
    • Export Citation
  • 13

    Plessis M, Zipfel B, Brantingham JW, et al: Manual and manipulative therapy compared to night splint for symptomatic hallux abducto valgus: an exploratory randomized clinical trial. The Foot 21: 71, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Kitaoka HB, Alexander IJ, Adelaar RS, et al: Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15: 34, 1994.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Diamond JE, Muller MJ, Sinacore DR: Reliability of a diabetic foot evaluation. Phys Ther 69: 797, 1989.

  • 16

    Nix S, Vicenzino B, Smith M: Foot pain and functional limitation in healthy adults with hallux valgus: a cross-sectional study. BMC Musculoskelet Disord 13: 197, 1, 2012.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Uritani D, Fukumoto T, Matsumoto D: Intrarater and interrater reliabilities for a toe grip dynamometer. J Phys Ther Sci 24: 639, 2012.

  • 18

    Porter D, Barrill E, Oneacre K, et al: The effects of duration and frequency of Achilles tendon stretching on dorsiflexion outcome in painful heel syndrome: a randomized, blinded, control study. J Foot Ankle Int 23: 619, 2002.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Baechle TR, Erle RW, eds: Essentials of Strength Training and Conditioning, 2nd Ed, Human Kinetics, Champaign, IL, 2000.

  • 20

    Heo H, Koo Y, Yoo W: Comparison of selective activation of the abductor halluces during various exercises. J Phys Ther Sci 23: 915, 2011.

  • 21

    Lyn SK, Padilla RA, Tsang KK: Differences in static- and dynamic- balance task performance after 4 weeks of intrinsic-foot-muscle training: the short-foot exercise versus the towel-curl exercise. J Sport Rehabil 21: 327, 2012.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Gallagher EJ, Liebman M, Bijur PE: Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med 38: 633, 2001.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Torkki M, Malmivaara A, Sietsalo S, et al: Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. JAMA 285: 2474, 2001.

  • 24

    Torkki M, Malmivaara A, Siesalo S, et al: Hallux valgus: immediate operation versus 1 year of waiting with or without orthoses: a randomized controlled trial of 209 patients. Acta Orthop Scand 74: 209, 2003.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Brantingham JW, Guiry S, Kertzmann HH, et al: A pilot study of the efficacy of a conservative chiropractic protocol using graded mobilization, manipulation, and ice in the treatment of symptomatic hallux abductovalgus bunion. Clin Chiropr 8: 117, 2005.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Hurn SE, Vicenzino B, Smith MD: Functional impairments characterizing mild, moderate, and severe hallux valgus. Arthritis Care Res 67: 80, 2015.

  • 27

    Cho NH, Kim S, Kwon D-J, et al: The prevalence of hallux valgus and its association with foot pain and function in a rural Korean community. J Bone Joint Surg Br 91: 494, 2009.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Glasoe WM, Phadke V, Pena VA, et al: An image based simulation study of tarsal kinematics in women with hallux valgus. Phys Ther 93: 1551, 2013.

  • 29

    Perera AM, Mason L, Stephens MM: The pathogenesis of hallux valgus. J Bone Joint Surg Am 93: 1650, 2011.

  • 30

    Mickle KJ, Munro BJ, Lord SR, et al: Toe weakness and deformity increase the risk of fall in older people. Clin Biomech 24: 787, 2009.

  • 31

    Uritani D, Fukumoto T, Matsumoto D, et al: Associations between toe grip strength and hallux valgus, toe curl ability, and foot arch height in Japanese adults aged 20 to 79 years: a cross sectional study. J Foot Ankle Res 8: 18, 1, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Uritani D, Fukumoto T, Matsumoto D, et al: Reference values for toe grip strength among Japanese adults aged 20-79 years: a cross sectional study. J Foot Ankle Res 7: 28, 2014.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Jung DY, Kim MH, Koh EK, et al: A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises. Phys Ther Sport 12: 30, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Hardy RH, Clapham JC: Observations on hallux valgus; based on a controlled series. J Bone Joint Surg Br 33: 376, 1951.

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

View More View Less
  • 1 Faculty of Physical Therapy, Department of Physical Therapy for Musculoskeletal Disorder and Its Surgery, Cairo University, 2, street 107, Maadi, Eletehad Square, Cairo, Egypt 11431. (E-mail: saharabdalbary@yahoo.com)
Restricted access

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.