Dataset Information

Gait parameters associated with hallux valgus: a systematic review.

ABSTRACT:

Background

Hallux valgus (HV) has been linked to functional disability and increased falls risk in older adults. However, specific gait alterations in individuals with HV are unclear. This systematic review investigated gait parameters associated with HV in otherwise healthy adults.

Methods

Electronic databases (Medline, Embase, CINAHL) were searched to October 2011, including cross-sectional studies with clearly defined HV and non-HV comparison groups. Two investigators independently rated studies for methodological quality. Effect sizes (95% confidence intervals (CI)) were calculated as standardized mean differences (SMD) for continuous data and risk ratios (RR) for dichotomous data.

Results

Nine studies included a total of 589 participants. Three plantar pressure studies reported increased hallux loading (SMD 0.56 to 1.78) and medial forefoot loading (SMD 0.62 to 1.21), while one study found reduced first metatarsal loading (SMD -0.61, CI -1.19 to -0.03) in HV participants. HV participants demonstrated less ankle and rearfoot motion during terminal stance (SMD -0.81 to -0.63) and increased intrinsic muscle activity (RR 1.6, 1.1 to 2.2). Most studies reported no differences in spatio-temporal parameters; however, one study found reduced speed (SMD -0.73, -1.25 to -0.20), step length (SMD -0.66 to -0.59) and less stable gait patterns (SMD -0.86 to -0.78) in older adults with HV.

Conclusions

HV impacts on particular gait parameters, and further understanding of potentially modifiable factors is important for prevention and management of HV. Cause and effect relationships cannot be inferred from cross-sectional studies, thus prospective studies are warranted to elucidate the relationship between HV and functional disability.

SUBMITTER: Nix SE

PROVIDER: S-EPMC3602054 | biostudies-literature | 2013 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Gait parameters associated with hallux valgus: a systematic review.

Nix Sheree E SE Vicenzino Bill T BT Collins Natalie J NJ Smith Michelle D MD

Journal of foot and ankle research 20130312 1

<h4>Background</h4>Hallux valgus (HV) has been linked to functional disability and increased falls risk in older adults. However, specific gait alterations in individuals with HV are unclear. This systematic review investigated gait parameters associated with HV in otherwise healthy adults.<h4>Methods</h4>Electronic databases (Medline, Embase, CINAHL) were searched to October 2011, including cross-sectional studies with clearly defined HV and non-HV comparison groups. Two investigators independe ...[more]

PMID: 23497584

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Project description:BackgroundThough hallux valgus is a common foot deformity, the integrated information on its global prevalence and incidence is relatively lacking. The aim of this research was to assess the global prevalence and incidence of hallux valgus, thus providing reliable data reference for clinical practice.MethodsA systematic review of global hallux valgus research publications concerning its prevalence and incidence was performed based on six electronic databases ((PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), China Online Journals and CQVIP)) from their inception to November 16, 2022. The search terms included "hallux valgus or bunion and prevalence or incidence or epidemiology." All languages were included. Data were extracted by country, continent, age group, gender and other information. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data by using random-effects models to synthesize available evidence.ResultsA total of 45 studies were included in the meta-analysis. The overall pooled estimated prevalence was 19% (95% CI, 13% to 25%) (n=186,262,669) for hallux valgus. In subgroup meta-analyses, the prevalence of hallux valgus was 21.96% (95% CI, 10.95% to 35.46%) in Asia, 3% (95% CI, 0% to 15%) in Africa, 18.35% (95% CI, 11.65% to 26.16%) in Europe, 29.26% (95% CI, 4.8% to 63.26%) in Oceania, and 16.1% (95% CI, 5.9% to 30.05%) in North America, respectively. The pooled prevalence of hallux valgus by gender was 23.74% (95% CI, 16.21% to 32.21%) for females and 11.43% (95% CI, 6.18% to 18%) for males. The prevalence was 11% (95% CI, 2% to 26%) in individuals younger than 20 years old, 12.22% in adults aged 20-60 years (95% CI, 5.86% to 20.46%) and 22.7% in elderly people aged over 60 years (95% CI, 13.1% to 33.98%).ConclusionThis research provided the global prevalence and incidence of hallux valgus in terms of its spatial, temporal, and population distribution. The global estimated pooled prevalence and incidence of hallux valgus was 19%. A higher prevalence of hallux valgus was found in females, Oceania countries, and among people aged over 60 years. Due to the high heterogeneity of the included studies, the findings should be interpreted with caution.

Project description:BackgroundHallux valgus (HV) is a foot deformity commonly seen in medical practice, often accompanied by significant functional disability and foot pain. Despite frequent mention in a diverse body of literature, a precise estimate of the prevalence of HV is difficult to ascertain. The purpose of this systematic review was to investigate prevalence of HV in the overall population and evaluate the influence of age and gender.MethodsElectronic databases (Medline, Embase, and CINAHL) and reference lists of included papers were searched to June 2009 for papers on HV prevalence without language restriction. MeSH terms and keywords were used relating to HV or bunions, prevalence and various synonyms. Included studies were surveys reporting original data for prevalence of HV or bunions in healthy populations of any age group. Surveys reporting prevalence data grouped with other foot deformities and in specific disease groups (e.g. rheumatoid arthritis, diabetes) were excluded. Two independent investigators quality rated all included papers on the Epidemiological Appraisal Instrument. Data on raw prevalence, population studied and methodology were extracted. Prevalence proportions and the standard error were calculated, and meta-analysis was performed using a random effects model.ResultsA total of 78 papers reporting results of 76 surveys (total 496,957 participants) were included and grouped by study population for meta-analysis. Pooled prevalence estimates for HV were 23% in adults aged 18-65 years (CI: 16.3 to 29.6) and 35.7% in elderly people aged over 65 years (CI: 29.5 to 42.0). Prevalence increased with age and was higher in females [30% (CI: 22 to 38)] compared to males [13% (CI: 9 to 17)]. Potential sources of bias were sampling method, study quality and method of HV diagnosis.ConclusionsNotwithstanding the wide variation in estimates, it is evident that HV is prevalent; more so in females and with increasing age. Methodological quality issues need to be addressed in interpreting reports in the literature and in future research.

Project description:BackgroundHallux valgus (HV) surgery is an orthopaedic procedure that commonly causes mild to moderate postoperative pain. Effective management of this pain has become an important element of modern hallux valgus surgical treatment. A local anaesthetic (LA) with an antinociceptive effect can control this pain. However, relatively few papers have evaluated this strategy in depth. The objective of the current systematic review was to address this demand by comparing the efficacy of proximal and local blocks in controlling postoperative pain following hallux valgus surgery.Main textOvid-MEDLINE, Cochrane Central, PubMed, Web of Science (WOS), Scopus, and Embase were searched from their inceptions through December 29, 2021. Observational and clinical trial publications in peer-reviewed English-language journals with a sample size of at least 20 were included. The trials involved adults over 18 who could describe their discomfort and had a bunionectomy. The included studies were evaluated using the Cochrane risk of bias 2 method. Descriptive analysis synthesised the results. Among the 439 articles identified, five studies compromising 459 participants were included. Ankle blocks were superior to control in two studies (P = 0.001, P < 0.001) and superior to local blocks in one study (P < 0.001). Additionally, one study showed that popliteal and ankle blocks administered with lidocaine or levobupivacaine were equivalent (P = 0.123 and P = 0.055, respectively). However, one of these five included studies indicated that ankle blocks were not effective (P = 0.123) in reducing postoperative pain.ConclusionsThe key findings presented herein suggest that regional blocks effectively reduce postoperative pain and that an ankle block has more supportive evidence for its effectiveness. However, an adequate assessment of the effectiveness of various administrative routes was challenging due to the lack of reliable evidence. This needs to be addressed in future studies.Trial registrationPROSPERO registration: CRD42022307974.

Project description:While hallux valgus (HV) surgeries are useful for correcting skeletal alignment problems, their effects on plantar load, which reflects forefoot functions, are less understood. The objective of this study is to conduct a systematic review and meta-analysis on the plantar load change after HV surgeries. A systematic search of Web of Science, Scopus, PubMed, CENTRAL, EMBASE, and CINAHL was performed. Studies that assessed the pre- and post-operative plantar pressure of HV patients undergoing surgeries and reported load-related parameters over the hallux, medial metatarsal, and/or central metatarsal regions were included. Studies were appraised by using the modified NIH quality assessment tool for before-after study. Studies suitable for meta-analysis were pooled with the random-effects model, using the standardized mean difference of the before-after parameters as an effect measure. Twenty-six studies containing 857 HV patients and 973 feet were included for the systematic review. Meta-analysis was conducted on 20 of them, and most studies did not favor HV surgeries. Overall, HV surgeries reduced the plantar load over the hallux region (SMD -0.71, 95% CI, -1.15 to -0.26), indicating that forefoot function worsened after surgeries. For the other five outcomes, the overall estimates were not statistically significant, indicating that surgeries did not improve them either. There was substantial heterogeneity among the studies, which in most cases could not be resolved by pre-planned subgroup analyses by surgical classification, year of publication, median age of patients, and length of follow-up. Sensitivity analysis removing lower-quality studies showed that the load integrals (impulse) over the central metatarsal region significantly increased (SMD 0.27, 95% CI, 0 to 0.53), indicating that surgeries increased the risk of transfer metatarsalgia. There is no solid evidence that HV surgeries could improve forefoot functions from a biomechanical point perspective. Currently available evidence even suggests that surgeries might reduce the plantar load over the hallux and adversely affect push-off function. The reasons behind and the effectiveness of alternative surgical methods warrant further investigation.

Project description:BackgroundAlthough the etiology of hallux valgus is contested, in some patients it may be failure of the stabilizing soft tissue structures around the first ray of the foot. Because there is lack of effective soft tissue techniques, osteotomies have become the mainstream surgical approach to compensate for the underlying soft tissue deficiency; osteodesis, a soft tissue nonosteotomy technique, may be a third alternative, but its efficacy is unknown.Questions/purposesWe asked: (1) Can an osteodesis, a distal soft tissue technique, correct hallux valgus satisfactorily in terms of deformity correction and improvement in American Orthopaedic Foot and Ankle Society (AOFAS) score? (2) Is the effectiveness of an osteodesis affected by the patient's age or deformity severity? (3) What complications are associated with this procedure?MethodsBetween February and October 2010, we performed 126 operations to correct hallux valgus, of which 126 (100%) were osteodeses. Sixty-one patients (110 procedures) (87% of the total number of hallux valgus procedures) were available for followup at a minimum of 12 months (mean, 23 months; range, 12-38 months). This group formed our study cohort. During the study period, the general indications for this approach included failed conservative measures for pain relief and metatarsophalangeal angle greater than 20° or intermetatarsal angle greater than 9°. Intermetatarsal cerclage sutures were used to realign the first metatarsal and postoperative fibrosis was induced surgically between the first and second metatarsals to maintain its alignment. The radiologic first intermetatarsal angle, metatarsophalangeal angle, and medial sesamoid position were measured by Hardy and Clapham's methods for deformity and correction evaluation. Clinical results were assessed by the AOFAS score.ResultsThe intermetatarsal angle was improved from a preoperative mean of 14° to 7° (p<0.001; Cohen's d=1.8) at followup, the metatarsophalangeal angle from 31° to 18° (p<0.001; Cohen's d=3.1), the medial sesamoid position from position 6 to 3 (p<0.001; Cohen's d=2.4), and AOFAS hallux score from 68 to 96 points (p<0.001). Neither patient age nor deformity severity affected the effectiveness of the osteodesis in correcting all three radiologic parameters; however, the deformities treated in this series generally were mild to moderate (mean intermetatarsal angle, 14°; range, 9°-22°). There were six stress fractures of the second metatarsal (5%), five temporary metatarsophalangeal joint medial subluxations all resolved in one month by the taping-reduction method without surgery, and six metatarsophalangeal joints with reduced dorsiflexion less than 60°.ConclusionsThe osteodesis is a soft tissue nonosteotomy technique, and provided adequate deformity correction and improvement in AOFAS scores for patients with mild to moderate hallux valgus deformities, although a small number of the patients had postoperative stress fractures of the second ray develop. Future prospective studies should compare this technique with osteotomy techniques in terms of effectiveness of the correction, restoration of hallux function, complications, and long-term recurrence.Level of evidenceLevel IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Dataset Information

Gait parameters associated with hallux valgus: a systematic review.

Background

Methods

Results

Conclusions

Publications

Gait parameters associated with hallux valgus: a systematic review.

Similar Datasets

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