Phys. Ther. Korea 2024; 31(3): 183-190
Published online December 20, 2024
https://doi.org/10.12674/ptk.2024.31.3.183
© Korean Research Society of Physical Therapy
Kyeong-Ah Moon1 , PT, BPT, Ye Jin Kim1
, PT, BPT, Hye-Seon Jeon1,2
, PT, PhD
1Department of Physical Therapy, The Graduate School, Yonsei University, 2Department of Physical Therapy, College of Health Sciences, Yonsei University, Wonju, Korea
Correspondence to: Hye-Seon Jeon
E-mail: hyeseonj@yonsei.ac.kr
https://orcid.org/0000-0003-3986-2030
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Hallux valgus (HV) is a common foot deformity in which the great toe deviates laterally and the first metatarsal deviates medially, leading to pain, discomfort, and reduced mobility. HV severity is typically assessed using the hallux valgus angle (HVA) and intermetatarsal angle (IMA).
Objects: This study aimed to explore how changes in skeletal, muscular, and functional variables correlate with HV severity and to provide evidence for more integrated treatment approaches.
Methods: Sixty volunteers with mild to moderate bilateral HV (HVA 15–40 degrees) participated. The measurements included HVA and IMA via radiography, abductor hallucis muscle (AbdH) cross-sectional area (CSA) and tone using ultrasound and Myoton PRO, range of motion (ROM) of the ankle and great toe metatarsophalangeal (MTP) joint with a goniometer, and plantar pressure during gait with a Zebris FDM system. Pearson’s correlation coefficient was used for the statistical analysis.
Results: An Increased HVA was associated with a higher IMA (r = 0.858, p < 0.05). The HVA was inversely related to the AbdH CSA (r = –0.337, p < 0.05) and muscle tone (r = –0.889, p < 0.01). With increasing HVA, dorsiflexion ROM of the ankle (r = –0.307, p < 0.01) and both flexion (r = –0.197, p < 0.05) and extension (r=-0.182, p<0.05) ROM of the great toe MTP joint decreased. Conversely, ankle plantar flexion ROM increased with the HVA (r = 0.312, p < 0.01). Additionally, plantar pressure increased in the second metatarsal areas (r = 0.457, p < 0.05) a with higher HVA.
Conclusion: This study demonstrates significant correlations between HV severity and various biomechanical factors, highlighting the need for comprehensive treatment strategies. While stretching the adductor hallucis muscle and strengthening the AbdH have been widely recognized interventions for HV, our findings provide evidence that ROM exercises for the ankle and the MTP joint of the great toe are also critical components of a physical therapy program for managing HV. Longitudinal studies are required to assess the effectiveness of these approaches.
Keywords: Bunion, Foot deformities, Hallux valgus, Musculoskeletal abnormalities, Range of motion, Ultrasonography
Phys. Ther. Korea 2024; 31(3): 183-190
Published online December 20, 2024 https://doi.org/10.12674/ptk.2024.31.3.183
Copyright © Korean Research Society of Physical Therapy.
Kyeong-Ah Moon1 , PT, BPT, Ye Jin Kim1
, PT, BPT, Hye-Seon Jeon1,2
, PT, PhD
1Department of Physical Therapy, The Graduate School, Yonsei University, 2Department of Physical Therapy, College of Health Sciences, Yonsei University, Wonju, Korea
Correspondence to:Hye-Seon Jeon
E-mail: hyeseonj@yonsei.ac.kr
https://orcid.org/0000-0003-3986-2030
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Hallux valgus (HV) is a common foot deformity in which the great toe deviates laterally and the first metatarsal deviates medially, leading to pain, discomfort, and reduced mobility. HV severity is typically assessed using the hallux valgus angle (HVA) and intermetatarsal angle (IMA).
Objects: This study aimed to explore how changes in skeletal, muscular, and functional variables correlate with HV severity and to provide evidence for more integrated treatment approaches.
Methods: Sixty volunteers with mild to moderate bilateral HV (HVA 15–40 degrees) participated. The measurements included HVA and IMA via radiography, abductor hallucis muscle (AbdH) cross-sectional area (CSA) and tone using ultrasound and Myoton PRO, range of motion (ROM) of the ankle and great toe metatarsophalangeal (MTP) joint with a goniometer, and plantar pressure during gait with a Zebris FDM system. Pearson’s correlation coefficient was used for the statistical analysis.
Results: An Increased HVA was associated with a higher IMA (r = 0.858, p < 0.05). The HVA was inversely related to the AbdH CSA (r = –0.337, p < 0.05) and muscle tone (r = –0.889, p < 0.01). With increasing HVA, dorsiflexion ROM of the ankle (r = –0.307, p < 0.01) and both flexion (r = –0.197, p < 0.05) and extension (r=-0.182, p<0.05) ROM of the great toe MTP joint decreased. Conversely, ankle plantar flexion ROM increased with the HVA (r = 0.312, p < 0.01). Additionally, plantar pressure increased in the second metatarsal areas (r = 0.457, p < 0.05) a with higher HVA.
Conclusion: This study demonstrates significant correlations between HV severity and various biomechanical factors, highlighting the need for comprehensive treatment strategies. While stretching the adductor hallucis muscle and strengthening the AbdH have been widely recognized interventions for HV, our findings provide evidence that ROM exercises for the ankle and the MTP joint of the great toe are also critical components of a physical therapy program for managing HV. Longitudinal studies are required to assess the effectiveness of these approaches.
Keywords: Bunion, Foot deformities, Hallux valgus, Musculoskeletal abnormalities, Range of motion, Ultrasonography
Table 1 . General characteristics of the participants (N = 60, 120 feet).
Variable | Value |
---|---|
Age (y) | 29.50 ± 4.16 |
Height (cm) | 168.13 ± 7.01 |
Weight (kg) | 63.23 ± 11.91 |
BMI (kg/m2) | 22.31 ± 2.80 |
Sex (male/female) | 24/36 |
Shoe size (mm) | 249.83 ± 16.01 |
Dominant foot (Rt./Lt.) | 58/2 |
HV classification (mild/moderate) | 16/104 |
Values are presented as mean ± standard deviation or number. BMI, body mass index; Rt., right; Lt., left; HV, hallux valgus..
Table 2 . Summary of average value (N = 60, 120 feet).
Variable | Value |
---|---|
HVA (°) | 24.32 ± 6.06 |
IMA (°) | 17.22 ± 6.16 |
CSA (cm2) | 1.61 ± 0.38 |
Muscle tone (Hz) | 20.76 ± 0.99 |
Muscle stiffness (N/m) | 458.30 ± 15.31 |
Ankle D/F (°) | 16.70 ± 4.58 |
Ankle P/F (°) | 47.75 ± 3.64 |
1st MTP flexion (°) | 44.50 ± 1.63 |
1st MTP extension (°) | 66.66 ± 4.62 |
Values are presented as mean ± standard deviation. HVA, hallux valgus angle; IMA, intermetatarsal angle; CSA, cross-sectional area; D/F, dorsiflexion; P/F, plantarflexion; MTP, metatarsophalangeal..
Table 3 . Summary of correlation analysis (N = 60, 120 feet).
Variable | HVA | IMA | CSA | Muscle tone | Muscle stiffness | Ankle D/F | Ankle P/F | Toe flexion | Toe extension |
---|---|---|---|---|---|---|---|---|---|
HVA (°) | 1 | 0.858* | –0.337** | –0.889** | –0.847** | –0.307** | 0.312** | –0.197* | –0.182* |
IMA (°) | 0.858* | 1 | –0.295* | –0.786** | –0.721** | –0.298* | 0.304** | –0.186* | –0.191* |
CSA (cm2) | –0.337* | –0.295* | 1 | 0.332** | 0.303** | 0.421** | 0.219 | –0.105 | –0.167 |
Muscle tone (Hz) | –0.889** | –0.786** | 0.332** | 1 | 0.924** | 0.205* | 0.155 | –0.113 | –0.118 |
Muscle stiffness (N/m) | –0.847** | –0.721** | 0.303** | 0.924** | 1 | 0.198* | 0.132 | –0.107 | –0.167 |
Ankle D/F (°) | –0.307** | –0.298* | 0.421** | 0.205* | 0.198* | 1 | 0.380** | 0.371** | 0.514** |
Ankle P/F (°) | 0.312** | 0.304** | 0.219 | 0.155 | 0.132 | 0.380** | 1 | 0.359** | 0.331** |
1st MTP flexion (°) | –0.197* | –0.186* | 0.105 | 0.113 | 0.107 | 0.371** | 0.359** | 1 | 0.336** |
1st MTP extension (°) | –0.182* | –0.191* | 0.167 | 0.118 | 0.167 | 0.514** | 0.331** | 0.336** | 1 |
HVA, hallux valgus angle; IMA, intermetatarsal angle; CSA, cross-sectional area; D/F, dorsiflexion; P/F, plantarflexion; MTP, metatarsophalangeal. *p < 0.05, **p < 0.01..
Table 4 . Correlation analysis between plantar pressure and HVA and IMA.
Variable | Value (N) | Correlation | ||
---|---|---|---|---|
HVA (r) | IMA (r) | |||
![]() | Toe | 84.01 ± 12.02 | –0.247** | –0.157 |
M1 | 82.37 ± 13.51 | –0.347** | –0.258** | |
M2 | 166.43 ± 21.98 | 0.457* | 0.370** | |
M3 | 86.66 ± 16.03 | 0.398** | 0.366** | |
M4 | 60.50 ± 8.82 | 0.195* | 0.142 | |
M5 | 44.94 ± 3.97 | –0.248** | –0.193* | |
MF | 51.23 ± 11.46 | –0.335** | –0.254** | |
HL | 139.36 ± 28.02 | 0.380** | 0.355** | |
HC | 74.53 ± 13.36 | –0.197* | –0.194* | |
HM | 142.05 ± 29.18 | 0.221* | 0.172 |
Values are presented as mean ± standard deviation. HVA, hallux valgus angle; IMA, intermetatarsal angle; M1, the 1st metatarsal region representing the medial forefoot; M2, the 2nd metatarsal region representing the medial forefoot; M3, the 3rd metatarsal region representing the middle forefoot; M4, the 4th metatarsal region representing the lateral forefoot; M5, the 5th metatarsal region representing the lateral forefoot; MF, the mid-foot region; HM, medial heel region; HC, central heel region; HL, lateral heel region. *p < 0.05, **p < 0.01..