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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

Correlation Between Hallux Valgus Severity, Abductor Hallucis Muscle Properties, and Plantar Pressure Distribution

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

Received: August 10, 2024; Revised: August 16, 2024; Accepted: August 16, 2024

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.

Abstract

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

Article

Original Article

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.

Correlation Between Hallux Valgus Severity, Abductor Hallucis Muscle Properties, and Plantar Pressure Distribution

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

Received: August 10, 2024; Revised: August 16, 2024; Accepted: August 16, 2024

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.

Abstract

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).

VariableValue
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).

VariableValue
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).

VariableHVAIMACSAMuscle
tone
Muscle
stiffness
Ankle
D/F
Ankle
P/F
Toe
flexion
Toe
extension
HVA (°)10.858*–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*10.332**0.303**0.421**0.219–0.105–0.167
Muscle tone (Hz)–0.889**–0.786**0.332**10.924**0.205*0.155–0.113–0.118
Muscle stiffness (N/m)–0.847**–0.721**0.303**0.924**10.198*0.132–0.107–0.167
Ankle D/F (°)–0.307**–0.298*0.421**0.205*0.198*10.380**0.371**0.514**
Ankle P/F (°)0.312**0.304**0.2190.1550.1320.380**10.359**0.331**
1st MTP flexion (°)–0.197*–0.186*0.1050.1130.1070.371**0.359**10.336**
1st MTP extension (°)–0.182*–0.191*0.1670.1180.1670.514**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.

VariableValue (N)Correlation

HVA (r)IMA (r)
Toe84.01 ± 12.02–0.247**–0.157
M182.37 ± 13.51–0.347**–0.258**
M2166.43 ± 21.980.457*0.370**
M386.66 ± 16.030.398**0.366**
M460.50 ± 8.820.195*0.142
M544.94 ± 3.97–0.248**–0.193*
MF51.23 ± 11.46–0.335**–0.254**
HL139.36 ± 28.020.380**0.355**
HC74.53 ± 13.36–0.197*–0.194*
HM142.05 ± 29.180.221*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..