Functional Impairments Characterizing Mild, Moderate, and Severe Hallux Valgus
Functional Impairments Characterizing Mild, Moderate, and Severe Hallux Valgus
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DOI：
10.1002/acr.22380
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发表时间：
2015-01-01
影响因子：
4.7
通讯作者：
Smith, Michelle D.
中科院分区：
文献类型：
--
作者：
Hurn, Sheree E.;Vicenzino, Bill;Smith, Michelle D.
Objective.拇外翻（HV）与功能障碍和福尔斯风险增加有关，但功能障碍的机制尚不清楚。本研究调查了轻度、中度和重度HV成人与对照组相比的功能表现、肌肉力量和足底压力，同时考虑了足部疼痛的影响。60名HV成人（在背跖X线片上分为轻度、中度和重度）和30名对照组参与研究。测量指标包括拇趾跖屈和外展力量、行走能力、姿势摇摆和前足跖压力。采用多变量协方差分析和成对比较（Bonferroni校正后P < 0.05）来研究组间差异，校正年龄、性别、体重指数和足部疼痛。与对照组相比，中度HV（平均差异：跖屈-45.8 N，外展-12.3 N; P < 0.001）和重度HV（跖屈-50.1 N; P <0.001，外展-11.2 N; P = 0.01）患者的拇趾跖屈和外展强度显著降低。与对照组相比，中度（峰值压力-90.8 kPa; P < 0.001）和重度HV（峰值压力-106.2 kPa; P < 0.001）的拇趾峰值压力和压力-时间积分明显降低。与对照组相比，重度HV患者单腿站立时的中外侧姿势摇摆也增加（3.5 cm; P = 0.01）。中度至重度HV与拇趾足底压力和力量指标降低相关，而与对照组相比，轻度畸形患者的功能相对正常。更好地了解与HV不同阶段相关的特定功能缺陷将有助于为临床管理和未来研究提供信息。
Objective. Hallux valgus (HV) has been linked to functional disability and increased risk of falls, but mechanisms underpinning functional disability are unclear. This study investigated functional performance, muscle strength, and plantar pressures in adults with mild, moderate, and severe HV compared to controls, while considering the influence of foot pain.Methods. Sixty adults with HV (classified as mild, moderate, and severe on dorsalplantar radiographs) and 30 controls participated. Measures included hallux plantar flexion and abduction strength, walking performance, postural sway, and forefoot plantar pressures. Multivariate analysis of covariance and pairwise comparisons (P < 0.05 after Bonferroni adjustment) were used to investigate differences between groups, adjusting for age, sex, body mass index, and foot pain.Results. Hallux plantar flexion and abduction strength were significantly reduced in those with moderate (mean differences: plantar flexion -45.8 N, abduction -12.3 N; P < 0.001) and severe HV (plantar flexion -50.1 N; P < 0.001, abduction -11.2 N; P = 0.01) compared to controls. A significant reduction in hallux peak pressure and pressure-time integral was evident in moderate (peak pressure -90.8 kPa; P < 0.001) and severe HV (peak pressure -106.2 kPa; P < 0.001) compared to controls. Those with severe HV also demonstrated increased mediolateral postural sway in single leg stance compared to controls (3.5 cm; P = 0.01).Conclusion. Moderate to severe HV is associated with reduced hallux plantar pressures and strength measures, while relatively normal function compared to controls was found in those with mild deformity. Greater understanding of specific functional deficits associated with different stages of HV will help inform clinical management and future research.