10/01/2025
🎊🌲Between the years, we traditionally announce our "Best-of series" of the most influential posts of 2024 on FB.
📣 today 🥇 5
Hallux valgus: pathoanatomy and exercise therapy 🦶
🦶 Hallux valgus is a common and disabling deformity characterized by a lateral deviation of the hallux in the direction of the little toes.
🦶 A systematic review of population-based studies (a total of 496,957 participants) found pooled prevalence estimates of 23% in people aged 18–65 and 36% in people aged 65 and over, with women being twice as likely to be affected. https://pubmed.ncbi.nlm.nih.gov/20868524/
🦶 Hallux valgus is not a purely aesthetic problem, but is associated with gait deviations (https://pubmed.ncbi.nlm.nih.gov/23497584/), balance disorders (https://pubmed.ncbi.nlm.nih.gov/23067345/), an increased risk of falling in older people (https://pubmed.ncbi.nlm.nih.gov/30415759/) and a reduced quality of life (https://pubmed.ncbi.nlm.nih.gov/21080349/).
👉 Hallux valgus deformity is defined as valgus deviation and pronation of the big toe with a prominent metatarsophalangeal (MTP) I joint (pseudoexostosis).
🦶 The pathoanatomy of hallux valgus can be summarized as follows (see Fig. 1): The medial capsule, the medial collateral ligament, and the medial metatarso-sesamoid ligament of the MTP-I joint fail first, causing the first metatarsal head to migrate medially and drift away from the sesamoids. By binding to the sesamoids and the adductor hallucis, the proximal phalanx moves laterally, with the pull of the tendon of the adductor hallucis brevis muscle increasing the deviation. In addition, the tensile effect of the extensor and flexor hallucis longus tendon increases the abduction force on the hallux. The abductor hallucis brevis muscle migrates plantar towards the metatarsophalangeal joint of the big toe and is therefore unable to counteract the hallux valgus deformity; it also plantar flexes and pronates the phalanx. https://pubmed.ncbi.nlm.nih.gov/20868524/
🦶 The bursa, which is located above the medial eminence of the first metatarsal bone, can thicken and become painful as a result of the deformity-related friction on the footwear. https://www.sciencedirect.com/.../pii/S2214963521000432
🦶 The elevation of the head of the first metatarsal due to its medial migration may result in transfer metatarsalgia with pain and subluxations in the adjacent MTP joints. https://pubmed.ncbi.nlm.nih.gov/31653363/
👉 In the non-surgical treatment of hallux valgus, shoe advice or modification, shoe insoles, night splints and physiotherapy such as manual therapy, taping and foot exercises are discussed, although the evidence here is very weak overall according to the results of a recent meta-analysis. Most studies had small sample sizes (12 out of 16 studies < 60 participants) and short follow-up periods (10 out of 16 had follow-up < 3 months). https://pubmed.ncbi.nlm.nih.gov/33768721/
👉 Exercise selection in the early phase of hallux valgus focus on activating the abductor hallucis in contrast to the adducor hallucis: https://pubmed.ncbi.nlm.nih.gov/12704272/, https://pubmed.ncbi.nlm.nih.gov/3383479/, https://pubmed.ncbi.nlm.nih.gov/1955440/, https://pubmed.ncbi.nlm.nih.gov/29373047/).
👉 In several studies, the "Toe-Spread-Out Exercise (TSO)" is considered to be a central foot exercise for activating the abductor hallucis. https://pubmed.ncbi.nlm.nih.gov/25995546/;
👉 In TSO, the patient is instructed to lift all toes, keeping the metatarsal heads and heel on the floor (Fig. 2A). Then the little toe is pushed down in a lateral direction (Fig. 2B) and the big toe is slowly brought down in the medial direction. (Fig. 2C). https://pubmed.ncbi.nlm.nih.gov/25995546/.
👉 Based on biomechanical considerations, Glasoe (2016) also recommends the training forms "short foot" and "heel lift". (see Fig. 3, https://www.jospt.org/doi/10.2519/jospt.2016.6704)
