Effects of using hallux valgus (HV) splint, HV splint plus exercise or HV splint plus electrical stimulation (ES) on treatment of flexible HV in Young Population

Document Type : Original article

Authors

1 1. Associate professor of Physiotherapy, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Lecturer of Physiotherapy, PhD student of orthosis prosthesis, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 3. BSc in Physiotherapy, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background and Aim: The dramatically increased incidence of hallux valgus (HV) deformity is more related to the cultural rather than genetic parameters. Satisfaction rate following either conservative or surgical treatments are very low. The current study aimed to compare the effects of three commonly used conservative treatments including hallux valgus (HV) splint, HV splint plus electrical stimulation (ES) currents, or HV splint plus exercise to treat this deformity.
Materials & Methods: Thirty-six university students with a mild to moderate HV deformity were recruited in this study. Before starting the study, anterior-posterior view radiographies were taken from their feet. HV angle (HVA) less than 20º was considered as normal, between 21-25º as mild, between 26-40 º as moderate and higher than 40 degrees was considered as a sever HV deformity. Then, the subjects were divided into three groups (n=12) and were randomly placed into Splint, Splint plus Exercise, and Splint plus Exercise plus ES groups for 6 weeks. At the end of week six, the radiographies were repeated and the pre/post treatments HVA were compared.
Results: The results of the current study showed a non-significant 4.7% reduction of HVA in Splint group (p=0.12). However, 15.4% reduction of HVA occurred in Splint plus Exercise group, which was significant (p=0.005).The subjects used Splint plus Electrical stimulation showed a significant 13.9% reduction in HVA (p=0.008). Furthermore, AOFAS scores of the subjects revealed no significant differences among treatment groups in terms of pain reduction.
Conclusion: Although using a HV splint alone could not significantly reduce the HVA, mixing it with either exercise or ES could significantly expedite its corrective effects. It should be mentioned that correction of the deformity was not always associated with decreasing the subjects’ pain, which might be due to the immediate counter force of the splint. Repeating the study with a long follow-up time is recommended.
 

Keywords


1. Jahss M. Disorders of the foot. WB Saunders Co. 1982.Vol 1: 548-608.
2. Nakhaee Z, Rahimi A, Abaee M, Rezasoltani A, Khademi Kalantari K.  The relationship between the height of the medial longitudinal arch (MLA) and the ankle and knee injuries in professional runner. Foot (Edinb). 2008;18(2):84-90.
3. Lee KM, Ahn S, Chung CY, Sung KH, Park MS. Reliability and relationship of radiographic measurements in hallux valgus. Clin Orthop Relat Res. 2012;470(9):2613-21.
4. Deenik AR, de Visser E, Louwerens JW, de Waal Malefijt M, Draijer FF, de Bie RA. Hallux valgus angle as main predictor for correction of hallux valgus. BMC Musculoskelet Disord. 2008 15;9:70.
5. Wülker N, Mittag F. The treatment of hallux valgus. Dtsch Arztebl Int. 2012; 109(49):857-67
6. Young KW, Park YU, Kim JS, Jegal H, Lee KT. Unilateral hallux valgus: is it true unilaterality, or does it progress to bilateral deformity? Foot Ankle Int. 2013; 34(4):498-503
7. Nery C, Coughlin MJ, Baumfeld D, Ballerini FJ, Kobata S. Hallux Valgus in Males- Part 1: Demographics, Etiology, and Comparative Radiology. Foot Ankle Int. 2013 Feb 5. [Epub ahead of print]
8. Hart ES, deAsla RJ, Grottkau BE. Current concepts in the treatment of hallux valgus. Orthop Nurs. 2008;27(5):274-80.
9. Golightly YM, Hannan MT, Dufour AB, Jordan JM. Racial differences in foot disorders and foot type.  Arthritis Care Res (Hoboken). 2012;64(11):1756-9.
10. Nix SE, Vicenzino BT, Collins NJ, Smith MD. Gait parameters associated with hallux valgus: a systematic review. J Foot Ankle Res. 2013 12;6(1):9.
11. Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg Am. 2011 7;93(17):1650-61.
12. Stewart S, Ellis R, Heath M, Rome K. Ultrasonic evaluation of the abductor hallucis muscle in hallux valgus: a cross-sectional observational study. BMC Musculoskelet Disord. 2013 28;14:45.
13. Nix SE, Vicenzino BT, Smith MD. Foot pain and functional limitation in healthy adults with hallux valgus: a cross-sectional study. BMC Musculoskelet Disord. 2012 16;13:197.
14. Hwang S, Choi H, Cha S, Lee K, Kim Y. Multi-segment foot motion analysis on hallux valgus patients. Conf Proc IEEE Eng Med Biol Soc. 2005;7:6875-7.
15. Canseco K, Rankine L, Long J, Smedberg T, Marks RM, Harris GF. Motion of the multisegmental foot in hallux valgus. Foot Ankle Int. 2010; 31(2):146-52.
16. Cho NH, Kim S, Kwon DJ, Kim HA. The prevalence of hallux valgus and its association with foot pain and function in a rural Korean community. J Bone Joint Surg Br. 2009; 91(4):494-8.

17. Butterworth PA, Landorf KB, Smith SE, Menz HB. The association between body mass index and musculoskeletal foot disorders: a systematic review. Obes Rev. 2012; 13(7):630-42.

18. Steinberg N, Finestone A, Noff M, Zeev A, Dar G. Relationship Between Lower Extremity Alignment and Hallux Valgus in Women. Foot Ankle Int. 2013. [Epub ahead of print].

19. Kaya D, Atay OA, Callaghan MJ, Cil A, Cağlar O, Citaker S, Yuksel I, Doral MN. Hallux valgus in patients with patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2009; 17(11):1364-7.

20. Ozgüçlü E, Kiliç E, Kaymak B. A knee osteoarthritis connected with hallux valgus-related pes planus. J Biomech. 2008 5;41(16):3523-4.
21. Klemola T. [Hallux valgus--several ways to treat]. Duodecim. 2011; 127(16):1709-18.
22. Fuhrmann RA. [Therapy of pediatric hallux vagus]. Orthopade. 2013; 42(1):38-44.

23. Reina M, Lafuente G, Munuera PV. Effect of custom-made foot orthoses in female hallux valgus after one-year follow up. Prosthet Orthot Int. 2013; 37(2):113-9.

24. Morandi A, Ungaro E, Fraccia A, Sansone V. Chevron osteotomy of the first metatarsal stabilized with an absorbable pin: our 5-year experience. Foot Ankle Int. 2013; 34(3):380-5.
25. Kalender AM, Uslu M, Bakan B, Ozkan F, Erturk C, Altay MA, Guner S, Kalender M. Mitchell's osteotomy with mini-plate and screw fixation for hallux valgus. Foot Ankle Int. 2013; 34(2):238-43.
26. Okuda R, Yasuda T, Jotoku T, Shima H. Proximal abduction-supination osteotomy of the first metatarsal for adolescent hallux valgus: a preliminary report. J Orthop Sci. 2013 Mar 20. [Epub ahead of print].
27. Helal B. Surgery for adolescent hallux valgus. Clin Orthop Relat Res. 1981 ;(157):50-63.
28. Coughlin MJ. Hallux valgus.  Instr Course Lect. 1997; 46:357-91.
29. Tadchian MO . Pediatric orthopedics. 3rd Edition. Philadelphia. 2000.  WB Sanders Co.
30. Scranton PE, Zuckerman JD. Bunion Surgery in Adolescents: results of surgical     treatment. J Pediatr Orthop. 1984;4(1):39-43.
 
31. Kilmartin E. A controlled prospective trial of a foot orthosis for juvenile hallux valgus. J Bone Joint Surg Br. 1994;76(2):210-4.
32. Farahmand B. [M.S Thesis].Tehran: Rehabilitation Sciencses School. Iran University of Medical Scienses. 1382.
33. Ferrari J, Higgins JPT, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. The Cochrane Database of Systematic Reviews. Published Online: 21 JAN 2009.
34. Krämer J. Functional treatment of beginning hallux valgus with a special sandal. Zeitschrift Fur Orthopadie Und Ihre Grenzgebiete. 1978; 116(3):404-406.
35. Brantingham JW, Guiry S, Kretzmann HH, Kite VJ, Globe G. A pilot study of the efficacy of a conservative chiropractic protocol using graded mobilization, manipulation and ice in the treatment of symptomatic hallux abductovalgus bunion. Clinical Chiropractic. 2005; 8(3):117-133.
36. Groiso JA: Juvenile Hallux Valgus: a conservative approach to treatment. J Bone Joint Surg Am. 1992;74(9):1367-74.
37. Kitchen S, Bazin S. Clayton’s electrotherapy. 10th edition. London: WB Saunders:276-86. 1996.
38. Kahn J. Principles and practice of electrotherapy. 3rd edition. New York: Churchill Livingstone: 75-105. 1994.
39. Gudas CJ, Marcinko DE. The complex deformity known as hallux abductor valgus. In: Marcmko DE, ed. Comprehensive textbook of hallux valgus reconstruction. St Louis: Mosby, 1992.
40. Mani SB, Brown HC, Nair P, Chen L, Do HT, Lyman S, Deland JT, Ellis SJ. Validation of the Foot and Ankle Outcome Score in Adult Acquired Flatfoot Deformity. Foot Ankle Int. 2013 19. [Epub ahead of print].
41. Chen L, Lyman S, Do H, Karlsson J, Adam SP, Young E, Deland JT, Ellis SJ. Validation of foot and ankle outcome score for hallux valgus. Foot Ankle Int. 2012;33(12):1145-55.
Volume 1, Issue 3 - Serial Number 3
September and October 2012
Pages 41-50
  • Receive Date: 11 July 2011
  • Revise Date: 27 January 2012
  • Accept Date: 07 July 2012
  • First Publish Date: 22 September 2012