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Functional outcomes characterising mild, moderate and severe hallux valgus


Previous studies investigating functional performance and plantar pressures in HV have reported inconsistent findings. This study investigated functional performance, muscle strength and plantar pressures in otherwise healthy adults with mild, moderate and severe HV compared to controls.


Sixty adults with HV and 30 controls participated. Functional measures included: hallux muscle strength, walking performance, postural sway and forefoot plantar pressures. Cluster analysis was used to classify HV subjects as mild, moderate or severe based on radiographic HV angle. Multiple analysis of covariance and pairwise comparisons (P<0.05, Bonferroni adjustment) were used to investigate differences between groups, adjusting for age, gender, body mass index and foot pain.


In those with moderate and severe HV, we found reduced hallux plantarflexion (mean differences (MDs) -50.1N to -45.8N) and abduction strength (MDs -12.3N to -11.2N) compared to controls (P≤0.01). A significant reduction in hallux peak pressure (PP) and pressure-time integral (PTI) was evident in moderate HV (MD: PP -90.8kPa; PTI -18.3kPa*s) and severe HV (MD: PP -106.2kPa, PTI -24.4kPa*s) compared to controls (P<0.01). Those with severe HV demonstrated increased mediolateral postural sway in single leg stance compared to controls (MD 3.5cm, P=0.01). There were no significant differences in walking performance across groups (P>0.05).


Adults with moderate to severe HV may have reduced hallux plantar pressures and muscle strength, whereas those with mild HV appear to function similarly to controls on these parameters. It is important to consider severity of deformity in HV, and target interventions towards specific functional deficits.

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Correspondence to Sheree Nix.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Nix, S., Vicenzino, B. & Smith, M. Functional outcomes characterising mild, moderate and severe hallux valgus. J Foot Ankle Res 6 (Suppl 1), O30 (2013).

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