Hallux Valgus from the Physiotherapist Standpoint or Is Hallux Valgus Just a Hallux Deformity?

Authors: J. Kozáková 1;  M. Janura 1,2;  A. Gregorková 3;  Z. Svoboda 1
Authors‘ workplace: Katedra biomechaniky a technické kybernetiky, Fakulta tělesné kultury UP, Olomouc 1;  Katedra rehabilitace, Fakulta zdravotnických studií, Ostravská univerzita, Ostrava 2;  Fakultní nemocnice Ostrava - Poruba 3
Published in: Rehabil. fyz. Lék., 17, 2010, No. 2, pp. 71-77.
Category: Original Papers


Hallux valgus is a complex progressive triplanar forefoot deformity, it characterise by valgus deviation of the big toe, higher varus of the first metatarsus and a medial prominence on its head. The development of this deformity is subsequent. Its risk factors include biomechanical and structural anomalies, systemic diseases, hereditary predispositions, footwear, etc. The hallux and first metatarsophalangeal joint play the main role in a load transmission during walking. The valgus deformity of the big toe is typical first ray dynamic stabilization failure and loss of contact between the first metatarsophalangeal joint surfaces and sesamoid bones. The centralization and stabilization failure of the first metatarsophalangeal joint in the case of hallux valgus deformity does not enable to perform heel-off and toe-off optimally. It could negatively project especially at the end of a pre-swing phase during walking. The clinical examination and early diagnosis play key role in successful therapy. The aim of kinesiotherapy is to recover a hallux and foot function and their submission to function of proximal segments of lower extremities.

Key words:
hallux valgus, gait, diagnosis, kinesiotherapy


1. ALVAREZ, R., HADDAD, R. J., GOULD, N., TREVINO, S.: The simple bunion: anatomy at the metatarsophalangeal joint of the great toe. Foot Ankle, 4, 1984, s. 229.

2. CARL, A., ROSS, S., EVANSKI, P., WAUGH, T.: Hypermobility in hallux valgus. Foot Ankle, 8, 1988, s. 264.

3. COUGHLIN, M. J.: Juvenile hallux valgus: etiology and treatment. Foot Ankle Int, 16, 1995, s. 682.

4. DE CHARDIN, T. P.: The future of man. New York, Doubleday, 1959.

5. DUNGL, P.: Ortopedie. Praha, Grada Publishing, 2005.

6. EUSTACE, S., BYRNE, J. O., STACK, J., STEPHENS, M. M.: Radiographic features that enable assessment of first metatarsal rotation: The role of pronation in hallux valgus. Skeletal Radiology, 22, 1993, 3, s. 153-156.

7. EUSTACE, S., BYRNE, J. O., BEAUSANG, O., CODD, M., STACK, J., STEPHENS, M. M.: Hallux valgus, first metatarsal pronation and collapse of the medial longitudinal arch - a radiological correlation. Skeletal Radiology, 23, 1994, 3, s. 191-194.

8. EUSTACE, S., WILLIAMSON, D., WILSON, M., O’BYRNE, J., BUSSOLARI, L., THOMAS, M., STEPHENS, M., STACK, J., WEISSMAN, B.: Tendon shift in hallux valgus: observations at MR imaging. Skeletal Radiology, 25, 1996, 6, s. 519-524.

9. FRANK, C. J., SATAKE, N., ROBINSON, D. E., GENTCHOS, C. E.: Hallux valgus [online]. Available from: http://emedicine.medscape.com/article/1232902-overview. Updated: Sep. 30, 2009.

10. GAINES, S. S., HALEBIAN, J. D.: Juvenile hallux valgus. The Journal of Foot Surgery, 22, 1983, 4, s. 290-293.

11. GARROW, A. P., PAPAGEORGIOU, A., SILMAN, A. J., THOMAS, E., JAYSON, M. I. V., MACFARLANE, G. J.: The grading of hallux valgus, the Manchester Scale. Journal of the Američan Podiatric Medical Association, 91, 2001, 2, s. 74-78.

12. GLASOE, W. M., ALLEN, M. K., SALTZMAN, C. L.: First ray dorsal mobility in relation to hallux valgus deformity and first intermetatarsal angle. Foot and Ankle International, 22, 2001, 2, s. 98-101.

13. HAINES, R. W., MCDOUGALL, A.: The anatomy of hallux valgus. J. Bone Joint Surg., 36, 1954, s. 272.

14. HARDY, R. H., CLAPHAM, J. C. R.: Observations on hallux valgus based on a controlled series. J. Bone Joint Surg., 33, 1951, s. 376.

15. HUANG, C. K., KITAOKA, H. B.: Biomechanical evaluation of the longitudinal arch stability. Foot Ankle Int., 14, 1999, s. 353-357.

16. HERMACHOVÁ, H.: Jaké boty? Rehabilitace a fyzikální lékařství, 1998, 1, s. 29-31.

17. HWANG, S. J., CHOI, H. S., LEE, K. T., KIM, Y. H.: 3D motion analysis on the hallux valgus by using a multi-segment foot model. Key Engineering Materials, 326-328, 2006, s. 988-991.

18. INCEL, N. A., GENC, H., ERDEM, H. R., YORGANCIOGLU, Z. R.: Muscle imbalance in hallux valgus - An electromyographic study. Am. J. Phys. Med. Rehabil., 82, 2003, 5, s. 345-349.

19. JANDA, V., VÁVROVÁ, M.: Senzomotorická stimulace. Rehabilitácia, 25, 1992, 3, s. 14-34.

20. JANURA, M., CABELL, L., SVOBODA, Z., KOZÁKOVÁ, J., GREGORKOVÁ. A.: Kinematic analysis of gait in patients with juvenile hallux valgus deformity. Journal of Biomechanical Science and Engineering, 2 (Suppl. 1), 36, 2007.

21. KILMARTIN, T. E., WALLACE, W. A.: The significance of pes planus in juvenile hallux valgus. Foot Ankle, 13, 1992, 53.

22. KLAUE, K., HANSEN, S. T., MASQUELET, A. C.: Clinical, quantitative assessment of first tarsometatarsal mobility in the sagittal plane and its relation to hallux valgus deformity. Foot Ankle Int, 15, 1994, 9.

23. KOLÁŘ, P.: Systematizace svalových dysbalancí z pohledu vývojové kineziologie. Rehabilitace a fyzikální lékařství, 8, 2001, s. 152-164.

24. KUČERA, M., KORBELÁŘ, P, KOLÁŘ, P., LINZ, R.: Noha – jeden z limitujících faktorů výkonnosti. Med. Sport. Boh. Slov., 3, 1994, s. 114-119.

25. LEWIT, K.: Manipulační léčba. 4. vyd. Heidelberg-Leipzig: J. A. Barth Verlag, 1996. s. 11–17.

26. LORIMER, D. L., FRENCH, G., O‘DONNELL, M., BURROW, J. G., WALL, B. (Eds.): Neale‘s disorders of the foot 7th Ed). Churchill Livingstone Edinburgh, 2005.

27. MACLENNAN, R.: Prevalence of hallux valgus in a neolithic New Guinea population. Lancet, 25, 1966, 1, s. 1398-1400.

28. MAFART, B.: Hallux valgus in a historical French population: Paleopathological study of 605 first metatarsal bones. Joint Bone Spine, 74, 2007, 2, s. 166-170.

29. MANCUSO, J. E., ABRAMOW, S. P., LANDSMAN, M. J., WALDMAN, M., CARIOSCIA, M.: The zero-plus first metatarsal and its relationship to bunion deformity. J. Foot Ankle Surg., 42, 2003, 6, s. 319-326.

30. MENZ, H. B., LORD, S. R.: Gait instability in older people with hallux valgus. Foot Ankle Int., 26, 2005, 6, s. 483-489.

31. MYERSON, M. S., EDWARDS, W. H. B.: The etiology and pathogenesis of hallux valgus. Foot Ankle Clin., 2, 2007, s. 583-598.

32. NASHNER, L. M., CORDO, P. J.: Relation of postural responses and reaction-time voluntary movements in human leg muscles. Exp. Brain Res., 44, 1981, s. 395-405.

33. PIGGOTT, H.: The natural history of hallux valgus in adolescence and early adult life. J. Bone Joint Surg., 42B, 1960, s. 749.

34. PIQUÉ-VIDAL, C., SOLÉ, M. T., ANTICH, J.: Hallux valgus inheritance: Pedigree research in 350 patients with bunion deformity. J. Foot Ankle Surg., 46, 2007, 3, s. 149-154.

35. RICHARDSON, E. G., GRAVES, S. C., MCCLURE, J. T., BOONE, R. T.: First metatarsal head-shaft angle: a method of determination. Foot Ankle, 14, 1993, s. 181.

36. ROBINSON, A. H., LIMBERS, J. P.: Modern concepts in the treatment of hallux valgus. J. Bone Joint Surg. Br., 87, 2005, s. 1038-1045.

37. SANDERS, A. P., SNIJDERS, C. J., VAN LINGE, B.: Medial deviation of the first metatarsal head as a result of flexion forces in hallux valgus. Foot Ankle, 13, 1992, s. 515.

38. SARAGAS, N. P., BECKER, P. J.: Comparative radiographic analysis of parameters in feet with and without hallux valgus. Foot Ankle Int., 16, 1995, s. 139.

39. SHRINE, I. B.: Incidence of hallux valgus in a partially shoe-wearing community. Br. Med. J., 1, 1965, s. 1648.

40. SIM-FOOK, L., HODGSON, A. R.: A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. J. Bone Joint Surg., 40A, 1958, s. 1058.

41. TANAKA, Y., TAKAKURA, Y., KUMAI, T., SAMOTO, N., TAMAI, S.: Radiographic analysis of hallux valgus. A two-dimensional coordinate system. J. Bone Joint Surg., 77A, 1995, s. 205.

42. THOMAS, S., BARRINGTON, R.: Hallux valgus. Current Orthopaedics, 17, 2003, 4, s. 299-307.

43. TORKKI, M.: Surgery for hallux valgus. 2005. [online]. [cit.2009-11-25]. The World Wide. Dostupné z WWW: http://ethesis.helsinki.fi/julkaisut//aa/kliin/vk/torkki/ surgeryf.pdf.

44. TRUSLOW, W.: Metatarsus primus varus or hallux valgus? J. Bone Joint Surg., 7, 1925, s. 98.

45. UCHIYAMA, E., KITAOKA, H. B., LUO, Z. P., GRANDE, J. P., KURA, H., AN, K. N.: Pathomechanics of hallux valgus: Biomechanical and immunohistochemical study. Foot Ankle Int., 26, 2005, 9, s. 732-738.

46. VAŘEKA, I., VAŘEKOVÁ, R.: Klinická typologie nohy. Rehabilitace a fyzikální lékařství, 2003, 3, s. 94-102.

47. VÉLE, F.: Kineziologie pro klinickou praxi. 1. vyd., Praha, Grada Publishing, 1997. ISBN 80-85424-98-7.

48. WALDECKER, U.: Pedographic analysis of hallux valgus deformity. Foot Ankle Surg., 2004, 10, s. 121-124.

49. WONG, Y. S.: Influence of the abductor hallucis muscle on the medial arch of the foot: A kinematic and anatomical cadaver study. Foot Ankle Int., 28, 2007, 5, s. 617-620.

Physiotherapist, university degree Rehabilitation Sports medicine
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