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      Transfer of plantar pressure from the medial to the central forefoot in patients with hallux valgus

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          Abstract

          Background

          The aim of the study was to evaluate changes in plantar pressure distribution in feet affected by hallux valgus compared with their contralateral non-affected feet and with the feet of healthy control subjects.

          Methods

          Thirty-six patients with unilateral hallux valgus who were indicated for surgery and 30 healthy subjects were assessed on a pedobarographic instrumented treadmill for step length and width, mean stance phase, and plantar foot pressure distribution. Plantar pressure distribution was divided into eight regions.

          Results

          Significantly higher plantar pressures were observed in hallux valgus feet under the second and third metatarsal heads ( p = .033) and the fourth and fifth toes ( p < .001) than in the healthy control feet. Although decreased pressures were measured under the hallux in affected feet (197 [82–467] kPa) in contrast to the contralateral side (221 [89–514] kPa), this difference failed to reach statistical significance ( p = .055). The gait parameters step width, step length, and single-limb support did not show any differences between hallux valgus and control feet.

          Conclusion

          Although the literature on changes in plantar pressures in hallux valgus remains divided, our findings on transferring load from the painful medial to the central and lateral forefoot region are consistent with the development of transfer metatarsalgia in patients with hallux valgus.

          Electronic supplementary material

          The online version of this article (10.1186/s12891-019-2531-2) contains supplementary material, which is available to authorized users.

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          Most cited references30

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          A kinematic and kinetic comparison of overground and treadmill walking in healthy subjects.

          Gait evaluation protocols using instrumented treadmills will be increasingly used in the near future. For this reason, it must be shown that using instrumented treadmills will produce measures of the ground reaction force adequate for inverse dynamic analysis, and differences between treadmill and overground gait must be well characterized. Overground walking kinetics were estimated with the subjects walking at their self-selected comfortable walking speed. For the treadmill gait trials, the subjects walked on two treadmills, such that heel-strike occurred on the forward treadmill and toe-off occurred on the trailing treadmill. The treadmill was set to the average overground walking speed. Overground and treadmill data were evaluated using Vicon Plug-in Gait. The differences between the maxima and minima of kinematic and kinetic parameters for overground and treadmill gait were evaluated. The kinematics of treadmill and overground gait were very similar. Twelve of 22 kinematic parameter maxima were statistically significantly different (p<0.05), but the magnitude of the difference was generally less than 2 degrees . All GRF maxima were found to be statistically significantly smaller for treadmill versus overground gait (p<0.05) as were 15 of 18 moment, and 3 of 6 power maxima. However, the magnitude of the differences was comparable to the variability in normal gait parameters. The sagittal plane ankle moments were not statistically different for treadmill and overground gait. We have shown that treadmill gait is qualitatively and quantitatively similar to overground gait. Differences in kinematic and kinetic parameters can be detected in matched comparisons, particularly in the case of kinetic parameters. However, the magnitudes of these differences are all within the range of repeatability of measured kinematic parameters. Thus, the mechanics of treadmill and overground gait are very similar. Having demonstrated the essential equivalence of treadmill and overground gait, it is now possible for clinical movement analysis to take advantage of treadmill-based protocols.
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            Prevalence of foot and ankle conditions in a multiethnic community sample of older adults.

            The prevalence of foot and ankle disorders was determined in a community-based, multiethnic (non-Hispanic White, African American, and Puerto Rican) random sample of 784 community-dwelling adults aged 65 or more years in 2001-2002 in Springfield, Massachusetts. Overall, the five most common conditions were toenail disorders (74.9%), lesser toe deformities (60.0%), corns and calluses (58.2%), bunions (37.1%), and signs of fungal infection, cracks/fissures, or maceration between toes (36.3%); 30.9% had some tenderness to palpation of the foot or ankle, and 14.9% had ankle joint pain on most days in the past 4 weeks. Toenail conditions, fungal symptoms, and ulcers or lacerations were more common in men, while bunions and corns and calluses were more common in women (p < 0.001). Significant racial/ethnic differences, independent of education or gender, were found for the prevalence of most toe deformities and flat feet, as well as for corns and calluses, fungal signs, edema, ankle joint pain, tenderness to palpation, and sensory loss. Foot and ankle disorders are common in these older adults. Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention.
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              Prevalence and correlates of foot pain in a population-based study: the North West Adelaide health study

              Background Few population-based studies have examined the prevalence of foot pain in the general community. The aims of this study were therefore to determine the prevalence, correlates and impact of foot pain in a population-based sample of people aged 18 years and over living in the northwest region of Adelaide, South Australia. Methods The North West Adelaide Health Study is a representative longitudinal cohort study of n = 4,060 people randomly selected and recruited by telephone interview. The second stage of data collection on this cohort was undertaken between mid 2004 and early 2006. In this phase, information regarding the prevalence of musculoskeletal conditions was included. Overall, n = 3,206 participants returned to the clinic during the second visit, and as part of the assessment were asked to report whether they had pain, aching or stiffness on most days in either of their feet. Data were also collected on body mass index (BMI); major medical conditions; other joint symptoms and health-related quality of life (the Medical Outcomes Study Short Form 36 [SF-36]). Results Overall, 17.4% (95% confidence interval 16.2 – 18.8) of participants indicated that they had foot pain, aching or stiffness in either of their feet. Females, those aged 50 years and over, classified as obese and who reported knee, hip and back pain were all significantly more likely to report foot pain. Respondents with foot pain scored lower on all domains of the SF-36 after adjustment for age, sex and BMI. Conclusion Foot pain affects nearly one in five of people in the community, is associated with increased age, female sex, obesity and pain in other body regions, and has a significant detrimental impact on health-related quality of life.
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                Author and article information

                Contributors
                ulf.hofmann@med.uni-tuebingen.de
                marco.goetze@med.uni-heidelberg.de
                ina3004@gmx.net
                otto.mueller@med.uni-tuebingen.de
                markus.wuenschel@med.uni-tuebingen.de
                falk.mittag@med.uni-tuebingen.de
                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                1471-2474
                9 April 2019
                9 April 2019
                2019
                : 20
                : 149
                Affiliations
                [1 ]ISNI 0000 0001 0196 8249, GRID grid.411544.1, Department of Orthopaedic Surgery, , University Hospital Tübingen, ; Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
                [2 ]ISNI 0000 0001 0328 4908, GRID grid.5253.1, Department of Orthopaedic and Trauma Surgery, , University Hospital Heidelberg, ; Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
                [3 ]Orthopädische Gemeinschaftspraxis am Ludwigsplatz, Waldstraße 67, 76133 Karlsruhe, Germany
                Author information
                http://orcid.org/0000-0003-0589-6654
                Article
                2531
                10.1186/s12891-019-2531-2
                6454622
                30961591
                6220d884-04a7-4721-9133-1239bfad2abc
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 April 2018
                : 26 March 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Orthopedics
                hallux valgus,pedobarography,treadmill,plantar pressure distribution,gait analysis
                Orthopedics
                hallux valgus, pedobarography, treadmill, plantar pressure distribution, gait analysis

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