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01-12-2013 | Review | Uitgave 1/2013 Open Access

Journal of Foot and Ankle Research 1/2013

Gait parameters associated with hallux valgus: a systematic review

Journal of Foot and Ankle Research > Uitgave 1/2013
Sheree E Nix, Bill T Vicenzino, Natalie J Collins, Michelle D Smith
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1757-1146-6-9) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

All authors contributed equally to the conception and design of this study. SEN conducted literature searches, quality rating, data extraction, statistical analysis and drafted the manuscript. NJC also rated studies for methodological quality. BTV, NJC and MDS contributed to data interpretation and critical revision of the manuscript. All authors read and approved the final manuscript.



Hallux valgus (HV) has been linked to functional disability and increased falls risk in older adults. However, specific gait alterations in individuals with HV are unclear. This systematic review investigated gait parameters associated with HV in otherwise healthy adults.


Electronic databases (Medline, Embase, CINAHL) were searched to October 2011, including cross-sectional studies with clearly defined HV and non-HV comparison groups. Two investigators independently rated studies for methodological quality. Effect sizes (95% confidence intervals (CI)) were calculated as standardized mean differences (SMD) for continuous data and risk ratios (RR) for dichotomous data.


Nine studies included a total of 589 participants. Three plantar pressure studies reported increased hallux loading (SMD 0.56 to 1.78) and medial forefoot loading (SMD 0.62 to 1.21), while one study found reduced first metatarsal loading (SMD −0.61, CI −1.19 to −0.03) in HV participants. HV participants demonstrated less ankle and rearfoot motion during terminal stance (SMD −0.81 to −0.63) and increased intrinsic muscle activity (RR 1.6, 1.1 to 2.2). Most studies reported no differences in spatio-temporal parameters; however, one study found reduced speed (SMD −0.73, -1.25 to −0.20), step length (SMD −0.66 to −0.59) and less stable gait patterns (SMD −0.86 to −0.78) in older adults with HV.


HV impacts on particular gait parameters, and further understanding of potentially modifiable factors is important for prevention and management of HV. Cause and effect relationships cannot be inferred from cross-sectional studies, thus prospective studies are warranted to elucidate the relationship between HV and functional disability.

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Extra materiaal
Additional file 1: Results from quality assessment using the Epidemiological Appraisal Instrument (9 included studies). (XLSX 12 KB)
Additional file 2: Selected characteristics of included studies. (XLSX 12 KB)
Authors’ original file for figure 1
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