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Open Access Highly Accessed Research article

Foot pain and functional limitation in healthy adults with hallux valgus: a cross-sectional study

Sheree E Nix12*, Bill T Vicenzino1 and Michelle D Smith1

Author Affiliations

1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, QLD, Australia

2 School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, 4059, QLD, Australia

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BMC Musculoskeletal Disorders 2012, 13:197  doi:10.1186/1471-2474-13-197

Published: 16 October 2012



Hallux valgus (HV) is a very common deformity of the first metatarsophalangeal joint that often requires surgical correction. However, the association between structural HV deformity and related foot pain and disability is unclear. Furthermore, no previous studies have investigated concerns about appearance and difficulty with footwear in a population with HV not seeking surgical correction. The aim of this cross-sectional study was to investigate foot pain, functional limitation, concern about appearance and difficulty with footwear in otherwise healthy adults with HV compared to controls.


Thirty volunteers with HV (radiographic HV angle >15 degrees) and 30 matched controls were recruited for this study (50 women, 10 men; mean age 44.4 years, range 20 to 76 years). Differences between groups were examined for self-reported foot pain and disability, satisfaction with appearance, footwear difficulty, and pressure-pain threshold at the first metatarsophalangeal joint. Functional measures included balance tests, walking performance, and hallux muscle strength (abduction and plantarflexion). Mean differences (MD) and 95% confidence intervals (CI) were calculated.


All self-report measures showed that HV was associated with higher levels of foot pain and disability and significant concerns about appearance and footwear (p < 0.001). Lower pressure-pain threshold was measured at the medial first metatarsophalangeal joint in participants with HV (MD = −133.3 kPa, CI: -251.5 to −15.1). Participants with HV also showed reduced hallux plantarflexion strength (MD = −37.1 N, CI: -55.4 to −18.8) and abduction strength (MD = −9.8 N, CI: -15.6 to −4.0), and increased mediolateral sway when standing with both feet with eyes closed (MD = 0.34 cm, CI: 0.04 to 0.63).


These findings show that HV negatively impacts on self-reported foot pain and function, and concerns about foot appearance and footwear in otherwise healthy adults. There was also evidence of impaired hallux muscle strength and increased postural sway in HV subjects compared to controls, although general physical functioning and participation in physical activity were not adversely affected.

Hallux valgus; Foot pain; Physical function; Footwear