Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072, Australia.
Osteoarthritis Cartilage. 2012 Oct;20(10):1059-74. doi: 10.1016/j.joca.2012.06.007. Epub 2012 Jul 5.
Factors associated with the development of hallux valgus (HV) are multifactorial and remain unclear. The objective of this systematic review and meta-analysis was to investigate characteristics of foot structure and footwear associated with HV.
Electronic databases (Medline, Embase, and CINAHL) were searched to December 2010. Cross-sectional studies with a valid definition of HV and a non-HV comparison group were included. Two independent investigators quality rated all included papers. Effect sizes and 95% confidence intervals (CIs) were calculated (standardized mean differences (SMDs) for continuous data and risk ratios (RRs) for dichotomous data). Where studies were homogeneous, pooling of SMDs was conducted using random effects models.
A total of 37 papers (34 unique studies) were quality rated. After exclusion of studies without reported measurement reliability for associated factors, data were extracted and analysed from 16 studies reporting results for 45 different factors. Significant factors included: greater first intermetatarsal angle (pooled SMD = 1.5, CI: 0.88-2.1), longer first metatarsal (pooled SMD = 1.0, CI: 0.48-1.6), round first metatarsal head (RR: 3.1-5.4), and lateral sesamoid displacement (RR: 5.1-5.5). Results for clinical factors (e.g., first ray mobility, pes planus, footwear) were less conclusive regarding their association with HV.
Although conclusions regarding causality cannot be made from cross-sectional studies, this systematic review highlights important factors to monitor in HV assessment and management. Further studies with rigorous methodology are warranted to investigate clinical factors associated with HV.
拇外翻（HV）的发病因素是多因素的，目前仍不清楚。本系统评价和荟萃分析的目的是研究与 HV 相关的足部结构和鞋类特征。
检索电子数据库（Medline、Embase 和 CINAHL）至 2010 年 12 月。纳入有 HV 明确定义和非 HV 对照组的横断面研究。两位独立研究者对所有纳入的文献进行质量评价。计算效应大小和 95%置信区间（连续数据为标准化均数差（SMD），二分类数据为风险比（RR））。如果研究同质，采用随机效应模型进行 SMD 合并。
共有 37 篇文献（34 项独立研究）进行了质量评价。排除了未报告相关因素测量可靠性的研究后，从 16 项报告了 45 个不同因素结果的研究中提取和分析数据。显著相关的因素包括：第一跖骨间角更大（合并 SMD=1.5，CI：0.88-2.1），第一跖骨更长（合并 SMD=1.0，CI：0.48-1.6），第一跖骨头呈圆形（RR：3.1-5.4）和外侧籽骨移位（RR：5.1-5.5）。关于临床因素（如第一跖骨活动度、扁平足、鞋类）与 HV 的相关性，结果不太明确。
虽然横断面研究不能得出因果关系的结论，但本系统评价突出了 HV 评估和管理中需要监测的重要因素。需要进一步开展方法严谨的研究来调查与 HV 相关的临床因素。
