Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, RJ, Brasil.
Midwest Orthopedics at Rush (MOR), Chicago, IL, USA.
Foot Ankle Int. 2023 Aug;44(8):763-777. doi: 10.1177/10711007231166667. Epub 2023 Apr 21.
Foot pathologies can affect the kinetic chain during gait, leading to altered loading at other joints that can lead to subsequent pathologies. Although hallux valgus is the most common foot disease, little has been discussed about the biokinetic effects of hallux valgus on the foot and lower limb. This systematic review evaluated the kinematic, kinetic, and pedobarographic changes of the hallux valgus foot compared to a healthy one.
Several electronic databases were searched up to January 2022, including only cross-sectional studies with clearly defined isolated hallux valgus diseases and healthy groups. Two investigators independently rated studies for methodological quality using the NIH Study Quality Assessment Tool for cross-sectional studies. Kinetic data were extracted, including temporal data, kinematics of the foot joint, kinematics of the proximal lower limb, and pedobarography. We did meta-analyses tests with a random effects model using the metafor package in R.
Hallux valgus patients walk slower compared to a disease-free control group -0.16 m/s (95% CI -0.27, -0.05). Hallux valgus patients exhibited significantly reduced coronal plane motion of the hindfoot-shank during preswing 1.16 degrees (95% CI 0.31, 2.00). Hallux valgus patients generated less force in the hallux region 33.48 N (95% CI 8.62, 58.35) but similar peak pressures in the hallux compared to controls. Hallux valgus patients generated less peak pressure at the medial and lateral hindfoot as compared to controls: 8.28 kPa (95% CI 2.92, 13.64) and 8.54 kPa (95% CI 3.55, 13.52), respectively.
Although hallux valgus is a deformity of the forefoot, the kinematic changes due to the pathology are associated with significant changes in the range of motion at other joints, underscoring its importance in the kinetic chain. This is demonstrated again with the changes of peak pressure. Nevertheless, more high-quality studies are still needed to develop a fuller understanding of this pathology.
足部病变会影响步态中的动力链，导致其他关节的负荷改变，从而引发后续的病变。尽管拇外翻是最常见的足部疾病，但对于拇外翻对足部和下肢的生物动力学影响却鲜有讨论。本系统评价评估了与健康足相比，拇外翻足的运动学、动力学和足底压力变化。
截至 2022 年 1 月，我们对多个电子数据库进行了检索，仅纳入了明确界定的孤立性拇外翻疾病和健康组的横断面研究。两名调查员使用 NIH 横断面研究质量评估工具独立评估研究的方法学质量。提取动力学数据，包括时间数据、足部关节运动学、近端下肢运动学和足底压力计。我们使用 R 中的 metafor 包进行随机效应模型的荟萃分析测试。
与无疾病对照组相比，拇外翻患者的步行速度较慢-0.16 m/s（95% CI -0.27，-0.05）。拇外翻患者在预摆期时后足-小腿的冠状面运动明显减少 1.16 度（95% CI 0.31，2.00）。拇外翻患者在拇趾区域产生的力较小 33.48 N（95% CI 8.62，58.35），但与对照组相比，拇趾的峰值压力相似。与对照组相比，拇外翻患者在内侧和外侧后足的峰值压力较小：分别为 8.28 kPa（95% CI 2.92，13.64）和 8.54 kPa（95% CI 3.55，13.52）。
尽管拇外翻是前足的一种畸形，但由于该病理导致的运动学变化与其他关节的运动范围显著变化相关，这突显了其在动力链中的重要性。这再次通过峰值压力的变化得到了证明。然而，仍需要更多高质量的研究来更全面地了解这种病理。
