Wong Duo Wai-Chi, Chow Esther Man-Wai, Liyeung Lucci Lugee, Wang Jiao, Mak Toby Chi-To, Cheung James Chung-Wai, Ni Ming, Leung Aaron Kam-Lun
Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong, China.
J Foot Ankle Res. 2025 Sep;18(3):e70073. doi: 10.1002/jfa2.70073.
Hallux valgus is a common foot deformity that may alter plantar pressure distribution. This study aimed to determine whether hallux valgus consistently reduces medial forefoot (hallux and medial metatarsal) load and impulse through a meta-analysis of plantar pressure data and increases central metatarsal loading.
A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Web of Science, Scopus, CINAHL, and Embase were searched for studies comparing plantar pressure distribution between hallux valgus and non-hallux valgus feet. Random-effects meta-analyses were performed using standardized mean differences (SMD) for load (force and pressure) and impulse (force and pressure-time integrals) measures in hallux, medial metatarsal, and central metatarsal regions. Risk of bias was assessed using the JBI critical appraisal checklist for analytical cross-sectional studies.
Twenty-one studies (3911 participants and 6407 feet) were included. In-shoe measurements showed significant reductions in hallux loading (force SMD: -0.78 [95% CI: -1.08, -0.49]; force-time integral SMD: -0.39 [-0.71, -0.07]). Platform-based measurements yielded inconsistent results. No conclusive evidence was found for reduced medial metatarsal loading or increased central metatarsal loading. Measurement modality significantly influenced results, with platform-based systems generally showing higher heterogeneity than in-shoe sensors. Nine (43%) and 12 studies (57%) had a high risk of bias on statistical analysis and confounder management, respectively.
Hallux valgus is associated with reduced hallux loading in in-shoe measurements, but evidence for load redistribution to other forefoot regions is inconclusive. The choice of measurement modality significantly impacts results, highlighting the need for standardized assessment protocols in hallux valgus research.
This study was registered in PROSPERO with the reference number CRD42024574195.
拇外翻是一种常见的足部畸形，可能会改变足底压力分布。本研究旨在通过对足底压力数据的荟萃分析，确定拇外翻是否始终会降低前足内侧（拇趾和第一跖骨）负荷和冲量，并增加中跖骨负荷。
按照PRISMA指南进行系统评价和荟萃分析。在PubMed、Web of Science、Scopus、CINAHL和Embase中检索比较拇外翻足与非拇外翻足之间足底压力分布的研究。使用标准化均数差（SMD）对拇趾、第一跖骨和中跖骨区域的负荷（力和压力）以及冲量（力和压力-时间积分）测量进行随机效应荟萃分析。使用JBI分析性横断面研究的关键评价清单评估偏倚风险。
纳入21项研究（3911名参与者和6407只脚）。鞋内测量显示拇趾负荷显著降低（力SMD：-0.78 [95% CI：-1.08，-0.49]；力-时间积分SMD：-0.39 [-0.71，-0.07]）。基于平台的测量结果不一致。未发现第一跖骨负荷降低或中跖骨负荷增加的确凿证据。测量方式对结果有显著影响，基于平台的系统通常比鞋内传感器显示出更高的异质性。分别有9项（43%）和12项（57%）研究在统计分析和混杂因素管理方面存在高偏倚风险。
在鞋内测量中，拇外翻与拇趾负荷降低有关，但关于负荷重新分布到其他前足区域的证据尚无定论。测量方式的选择对结果有显著影响，突出了拇外翻研究中标准化评估方案的必要性。
本研究已在PROSPERO注册，注册号为CRD42024574195。
