Comparison of foot function, physical performance, and quality of life between women with and without symptomatic bilateral hallux valgus deformity

Hallux valgus deformity (HV), which is among the most common foot deformities in adulthood, has been associated with impaired quality of life and function [1–4]. On the other hand, not only the presence of HV but also unilateral or bilateral involvement and whether it is painful or not may affect self-reported and performance-based measures [1,4]. Do foot function, physical performance, and quality of life differ between women with and without symptomatic bilateral HV? Forty-four women with bilateral HV (average HV angle for dominant foot=27.98±9.51° and for non-dominant foot=29.48±9.12°, average age=37.68±12.1 years, average BMI=25.30±5.17 kg/m2) and forty-three controls (average age=37.47±10.35 years, average BMI=24.87±4.52 kg/m2) were included. The HV angles of women presenting to orthopedic outpatient clinics with HV complaints were calculated from weight-bearing dorsoplantar radiographs. Women having HV angles equal to or greater than 15° in both feet were included in the HV group, also severity of HV was classified according to the HV angle of the dominant foot as mild (15-20°), moderate (21-39°), and severe (equal or greater than 40°). Volunteer women classified using the Manchester scale as normal were included in the control group. Foot pain and foot function were assessed using the Foot Function Index (FFI) and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal Joints Scale (AOFAS Hallux MTF-IP). To assess physical performance, the time required to complete the following tasks was measured: (1) Walking 10 meter-walkway, (2) ascending ten stairs as fast as possible, and (3) descending ten stairs as fast as possible. Also, single-limb stance time with eyes-open was measured for both limbs. The Manchester-Oxford Foot Questionnaire was used to assess health-related quality of life. The Mann-Whitney U test was used to compare women with and without HV, also the Kruskal-Wallis test with Dunn’s post-hoc test was used to compare women with mild HV (n=16), moderate HV (n=19), and severe HV (n=9). Women with HV had poorer foot function, physical performance, and quality of life than those without HV according to the subscores and total scores of all assessment tools (p<0.05). Women with mild HV had less foot pain according to AOFAS Hallux MTF-IP and better foot function according to both AOFAS Hallux MTF-IP and FFI than those with severe HV (p<0.05). Furthermore, women with mild HV also had better foot function according to AOFAS Hallux MTF-IP than those with moderate HV (p<0.05). No difference was found between women with moderate and severe HV (p>0.05). Women with symptomatic bilateral HV had poorer self-reported foot function, self-reported quality of life, and physical performance. Furthermore, self-reported foot function differed between women with mild HV and moderate to severe HV, and the mild HV group had better foot function than the moderate HV and severe HV groups.