The Association between Hallux Valgus and Proximal Joint Alignment in Young Female Dancers

Abstract

Very little is known about the relationship between proximal joint alignment and hallux valgus among young dancers. This study sought to determine the extent to which spinal and lower extremity alignments are involved in hallux valgus, and to identify predicting variables for its development in young dancers. A group of 1336 young female dancers aged 8-16 years, and 226 control participants of the same age cohort were screened for the presence of hallux valgus, body physique characteristics, joint range of motion, and anatomical anomalies. Hallux valgus was common in the 2 young female populations studied. Among the dancers, 40.0% had bilateral hallux valgus and 7.3% unilateral. Among the controls, 32.3% had bilateral and 1.8% unilateral hallux valgus (χ2=8.27, df=1, p=0.004). Following logistic regression analysis, age (OR=1.028, 95% CI=0.968-1.091), genu varum (OR=1.514; CI=1.139-2.013) and scoliosis (OR=2.089; CI=1.113-3.921) were found to be significant predicting factors for hallux valgus in the dancer group, whereas in the control group, the predicting factors were age (OR=0.911, 95% CI=0.801-1.036) and ankle plantar flexion range of motion (OR=0.972; CI=0.951-0.992). In conclusion, it was found that spinal deformity, lower extremity alignment, and joint range of motion are strongly related to hallux valgus.

Correlation between degree of hallux valgus and kinematics in classical ballet: A pilot study

“…Similarly, we did not find a significant correlation between the hallux valgus angle and the knee-foot alignment in the transverse plane (Fig 3). These kinematic characteristics are thought to be inappropriate ballet techniques that can exacerbate injuries, including hallux valgus [6,13,14,16] that is now common knowledge among ballet dancers and educators. Therefore, there is a possibility that the participants with hallux valgus might have performed such inappropriate ballet techniques at earlier stages of their careers, but had modified these inappropriate ballet techniques at the time of the experiment, considering their relatively advanced level of ballet (i.e., advanced college-level).…”

“…In conventional clinical practice, hallux valgus is diagnosed when the hallux valgus angle (i.e., the angle between the longitudinal axes of the proximal phalanx of the great toe and the first metatarsophalangeal bone) is greater than 15 degrees [4]. Etiological studies of hallux valgus have revealed that it results from complex factors, including proximal joint malalignment [5,6], hypermobility [7][8][9][10], footwear [11], inheritance [12], and/or inappropriate movement technique [13]. Morbidity of hallux valgus is reported to be higher in dancers of various dance PLOS ONE PLOS ONE | https://doi.org/10.1371/journal.pone.0231015 April 6, 2020 1 / 10 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111…”

“…styles whose basic techniques are based on classical ballet [6]. It is a serious medical concern, as it affects dancers' performance and career.…”

“…One of the inappropriate movement techniques in classical ballet that is said to exacerbate injuries, including hallux valgus, is forced turnout [6,[13][14][15]. Appropriate turnout should be accomplished by external rotation of hip joint [16].…”

Between-side Comparisons of Iliotibial Band Flexibility and the Tibial Torsion Angle in Subjects with an Asymmetric Hallux Valgus Angle

“…Hallux valgus (HV) is a progressive foot deformity characterized by lateral deviation of the first metatarsal creating an apex (a deformity) at the first metatarsalphalangeal joint, with or without medial soft tissue enlargement of the first metatarsal head (bunion). 1,2,3 The prevalence of HV ranges from 12 to 70% in the general population. 4,5 Nix et al (2010) reported pooled prevalence estimates for HV of 23% in adults aged 18-65 years and 35.7% in those aged>65 years.…”