Comparison of Static and Dynamic Balance in Female Athletes with and without Hallux Valgus

Transcription

1 International Journal of Sport Studies. Vol., 4 (12), , 2014 Available online at http: ISSN ; Science Research Publications Comparison of Static and Dynamic Balance in Female Athletes with and without Hallux Valgus Haniyeh Aryadoost*, Mohammad Hosain Alizadeh Department of Pathology and Sports Medicine, Faculty of Physical Education and sport Sciences, Tehran University, Tehran, Iran *Corresponding author, hany.aryadoost@gmail.com Abstract Hallux valgus (HV) which is defined by the medial deviation of the first metatarsal and the lateral deviation of the proximal phalanges is a common condition in women that may lead to a considerable pain and disability. There is evidence that HV may impair balance, though it is yet unknown how HV affects balance and big toe pain in athletes. The purposes of this study were to compare static and dynamic balance in female athletes with and without HV and examine the correlation between the big toe pain and the level of deformity. Thirty female athlete students from the Faculty of Physical Education and Sport Sciences of Tehran University with average age 21.13±2. 01 years and average body mass index ±1. 71 were selected and categorized based on HV angle into two groups: group1 including 15 athletes with normal foot, with HV mean angle of ±1. 38 and Group 2 including 15 athletes with HV mean angle of ± For measuring the samples HV angle a goniametre and a self-assessment tool called Manchester scale were used. The unilateral forefoot balance test as the static test and the Y balance test as the dynamic test were done in groups and the results were compared by independent t-test. The visual analogue scale also was used to assess the severity of pain in HV group. All the tests were done using the SPSS computer package version 17. Results: The results showed no significant difference in dynamic and static balance between two groups (P>0.05), and no significant correlation between big toe pain and the severity of the condition in athletes with HV (P>0.05). Conclusions: This study showed that HV does not affect static and dynamic balance in female athletes and it does not cause the big toe pain significantly. Keywords: Hallux valgus, dynamic balance, Static balance, Athlete, Big toe pain 1473 Introduction Balance control is important in standing, walking, and during daily activities (Ghoseiri Et al, 2009). Coaches and sports medicine professionals generally agree that athletes should possess good balance in order to be successful at their sport. Balance is defined as the ability to maintain the Center of Body Mass over the base of support (Brumitt, 2008). Balance is one of the important components of motor fitness (Bull, Et al, 2000). The ability to maintain balance comes from the integration of visual, vestibular, and proprioceptive neural input to the central nervous system (Nashner, 1993). Protection of balance in body occurs through the lower extremity joints which keep the body weight (18). The design of the anatomical structures of foot creates strength, flexibility and coordinated movement. Also, the toes make a wide surface for the body balance and moving it forward (khodadad,

2 2005). Hallux valgus is a deformity of the first metatarsophalangeal joint. It is characterized by lateral drift of the great toe in association with joint subluxation (Gilheany Et al, 2008; Phillips, 1994). Hardy and Clapham (1951, 1952) in extensive radiological studies on presumed normal subjects found that the mean valgus deviation of the great toe was l4 degrees at the age of 14 to 15 years and 15.7 degrees in young adults; therefore, in the present study the valgus of less than 15 degrees, has been considered normal(hardy, Clapham, 1952,1951). Piggott (1960) reported the age of occurrence of the deformity in the teens or earlier (Piggott, 1960). Occurrence rates forthe condition reported in the literature vary, almost four to 44 percent of women and two to 22 percent of men face the abnormality and it is twice more common in women than in men(abhishek, Roddy, Zhang, Doherty, 2010). Habib Honary (2003) studied the prevalence of the deformity among Iranian national athletes aged between 12 and 20 and stated that the most prevalence rates of hallux valgus is seen among weight lifters with 46% and the least prevalence rate is seen among gymnasts with 15% (Ghadami, 1993). There is evidence that foot deformities including hallux valgus correlate significantly with balance (Hylton, Menz,Stephen, 2001,Menz, Lord, 2005,Menz, Morris, Lord, 2005). Menz and Lord (2005) surveyed gait instability in older people with hallux valgus aged between 76 and 84. They measured temporospatial parameters of gait and acceleration patterns of the head and pelvis in 71 people (24 men, 47 women) on both a level surface and a specially designed irregular walkway (Menz, Lord, 2005). They reported that subjects with moderate to severe hallux valgus were found to exhibit significant reduction in gait patterns that may contribute to instability and risk of falling in older people, particularly when walking on irregular terrain compared to subjects with no or mild hallux valgus. In another study, foot problem assessments were performed on 135 community-dwelling older people aged between 78.8 and 83 years in conjunction with clinical tests of balance and functional ability by Menz et al. (2001). One of the foot conditions was hallux valgus which had a higher prevalence in women. There were no differences in performance between subjects with and without hallux valgus although subjects with severe hallux valgus as greater than 45 of abduction performed significantly worse on the coordinated stability tests (Hylton Et al, 2001). To determine the population prevalence and examine factors associated with hallux valgus in a primary care population, Roddy et al. (2008) assigned a self-report tool of hallux valgus assessment to a group of adults aged above 30 years in England. The questionnaire asked about big toe pain, gender and knee pain, and other factors. A total of 13,684 questionnaires were sent out to participants and 4,249 (32%) responses were received. The results showed that hallux valgus correlated with big toe pain and age (Roddy Et al, 2008). Cho et al. (2009) studied the prevalence of hallux valgus and its association with foot pain and function in a rural Korean community. A total of 563 participants were examined, using the foot health status questionnaire, the Short Form-36 questionnaire, and weight-bearing anteroposterior radiographs. Hallux valgus (HV) was present in 364 subjects (64.7%), 48 (13.2%) of whom had moderate or greater deformity, which is defined as a hallux valgus angle greater than 25. This was significantly associated with pain (Cho Et al, 2009). This brief review of literature stresses the probable impact of hallux valgus deformity on balance and functional impairment, though the correlation between hallux valgus and the big toe pain in women athletes with this health condition is yet unknown. The prime objectives of this study are to compare the static and dynamic balance in women athletes with and without hallux valgus and determine the correlation between the deformity and the big toe pain. Materials and Methods The present study is based around descriptions, comparisons, and correlation analysis. Thirty (30) female athletes aged between19 and 27 with the average body mass index between 18.5 and 24.5 were categorized into two groups. Group1: 15 athletes with normal feet, with HV mean angle of between 10 and 15. Group2: 15 athletes with HV mean angle between 16 and 29. The inclusion criteria included: female athletes of 19 to 27 years of age with the body mass index between 18.5 and 24.5 who had three years of experience in sports and had exercised three days a week in the past six months without any injuries in recent years and hallux rigidus. All participants had mild to moderate degrees of flat feet because HV highly correlates with pesplanus. HV angle was measured by a goniametre and a self-assessment tool called Manchester scale. To determine the severity of hallux valgus using the Manchester scale, the researcher placed the photographs alongside subjects weight-bearing feet, and selected which photograph most closely resembled their degree of hallux valgus. In this research, this scale was used for screening (Menz, 2010, Menz, Munteanu, 2005). 1474

3 Figure 1: Manchester scale A goniameter was used for measuring the HV angle (Rajabi, Samadi, 2008). The participants stood on their feet in the anatomical situation and the goniameter was placed on their metatarso-phalangeal joint so that the axis of it was on the joint and the stable arm on the first metatarsus and the moving arm along the center of the big toe. The angle formed between these two arms was recorded as the HV angle. The angle more than 15 degrees considered abnormal. Axis of goniameter: The first metatarsophalageal joint Moving arm: Along the center of the big toe Stable arm: The first metatarsal Figure 2: Measurement of HV angle by goniometr For identifying flat feet, two procedures were used. The rare angle of foot (between Achilles tendon and Calcaneous bone) and the footprint scale were applied. Then, the participants performed the Y balance test and the unilateral forefoot balance test for measuring the dynamic and static balance, respectively, and for determining the severity of pain in HV group the VAS pain scale was used. Kolmogorov-Smirnov test for setting the normality of data distribution and Levene s test for homogeneity of variances were carried out. For comparing the differences in group results, an independent t-test was used and the relationship between the severity of deformity and the big toe pain was examined through the Pearson correlation test ( α= 0.05). All the tests were carried out on SPSS computer package, Version 17. The unilateral forefoot balance test as the static test and the Y balance test as the dynamic test were undertaken and the results were compared by an independent t-test. In addition, the visual analogue scale was used to assess the severity of pain in HV group. 1475

4 Results Table 1: Comparison of the Mean Scores of Static Tests Row Groups Static balance (mean±sd) p value 1 With hallux valgus 22.89± Without hallux valgus 21.25± As Table 1 presents, comparing the mean value of static test in groups showed that the athletes who had hallux valgus were slightly more able in performing the unilateral forefoot balance test, but the difference was not significant. Table 2: Difference between Dynamic Balance Row Groups Dynamic balance (mean±sd) p value 1 With hallux valgus 81.34± Without hallux valgus 77.68± Table 2 reports the results of another independent t-test comparing the mean score of the static balance of the athletes with and without hallux valgus. The magnitude of the p value indicates that there is no statistically significant difference between the mean scores. Table 3: Correlation between HV angle and big toe pain Row Groups mean±sd p value 1 hallux valgus angle 20.93± Severity of pain 1.46± Table 3 demonstrates the correlation between the amount of pain in athletes and their hallux valgus. The magnitude of correlation which is too low and the p value which is big indicate that there is no statistically significant association between the two variables. Discussion and Conclusion The first and the second hypotheses were postulated to determine the difference between static and dynamic balance of women athletes with and without hallux valgus, which was measured by the examination of Y balance test for assessing dynamic balance and the forefoot balance test as a static test. We did not find a significant difference between results, though there was a slight superiority in the results of athletes with HV. This finding contradicts with Menz and Lord s (2005) study, who reported that participants with moderate to severe hallux valgus had a significant decrease in gait pattern and balance. However, our findings are resonator with Menz and Lord s finding that state participants with mild hallux valgus and no hallux valgus had no difference in results. The athletes in our research with hallux valgus had mild to moderate hallux valgus with mean angle of 20 (eight participants with mild and seven participants with moderate hallux valgus). It is likely that this deformity is a risk factor in the balance of elderly and non-athlete rather than in young individuals who are physically active and fit. In addition, the results of our study agree with Menz et al (2001) who did not find any difference in the tests taken, though participants with HV mean angle more than 45 degrees showed a significant weak performance in balance tests. 1476

5 In the present study where participants achieved better scores in balance tests, we can ascribe our findings to the reliance of weight on other phalangeal joins. It is likely that the athletes in our HV group, who had dislocated their first metatarsophalangeal joint in the past, had applied more force to other phalangeal joints, reinforced the other joints, and had better performance in the tests. Another possibility is that the HV group might have had more degrees of flat feet, because this condition leads to better balance as previous research shows (Hoseini, 2007), although another research has reported no effect of flat feet on static balance (Alizadeh Et al, 2008). Future research should investigate this speculation. As noted above, painful joints constitute limiting conditions in athletes performance (Pedowitz, Pedowitz, 2007). Since the incidence of this deformity is reported to associate with getting the first metatarsophalangeal joint painful (Cho Et al, 2009, Roddy Et al, 2008), one of the purposes of this study was to determine the relationship between the deformity and the big toe pain. We used the visual analogue scale and the HV participants with big toe pain (they reported that after walking or exercising for long hours they felt pain in their big toe). Five out of 15 participants reported big toe pain, four had moderate, and one had mild deformity. As test results show, this correlation was not significant because the (P<0.05). The result of our study does not agree with Roddy et al. (2008). It may be that the concept of pain had not been discerned by the participants in Roddy et al. s study similarly. That is, there is a possibility that all the participants had not figured out the questions in the same way and, therefore, reported any pain in the foot to the big toe pain. Also, the result of this study is different from the study of Cho et al. (2009) likely due to the age differences of the participants, the sample size, and the average HV angle of participants. This study showed that this abnormality is not always with pain or at least we could not find a correlation between hallux valgus and big toe pain. This study set out to investigate the relations among hallux valgus, pain, and balance of female Iranian athletes. We found that hallux valgus is not a hindering factor in static and dynamic balance of young women athletes; also,hallux valgus deformity might not always associate with big toe pain. The study simply boils down to a few pieces of suggestion. People with hallux valgus should not miss their chances for participating in (professional) sports and physical activities or doing physical exercise. We suggest that coaches should not regard this deformity as a barrier against sport performance and balance of athletes and should obviate excluding athletes with hallux valgus deformity from participating in sports fields, unless they have severe health issues. In addition, this deformity cannot be always associated with big toe pain, though pain is a possible symptom of this disorder. The effect of treatment should not be neglected if the pain precludes full performance. Conflict of interest The authors declare no conflict of interest References Abhishek A, Roddy E, Zhang W, Doherty M, Are hallux valgus and big toe pain associated with impaired quality of life? Across sectional study. Osteoarthritis and Cartilage. [brief report].1-4. Alizadeh MH, Rayisee J, Shirzad A, Bagheri L, Comparison of standing balance between athletes and nonathletes with pesplanus and normal foot under altered sensory condition. The journal of human motor science; 2: Brumitt J, Assessing Athletic Balance with the Star Excursion Balance Test. nsca s performance training journal.7(3):6-7. Bull R, Rascoe J, Rascoe D, Physical education and the study of sport. 4 th ed. Harcourt publishers limited. Cho NH, Kim S, Kwon DJ, Kim HA, The prevalence of hallux valgus and its association with foot pain and function in a rural Korean community. Journal of Bone and Joint Surgery British.91(4): Ghadami AA, Determining the abnormalities of lower extremety of secondary school boy ages 11 to 15 and presenting corrective and motor recommendations; Tehran University; Ghoseiri K, Forogh B, Sanjari MA, Bavi A, Effect of vibratory orthosis on balance in idiopathic Parkinson s disease, disability and rehabilitation. Disability and Rehabilitation, Assistive Technology; 4(1): Gilheany MF, Landorf KB, Robinson P, Hallux valgus and hallux rigidus: a comparison of impact on healthrelated quality of life in patients presenting to foot surgeons in Australia. Journal of Footand Ankle Research;(1):14. Hardy RH, Clapham JC, Observations on hallux valgus based on a controlled series. The Journal of Bone and Joint Surgery British volume;33 B:

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