New research determined that an increase in the severity of hallux valgus, or bunion deformity, progressively reduced both general and foot-specific health related quality of life (HRQOL). Bunion deformity was found in 36% of the study population and occurred more frequently in women and older individuals. Pain in other parts of the body beyond the foot was associated with increased bunion severity. Details of this UK population-based study appear in the March issue of Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.
Hallux valgus is a common foot condition that is caused when the big toe bends in towards the smaller toes. This condition develops over time and is accompanied by a painful soft tissue and boney protrusion, commonly known as a bunion. As the deformity progresses the lateral displacement of the hallux (big toe) begins to interfere with normal alignment and function of the smaller toes, leading to further deformities such as hammer toe or claw toe, altered weight-bearing patterns, and the development of corns and calluses. Family history, wearing high heeled shoes or shoes that are too narrow, and flat footedness have all been suggested to contribute to the development of bunions.
In the current study, Associate Professor Hylton Menz of La Trobe University in Melbourne, Australia, and colleagues at the Arthritis Research UK Primary Care Centre, Keele University examined the prevalence of and factors associated with hallux valgus, and assessed the severity of deformity on general and foot-specific HRQOL in a UK older adult population. Researchers collected information on 2,831 participants who were 56 years of age or older from the Medical Research Council funded North Staffordshire Osteoarthritis Project. Study subjects were asked to complete the Medical Outcomes Study Short Form 36 (SF-36) health survey and the Manchester Foot Pain and Disability Index (FPDI). The team established five severity grades of hallux valgus, corresponding to the angle of deformity of 0, 15, 30, 45, and 60 degrees, with one representing no angle and five indicating the most severe deformity.
Results showed that slightly more than one third of the respondents to the health survey had some degree of hallux valgus. The prevalence of bunion deformity was greater in women and increased with age. Researchers also noted that participants with hallux valgus exhibited lower SF-36 scores, indicating greater impairment. In participants who reported foot pain in the past 12 months, those with bunion deformity had a higher FPDI score in both the pain and function subscales which is indicative of greater impairment.
The study authors found that the impact of increasing hallux valgus severity on HRQOL is independent of age, sex, education, BMI, and pain in other regions, and extends beyond pain and physical function to affect general health, vitality, social function, and mental health. "Our findings indicate that hallux valgus is a significant and disabling musculoskeletal condition that affects overall quality of life," concluded Menz. "Interventions to correct or slow the progression of the deformity offer patients beneficial outcomes beyond merely localized pain relief."
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"Impact of Hallux Valgus Severity on General and Foot-Specific Health-Related Quality of Life." Hylton B. Menz, Edward Roddy, Elaine Thomas, and Peter R. Croft. Arthritis Care and Research; Published Online: November 10, 2010 (DOI: 10.1002/acr.20396); Print Issue Date: March 2011