The effectiveness of orthotics in reducing hallux valgus angle for patients with mild and moderate hallux valgus

Hallux valgus (HV) is the most common forefoot deformity among females and its prevalence increases with age. There is a lack of information available on the effectiveness of orthotics in clinical practice and there is very limited data published of previous studies on the reduction of hallux valgus angle (HVA) for patients with mild and moderate HV. This research aims to investigate the effectiveness of current orthotics in reducing HVA for patients suffering from mild to moderate HV, and also to develop new advanced orthotics and orthopaedic footwear to treat HV instead of surgical treatment. This research utilised qualitative and quantitative methods to analyse the data to be collected from interviews with podiatrists and orthopaedic consultants. Clinical responses to HV including identification and classification, main causes, recommended treatments, orthotics and their effects of treatments were explored. A further questionnaire survey from 125 HV patients with 250 footprints was carried out for the investigation of major causes for HV and their correlations to HV severity. The major causes to be investigated were age, body weight, foot types, footwear types and footwear fitting. A new manual Measuring Block for measuring HVA has been designed, developed and tested for its accuracy and reliability. The results show that the mean of the difference between the two repeat measurements of the HVA ranged between 0.35° and 0.88° with an average of 0.62°. The Intraclass Correlation Coefficient (ICC) value was 0.995, which indicates excellent reliability, which is recommended to use for HVA measurement in clinics. The findings also show that the ICC between x-ray and the average manual measurements was 0.868 with 95% CI (0.649, 0.947) (p = 0.000). The results showed a good correlation between x-ray and the manual method, therefore, had been achieved so that the new manual Measuring Block for measuring HVA can also be used to predict HVA by x-ray. Current orthotics available on the market were reviewed, and three major types of orthotics were selected for treatment trials on 42 HV feet of 26 HV patients. 12-month trials showed that the biomechanical style Orthotic (Type 1) reduced HVA by 5.05° (95% CI 1.37, 8.73) (p < 0.05) after 12 months of treatment for patients with moderate HV, which could be recommended for patients with moderate HV. The wrap style Orthotic (Type 2) reduced HVA by 2.44° (95% CI 1.39, 3.49) (p < 0.05) for patients with mild HV and by 1.20° (95% CI -0.71, 3.11) (p > 0.05) for moderate HV after 12 months of treatment, which did not provide a significant difference in reducing HVA for mild and moderate HV, making its recommendation difficult. The gel style Orthotic (Type 3) made a big reduction of HVA by 3.08° (95% CI -0.68, 6.83) (p > 0.05) for mild HV after 12 months of treatment. Finally, based on HV patients’ feedback and the results of the evaluation of existing orthotics for HV patients wearing orthotics over 12 months of treatment, new advanced orthotics and orthopaedic footwear were designed and explored. The new designed advanced orthotics and orthopaedic footwear were suggested to treat mild and moderate HV. The findings from the current research made a contribution to the knowledge in HV and will help podiatrists and orthopaedic consultants for HV treatment planning and decision making.

Name dc:type.qualificationname

PhD

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

De Montfort University

Year dc:date.issued

2019

Author dc:creator

• Li, Guoli

Licence

• https://dora.dmu.ac.uk/bitstreams/630944dc-11b9-4324-b62b-052c0726a1d0/download