Structural factors associated with hallux limitus/rigidus: a systematic review of case control studies.
METHODS
Systematic review of case control studies.


OBJECTIVE
To identify and analyze demographic and structural factors associated with hallux limitus/rigidus.


METHODS
A literature search was conducted across several electronic databases (Medline, EMBASE, CINAHL, and PubMed) using the following terms: hallux limitus, hallux rigidus, metatarsophalangeal joint, and big toe. Methodological quality of included studies was evaluated using the Quality Index. To evaluate the magnitude of differences between cases and controls, odds ratios were calculated for dichotomous variables and effect sizes (Cohen d) were calculated for continuous variables.


RESULTS
The methodological quality of the 7 included studies was moderate, with Quality Index scores ranging from 6 to 11 out of a possible score of 14. The overall mean age for the case group was 44.8 years (mean range, 23.4-54.9 years) and for the control group was 39.6 years (mean range, 23.4-58.8 years). There was a similar distribution of males and females across case and control groups. All studies used plain film radiography to assess foot structure. Cases were found to have a dorsiflexed first metatarsal relative to the second metatarsal, a plantar flexed forefoot on the rearfoot, reduced first metatarsophalangeal joint range of motion, a longer proximal phalanx, distal phalanx, medial sesamoid, and lateral sesamoid, and a wider first metatarsal and proximal phalanx. Measures of foot posture and arch height were not found to substantially differ between cases and controls.


CONCLUSIONS
This review of case control studies indicates that several variables pertaining to the structure of the first metatarsophalangeal joint may be associated with hallux limitus/rigidus. These findings have implications for the conservative and surgical treatment of the condition.
Zammit
Gerard V
GV
Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Victoria, Australia. g.zammit@latrobe.edu.au
Menz
Hylton B
HB
Munteanu
Shannon E
SE
D005529:Foot Bones / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D020857:Hallux Limitus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020859:Hallux Rigidus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology