title: Gait parameters associated with hallux valgus: a systematic review.
abstract: BACKGROUND
  Hallux valgus (HV) has been linked to functional disability and increased falls risk in older adults. However, specific gait alterations in individuals with HV are unclear. This systematic review investigated gait parameters associated with HV in otherwise healthy adults.
  
  
  METHODS
  Electronic databases (Medline, Embase, CINAHL) were searched to October 2011, including cross-sectional studies with clearly defined HV and non-HV comparison groups. Two investigators independently rated studies for methodological quality. Effect sizes (95% confidence intervals (CI)) were calculated as standardized mean differences (SMD) for continuous data and risk ratios (RR) for dichotomous data.
  
  
  RESULTS
  Nine studies included a total of 589 participants. Three plantar pressure studies reported increased hallux loading (SMD 0.56 to 1.78) and medial forefoot loading (SMD 0.62 to 1.21), while one study found reduced first metatarsal loading (SMD -0.61, CI -1.19 to -0.03) in HV participants. HV participants demonstrated less ankle and rearfoot motion during terminal stance (SMD -0.81 to -0.63) and increased intrinsic muscle activity (RR 1.6, 1.1 to 2.2). Most studies reported no differences in spatio-temporal parameters; however, one study found reduced speed (SMD -0.73, -1.25 to -0.20), step length (SMD -0.66 to -0.59) and less stable gait patterns (SMD -0.86 to -0.78) in older adults with HV.
  
  
  CONCLUSIONS
  HV impacts on particular gait parameters, and further understanding of potentially modifiable factors is important for prevention and management of HV. Cause and effect relationships cannot be inferred from cross-sectional studies, thus prospective studies are warranted to elucidate the relationship between HV and functional disability.
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. s.nix@qut.edu.au.
authors.forename: Sheree E
authors.initials: SE
authors.lastname: Nix
authors.forename: Bill T
authors.initials: BT
authors.lastname: Vicenzino
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Collins
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Smith