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Comparison of Q Angle in Hallux Valgus and Healthy Individuals

Year 2024, , 577 - 587, 02.08.2024
https://doi.org/10.21020/husbfd.1424616

Abstract

Objectives: To compare the Q angle in individuals with hallux valgus (HV) and healthy individuals and to explore the correlation between HV and Q angle.
Materials and Methods: In this cross-sectional study, 15 individuals with HV (HV group-mean age: 41.60 ± 18.66 years) and 15 healthy individuals without HV with similar characteristics (Control group-mean age: 39.80 ± 8.59 years) participated. Hallux valgus angle (HVA) and Q angle were measured with a universal goniometer while demographic information was recorded.
Results: No significant difference was found between the Q angle values on both the right and left sides in the HV group and the control group (p=0.056, Effect Size (ES)=0.730; p=0.376, ES=0.331, respectively). A weak positive correlation was found between the right-sided HV and right-sided Q angles of the study participants (r=0.446, p=0.013). When the relationship was analyzed according to the groups, a moderate positive correlation was found between right-sided HV and right-sided Q angles in the control group (r=0.533, p=0.041).
Conclusion: There is a relationship, albeit weak, between HVA and Q angle in individuals with HV and healthy individuals. HVA should be taken into consideration when evaluating lower extremity alignment.

References

  • Aglietti, P., Insall, J. N., & Cerulli, G. (1983). Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res (176), 217-224. https://www.ncbi.nlm.nih.gov/pubmed/6851329
  • Caylor, D., Fites, R., & Worrell, T. W. (1993). The Relationship between Quadriceps Angle and Anterior Knee Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy, 17(1), 11-16. https://doi.org/DOI 10.2519/jospt.1993.17.1.11
  • Condon, F., Kaliszer, M., Conhyea, D., T, O. D., Shaju, A., & Masterson, E. (2002). The first intermetatarsal angle in hallux valgus: an analysis of measurement reliability and the error involved. Foot Ankle Int, 23(8), 717-721. https://doi.org/10.1177/107110070202300807
  • Coughlin, M. J. (1995). Roger A. Mann Award. Juvenile hallux valgus: etiology and treatment. Foot Ankle Int, 16(11), 682-697. https://doi.org/10.1177/107110079501601104
  • Coughlin, M. J., & Freund, E. (2001). Roger A. Mann Award. The reliability of angular measurements in hallux valgus deformities. Foot Ankle Int, 22(5), 369-379. https://doi.org/10.1177/107110070102200503
  • Coughlin, M. J., & Jones, C. P. (2007). Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int, 28(7), 759-777. https://doi.org/10.3113/FAI.2007.0759
  • Fournier, M., Saxena, A., & Maffulli, N. (2019). Hallux Valgus Surgery in the Athlete: Current Evidence. J Foot Ankle Surg, 58(4), 641-643. https://doi.org/10.1053/j.jfas.2018.04.003
  • Gaston, M. S., Rutz, E., Dreher, T., & Brunner, R. (2011). Transverse plane rotation of the foot and transverse hip and pelvic kinematics in diplegic cerebral palsy. Gait Posture, 34(2), 218-221. https://doi.org/10.1016/j.gaitpost.2011.05.001
  • Gerlach, U. J., & Lierse, W. (1990). Functional construction of the superficial and deep fascia system of the lower limb in man. Acta Anat (Basel), 139(1), 11-25. https://doi.org/10.1159/000146973
  • Griffin, L. Y., Agel, J., Albohm, M. J., Arendt, E. A., Dick, R. W., Garrett, W. E., Garrick, J. G., Hewett, T. E., Huston, L., Ireland, M. L., Johnson, R. J., Kibler, W. B., Lephart, S., Lewis, J. L., Lindenfeld, T. N., Mandelbaum, B. R., Marchak, P., Teitz, C. C., & Wojtys, E. M. (2000). Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg, 8(3), 141-150. https://doi.org/10.5435/00124635-200005000-00001
  • Haim, A., Yaniv, M., Dekel, S., & Amir, H. (2006). Patellofemoral pain syndrome: validity of clinical and radiological features. Clin Orthop Relat Res, 451, 223-228. https://doi.org/10.1097/01.blo.0000229284.45485.6c
  • Hardy, R. H., & Clapham, J. C. (1951). Observations on hallux valgus; based on a controlled series. J Bone Joint Surg Br, 33-B (3), 376-391. https://doi.org/10.1302/0301-620X.33B3.376
  • Janssen, D. M., Sanders, A. P., Guldemond, N. A., Hermus, J., Walenkamp, G. H., & van Rhijn, L. W. (2014). A comparison of hallux valgus angles assessed with computerised plantar pressure measurements, clinical examination and radiography in patients with diabetes. J Foot Ankle Res, 7, 33. https://doi.org/10.1186/1757-1146-7-33
  • Kothari, A., Dixon, P. C., Stebbins, J., Zavatsky, A. B., & Theologis, T. (2016). Are flexible flat feet associated with proximal joint problems in children? Gait Posture, 45, 204-210. https://doi.org/10.1016/j.gaitpost.2016.02.008
  • Livingston, L. A., & Mandigo, J. L. (1997). Bilateral within-subject Q angle asymmetry in young adult females and males. Biomed Sci Instrum, 33, 112-117. https://www.ncbi.nlm.nih.gov/pubmed/9731345
  • Menz, H. B., Dufour, A. B., Riskowski, J. L., Hillstrom, H. J., & Hannan, M. T. (2013). Association of planus foot posture and pronated foot function with foot pain: the Framingham foot study. Arthritis Care Res (Hoboken), 65(12), 1991-1999. https://doi.org/10.1002/acr.22079
  • Merchant, A. C., Fraiser, R., Dragoo, J., & Fredericson, M. (2020). A reliable Q angle measurement using a standardized protocol. Knee, 27(3), 934-939. https://doi.org/10.1016/j.knee.2020.03.001
  • Messier, S. P., Davis, S. E., Curl, W. W., Lowery, R. B., & Pack, R. J. (1991). Etiologic factors associated with patellofemoral pain in runners. Med Sci Sports Exerc, 23(9), 1008-1015. https://www.ncbi.nlm.nih.gov/pubmed/1943620
  • Nguyen, A. D., Boling, M. C., Levine, B., & Shultz, S. J. (2009). Relationships Between Lower Extremity Alignment and the Quadriceps Angle. Clinical Journal of Sport Medicine, 19(3), 201-206. https://doi.org/DOI 10.1097/JSM.0b013e3181a38fb1
  • Nguyen, A. D., & Shultz, S. J. (2007). Sex differences in clinical measures of lower extremity alignment. J Orthop Sports Phys Ther, 37(7), 389-398. https://doi.org/10.2519/jospt.2007.2487
  • Nix, S., Smith, M., & Vicenzino, B. (2010). Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res, 3, 21. https://doi.org/10.1186/1757-1146-3-21
  • Ozguclu, E., Kilic, E., & Kaymak, B. (2008). A knee osteoarthritis connected with hallux valgus-related pes planus. J Biomech, 41(16), 3523-3524. https://doi.org/10.1016/j.jbiomech.2008.08.021
  • Pique-Vidal, C., & Vila, J. (2009). A geometric analysis of hallux valgus: correlation with clinical assessment of severity. J Foot Ankle Res, 2, 15. https://doi.org/10.1186/1757-1146-2-15
  • Plichta, S. B., & Kelvin, E. A. (2013). Munro's statistical methods for health care research (6th ed.). Lippincott Williams & Wilkins.
  • Powers, C. M. (2003). The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther, 33(11), 639-646. https://doi.org/10.2519/jospt.2003.33.11.639
  • Rao, S., Song, J., Kraszewski, A., Backus, S., Ellis, S. J., Deland, J. T., & Hillstrom, H. J. (2011). The effect of foot structure on 1st metatarsophalangeal joint flexibility and hallucal loading. Gait Posture, 34(1), 131-137. https://doi.org/10.1016/j.gaitpost.2011.02.028
  • Ray, J. J., Friedmann, A. J., Hanselman, A. E., Vaida, J., Dayton, P. D., Hatch, D. J., Smith, B., & Santrock, R. D. (2019). Hallux Valgus. Foot Ankle Orthop, 4(2), 2473011419838500. https://doi.org/10.1177/2473011419838500
  • Robinson, A. H., Cullen, N. P., Chhaya, N. C., Sri-Ram, K., & Lynch, A. (2006). Variation of the distal metatarsal articular angle with axial rotation and inclination of the first metatarsal. Foot Ankle Int, 27(12), 1036-1040. https://doi.org/10.1177/107110070602701207
  • Sato, T., Mochizuki, T., Katsumi, R., & Takahashi, Y. (2020). Functionally Oriented Alignment of the Lower Extremity Reflecting the Direction of Gait for Healthy Elderly, Knee Osteoarthritis, and Total Knee Arthroplasty Subjects. Journal of Medical and Biological Engineering, 40(6), 887-898. https://doi.org/10.1007/s40846-020-00569-w
  • Schulthies, S. S., Francis, R. S., Fisher, A. G., & Van de Graaff, K. M. (1995). Does the Q angle reflect the force on the patella in the frontal plane? Phys Ther, 75(1), 24-30. https://doi.org/10.1093/ptj/75.1.24
  • Shih, K. S., Chien, H. L., Lu, T. W., Chang, C. F., & Kuo, C. C. (2014). Gait changes in individuals with bilateral hallux valgus reduce first metatarsophalangeal loading but increase knee abductor moments. Gait Posture, 40(1), 38-42. https://doi.org/10.1016/j.gaitpost.2014.02.011
  • Shih, Y. F., Chen, C. Y., Chen, W. Y., & Lin, H. C. (2012). Lower extremity kinematics in children with and without flexible flatfoot: a comparative study. Bmc Musculoskeletal Disorders, 13, 31. https://doi.org/Artn 31 10.1186/1471-2474-13-31
  • Skouras, A. Z., Kanellopoulos, A. K., Stasi, S., Triantafyllou, A., Koulouvaris, P., Papagiannis, G., & Papathanasiou, G. (2022). Clinical Significance of the Static and Dynamic Q-angle. Cureus, 14(5), e24911. https://doi.org/10.7759/cureus.24911
  • Smith, J. T., & Bluman, E. M. (2014). Hallux valgus and hallux varus. In Orthopaedic Knowledge Update: Foot and Ankle (5th ed., pp. 183-191). Rosemont: American Academy of Orthopaedic Surgeons.
  • Steinberg, N., Finestone, A., Noff, M., Zeev, A., & Dar, G. (2013). Relationship Between Lower Extremity Alignment and Hallux Valgus in Women. Foot & Ankle International, 34(6), 824-831. https://doi.org/10.1177/1071100713478407
  • Svoboda, Z., Honzikova, L., Janura, M., Vidal, T., & Martinaskova, E. (2014). Kinematic gait analysis in children with valgus deformity of the hindfoot. Acta Bioeng Biomech, 16(3), 89-93. https://www.ncbi.nlm.nih.gov/pubmed/25306973
Year 2024, , 577 - 587, 02.08.2024
https://doi.org/10.21020/husbfd.1424616

Abstract

References

  • Aglietti, P., Insall, J. N., & Cerulli, G. (1983). Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res (176), 217-224. https://www.ncbi.nlm.nih.gov/pubmed/6851329
  • Caylor, D., Fites, R., & Worrell, T. W. (1993). The Relationship between Quadriceps Angle and Anterior Knee Pain Syndrome. Journal of Orthopaedic & Sports Physical Therapy, 17(1), 11-16. https://doi.org/DOI 10.2519/jospt.1993.17.1.11
  • Condon, F., Kaliszer, M., Conhyea, D., T, O. D., Shaju, A., & Masterson, E. (2002). The first intermetatarsal angle in hallux valgus: an analysis of measurement reliability and the error involved. Foot Ankle Int, 23(8), 717-721. https://doi.org/10.1177/107110070202300807
  • Coughlin, M. J. (1995). Roger A. Mann Award. Juvenile hallux valgus: etiology and treatment. Foot Ankle Int, 16(11), 682-697. https://doi.org/10.1177/107110079501601104
  • Coughlin, M. J., & Freund, E. (2001). Roger A. Mann Award. The reliability of angular measurements in hallux valgus deformities. Foot Ankle Int, 22(5), 369-379. https://doi.org/10.1177/107110070102200503
  • Coughlin, M. J., & Jones, C. P. (2007). Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int, 28(7), 759-777. https://doi.org/10.3113/FAI.2007.0759
  • Fournier, M., Saxena, A., & Maffulli, N. (2019). Hallux Valgus Surgery in the Athlete: Current Evidence. J Foot Ankle Surg, 58(4), 641-643. https://doi.org/10.1053/j.jfas.2018.04.003
  • Gaston, M. S., Rutz, E., Dreher, T., & Brunner, R. (2011). Transverse plane rotation of the foot and transverse hip and pelvic kinematics in diplegic cerebral palsy. Gait Posture, 34(2), 218-221. https://doi.org/10.1016/j.gaitpost.2011.05.001
  • Gerlach, U. J., & Lierse, W. (1990). Functional construction of the superficial and deep fascia system of the lower limb in man. Acta Anat (Basel), 139(1), 11-25. https://doi.org/10.1159/000146973
  • Griffin, L. Y., Agel, J., Albohm, M. J., Arendt, E. A., Dick, R. W., Garrett, W. E., Garrick, J. G., Hewett, T. E., Huston, L., Ireland, M. L., Johnson, R. J., Kibler, W. B., Lephart, S., Lewis, J. L., Lindenfeld, T. N., Mandelbaum, B. R., Marchak, P., Teitz, C. C., & Wojtys, E. M. (2000). Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg, 8(3), 141-150. https://doi.org/10.5435/00124635-200005000-00001
  • Haim, A., Yaniv, M., Dekel, S., & Amir, H. (2006). Patellofemoral pain syndrome: validity of clinical and radiological features. Clin Orthop Relat Res, 451, 223-228. https://doi.org/10.1097/01.blo.0000229284.45485.6c
  • Hardy, R. H., & Clapham, J. C. (1951). Observations on hallux valgus; based on a controlled series. J Bone Joint Surg Br, 33-B (3), 376-391. https://doi.org/10.1302/0301-620X.33B3.376
  • Janssen, D. M., Sanders, A. P., Guldemond, N. A., Hermus, J., Walenkamp, G. H., & van Rhijn, L. W. (2014). A comparison of hallux valgus angles assessed with computerised plantar pressure measurements, clinical examination and radiography in patients with diabetes. J Foot Ankle Res, 7, 33. https://doi.org/10.1186/1757-1146-7-33
  • Kothari, A., Dixon, P. C., Stebbins, J., Zavatsky, A. B., & Theologis, T. (2016). Are flexible flat feet associated with proximal joint problems in children? Gait Posture, 45, 204-210. https://doi.org/10.1016/j.gaitpost.2016.02.008
  • Livingston, L. A., & Mandigo, J. L. (1997). Bilateral within-subject Q angle asymmetry in young adult females and males. Biomed Sci Instrum, 33, 112-117. https://www.ncbi.nlm.nih.gov/pubmed/9731345
  • Menz, H. B., Dufour, A. B., Riskowski, J. L., Hillstrom, H. J., & Hannan, M. T. (2013). Association of planus foot posture and pronated foot function with foot pain: the Framingham foot study. Arthritis Care Res (Hoboken), 65(12), 1991-1999. https://doi.org/10.1002/acr.22079
  • Merchant, A. C., Fraiser, R., Dragoo, J., & Fredericson, M. (2020). A reliable Q angle measurement using a standardized protocol. Knee, 27(3), 934-939. https://doi.org/10.1016/j.knee.2020.03.001
  • Messier, S. P., Davis, S. E., Curl, W. W., Lowery, R. B., & Pack, R. J. (1991). Etiologic factors associated with patellofemoral pain in runners. Med Sci Sports Exerc, 23(9), 1008-1015. https://www.ncbi.nlm.nih.gov/pubmed/1943620
  • Nguyen, A. D., Boling, M. C., Levine, B., & Shultz, S. J. (2009). Relationships Between Lower Extremity Alignment and the Quadriceps Angle. Clinical Journal of Sport Medicine, 19(3), 201-206. https://doi.org/DOI 10.1097/JSM.0b013e3181a38fb1
  • Nguyen, A. D., & Shultz, S. J. (2007). Sex differences in clinical measures of lower extremity alignment. J Orthop Sports Phys Ther, 37(7), 389-398. https://doi.org/10.2519/jospt.2007.2487
  • Nix, S., Smith, M., & Vicenzino, B. (2010). Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res, 3, 21. https://doi.org/10.1186/1757-1146-3-21
  • Ozguclu, E., Kilic, E., & Kaymak, B. (2008). A knee osteoarthritis connected with hallux valgus-related pes planus. J Biomech, 41(16), 3523-3524. https://doi.org/10.1016/j.jbiomech.2008.08.021
  • Pique-Vidal, C., & Vila, J. (2009). A geometric analysis of hallux valgus: correlation with clinical assessment of severity. J Foot Ankle Res, 2, 15. https://doi.org/10.1186/1757-1146-2-15
  • Plichta, S. B., & Kelvin, E. A. (2013). Munro's statistical methods for health care research (6th ed.). Lippincott Williams & Wilkins.
  • Powers, C. M. (2003). The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther, 33(11), 639-646. https://doi.org/10.2519/jospt.2003.33.11.639
  • Rao, S., Song, J., Kraszewski, A., Backus, S., Ellis, S. J., Deland, J. T., & Hillstrom, H. J. (2011). The effect of foot structure on 1st metatarsophalangeal joint flexibility and hallucal loading. Gait Posture, 34(1), 131-137. https://doi.org/10.1016/j.gaitpost.2011.02.028
  • Ray, J. J., Friedmann, A. J., Hanselman, A. E., Vaida, J., Dayton, P. D., Hatch, D. J., Smith, B., & Santrock, R. D. (2019). Hallux Valgus. Foot Ankle Orthop, 4(2), 2473011419838500. https://doi.org/10.1177/2473011419838500
  • Robinson, A. H., Cullen, N. P., Chhaya, N. C., Sri-Ram, K., & Lynch, A. (2006). Variation of the distal metatarsal articular angle with axial rotation and inclination of the first metatarsal. Foot Ankle Int, 27(12), 1036-1040. https://doi.org/10.1177/107110070602701207
  • Sato, T., Mochizuki, T., Katsumi, R., & Takahashi, Y. (2020). Functionally Oriented Alignment of the Lower Extremity Reflecting the Direction of Gait for Healthy Elderly, Knee Osteoarthritis, and Total Knee Arthroplasty Subjects. Journal of Medical and Biological Engineering, 40(6), 887-898. https://doi.org/10.1007/s40846-020-00569-w
  • Schulthies, S. S., Francis, R. S., Fisher, A. G., & Van de Graaff, K. M. (1995). Does the Q angle reflect the force on the patella in the frontal plane? Phys Ther, 75(1), 24-30. https://doi.org/10.1093/ptj/75.1.24
  • Shih, K. S., Chien, H. L., Lu, T. W., Chang, C. F., & Kuo, C. C. (2014). Gait changes in individuals with bilateral hallux valgus reduce first metatarsophalangeal loading but increase knee abductor moments. Gait Posture, 40(1), 38-42. https://doi.org/10.1016/j.gaitpost.2014.02.011
  • Shih, Y. F., Chen, C. Y., Chen, W. Y., & Lin, H. C. (2012). Lower extremity kinematics in children with and without flexible flatfoot: a comparative study. Bmc Musculoskeletal Disorders, 13, 31. https://doi.org/Artn 31 10.1186/1471-2474-13-31
  • Skouras, A. Z., Kanellopoulos, A. K., Stasi, S., Triantafyllou, A., Koulouvaris, P., Papagiannis, G., & Papathanasiou, G. (2022). Clinical Significance of the Static and Dynamic Q-angle. Cureus, 14(5), e24911. https://doi.org/10.7759/cureus.24911
  • Smith, J. T., & Bluman, E. M. (2014). Hallux valgus and hallux varus. In Orthopaedic Knowledge Update: Foot and Ankle (5th ed., pp. 183-191). Rosemont: American Academy of Orthopaedic Surgeons.
  • Steinberg, N., Finestone, A., Noff, M., Zeev, A., & Dar, G. (2013). Relationship Between Lower Extremity Alignment and Hallux Valgus in Women. Foot & Ankle International, 34(6), 824-831. https://doi.org/10.1177/1071100713478407
  • Svoboda, Z., Honzikova, L., Janura, M., Vidal, T., & Martinaskova, E. (2014). Kinematic gait analysis in children with valgus deformity of the hindfoot. Acta Bioeng Biomech, 16(3), 89-93. https://www.ncbi.nlm.nih.gov/pubmed/25306973
There are 36 citations in total.

Details

Primary Language English
Subjects Physiotherapy, Rehabilitation
Journal Section Articles
Authors

Kamil Yılmaz 0000-0002-5242-3094

Ayşe Nihal Yurttaş 0000-0002-0069-6525

Early Pub Date July 29, 2024
Publication Date August 2, 2024
Submission Date January 23, 2024
Acceptance Date March 15, 2024
Published in Issue Year 2024

Cite

APA Yılmaz, K., & Yurttaş, A. N. (2024). Comparison of Q Angle in Hallux Valgus and Healthy Individuals. Hacettepe University Faculty of Health Sciences Journal, 11(2), 577-587. https://doi.org/10.21020/husbfd.1424616