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Comparison of Q Angle in Hallux Valgus and Healthy Individuals

Year 2024, Volume: 11 Issue: 2, 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, Volume: 11 Issue: 2, 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 Volume: 11 Issue: 2

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