On walking, balance and pressure distribution of the physiotherapy program in patients with symptomatic and asymptomatic Hallux valgus

The aim of this study is to investigate the effect of combined physiotherapy program on gait, balance, postural sway and pressure distribution in symptomatic and asymptomatic female hallux valgus (HV) patients. The research was carried out with 62 women between the ages of 30 and 65 who were diagnosed with HV in Fırat University Hospital, Department of Physical Medicine and Rehabilitation. Individuals were divided into two groups according to their pain levels. According to the Visual Analogue Scale (VAS), those who scored above 3 points were determined as Group 1 (n=31), and those who scored below 3 points were determined as Group 2 (n=31). The same physiotherapy program including strengthening, stretching, ROM exercises and mobilization techniques was applied to both groups for 8 weeks, 3 days a week. Hallux valgus angle with goniometric measurement; gait analysis, balance and plantar pressure distribution by Win-Track foot pressure plate; the impact of ankle-related problems on daily life with the FAOS foot-ankle research; quality of life with the Manchester Oxford Foot Questionnaire; the effect of pain in the foot on foot function with the Foot Function Index; shoe assesment with Shoe Evaluation Scale; Functional exercise capacity was evaluated with the 6-minute walk test before and after the treatment. After the physiotherapy program, the right and left HV angles decreased in Group 1 (p<0.05), while the left HV angle decreased in Group 2 (p<0.05), no change in the right HV angle was observed (p>0.05). When the differences in HV angle were compared, there was no difference between the groups (p>0.05). After the physiotherapy program, pain decreased in both groups, while quality of life and ADL levels increased (p<0.05). When the differences were compared, it was found that the difference obtained in Group 1 in all three parameters was more than Group 2 (p<0.05). After the physiotherapy program, a decrease was observed in the amount of energy consumed in both groups (p>0.05), but no difference was observed between the groups when the differences were compared (p>0.05). No change was observed after training and when the differences were compared in terms of other time-distance characteristics of gait (p>0.05). In the balance parameter, no change was observed in the foot angle after treatment in both groups (p>0.05), while a decrease in the mean sway velocity was determined (<0.05). When the balance parameter differences were compared, no difference was found between the groups (p>0.05). After the physiotherapy program, the mean foot pressure, which is one of the plantar pressure parameters, decreased in Group 1 (p>0.05), but no change was observed in Group 2 (p>0.05). No change was observed in other parameters of plantar pressure after the physiotherapy program in both groups (p>0.05), and when the differences were compared, the differences in both groups were found to be similar (p>0.05). It was determined that the physiotherapy program we applied was more effective in HV patients with pain in terms of HV angle, pain, quality of life, and ADL, but was not effective in painful and painless HV patients in terms of other parameters. We think that it would be beneficial to apply combined physiotherapy programs in order to improve HV angle, pain, quality of life, and ADL parameters, especially in painful HV patients. Keywords: Hallux valgus, pain, gait, balance, plantar pressure.