Hallux Valgus in a Hospital Population in Kenya

Abstract

Background Hallux Valgus is an irreversible foot deformity that’s often overlooked by the surgeon and medically unknown to the patient. Despite its abundant mention in literature, prevalence is not known and keeps on varying with every article while it’s associations with other foot deformities remains non constant. Being progressive, it’s known to lead to pain & impaired gait if not attended to early. No published literature concerning Hallux Valgus exists in our setup. The purpose of this study was to determine the prevalence of Hallux Valgus in the local population and to evaluate it’s severity and associated foot characteristics. Design Prospective Cross sectional Study Setting PCEA Kikuyu Rehab Hospital Orthopedic out-patient clinics Patients & Methods Persons between the ages 18-65 years who met the outlined criteria were recruited on a simple random basis. A questionnaire was given and clinical examination of the foot done to collect data on demographics, etiological parameters (extrinsic (Footwear/BMI) + Intrinsic (Family History/ Shape of foot, Sex, 1st MTPJ characteristics), pes planus and sensory modalities around the joint. Those who clinically demonstrated a HVA >15o qualified for a weight bearing foot radiograph to measure HVA/IMA/ Sesamoid positioning and joint congruency. Meyers angle was calculated to determine presence of Pes Planus. Data was then analysed using MS Excel and SPSS version 20. Frequency tables were formulated and chi square tests and spearman correlations done on the data together with Relative risk assessment where necessary. P values of 0.05 were considered significant. This was presented in the form of charts, tables and bar graphs. 2 Results A prevalence of 26.6% was recorded for persons between 18-65 years. Mild Hallux Valgus was seen in 56.5% with 37.7% and 5.8% having moderate and severe valgus respectively. Females (55.1%) were more affected than males (44.9%), Family history of Valgus was not an association though 35.7% of those with positive history mentioned their mother as the affected person and had higher risk of getting moderate and severe valgus. BMI was inversely related to prevalence and no associations were seen with flat feet or foot wear use. Severity of hallux valgus increased with age with an increasing proportion of people with hallux valgus as age progressed. Most had Egyptian feet (62.3%) while greek feet were at more risk of developing hallux valgus. No conclusion was reached on the types of metatarsal heads and a positive correlation was seen with altered sensory nerve function along the dorsocutaneous pathway. Data was not conclusive enough to show any statistical significance when it came to associated factors like Age, Sex, Family History, BMI, Footwear, Shape of foot, Shape of metatarsal head. Conclusions and Recommendations The Kenyan population aged 18-65 years has a 26.6% prevalence of Hallux Valgus with more than half of them having mild Hallux Valgus. Females are slightly more affected than males with an inverse relation of BMI to the prevalence and increasing proportion of Hallux valgus with advancing age. No significance was seen with flat feet, footwear, shape of feet, metatarsal heads, sex, age and family history with a positive correlation with altered dorsocutaneous sensory pathway. Lack of awareness of this condition and subsequent health seeking behaviors need to be looked into. Longer surveillance periods with larger sample populations are recommended with biomechanical studies to fully ascertain the role of footwear.