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Foot & AnkleFurther Opinion

The prevalence of hallux valgus and its association with foot pain and function in a rural Korean community

NH Cho, S Kim, D-J Kwon, HA Kim

J Bone Joint Surg [Br] 2009;91-B:494-9.


This is an excellent paper determining both the prevalence of hallux valgus and its association with pain and functional status in 563 subjects in a Korean population.

More than 130 operations have been described for the treatment of hallux valgus. There has been an explosion in the number of different screws and plates designed to fix different osteotomies.1 There remains however a paucity of data linking hallux valgus with pain and functional status

The prevalence of hallux valgus in this group of subjects, 65%, is higher than in previously reported groups (12% to 56%). The high prevalence has been linked to changes in footwear.  The link between footwear and hallux valgus has long been established.

A total of 13% had a hallux valgus angle greater than 25°.

Foot pain was reported in 10% of subjects questioned of whom 77% had hallux valgus. In subjects without hallux valgus only 6.5% reported foot pain.

The physical function domain of the SF-36, the foot health functional status as assessed by the FHSQ and self assessment of the foot condition were all statistically significantly worse in subjects with moderate or greater degrees of hallux valgus.

What is particularly interesting in this paper is that the subjects were all from the Ansung Community a rural farming community. Their footwear is likely to be different to those who live in cities. Their subjective responses may also be different to city dwelling communities.

It should be possible in this group of subjects to undertake a prospective follow-up as suggested to assess the rate of progression/deterioration of both the hallux valgus deformity and its effects on pain and functional status over time, a question commonly asked by patients.

Changes in footwear in developing communities will present new health issues. The effects of footwear are not confined to adults however. Rao and Joseph2 in a study of 2300 children aged 4 to 13 years in India found that the prevalence of flat foot deformity was 8.6% in shod children compared to 2.8% in unshod children. Sim-Fook and Hodgson3 noted that in the unshod foot, subjects had well developed arches, the forefoot had a tendency to spread and the great toe showed a remarkable degree of pre-hensile strength since it was often used to hold fishing nets and lines.

It is unlikely however we will ever revert to being unshod. The challenge remains to create footwear that is both comfortable and protective, respects the cultural and social issues we have grown to accept but at the same time reduces the incidence of static foot deformities associated with Western style footwear.


1. Robinson AHN, Limbers JP. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg [Br] 2005;87-B:1038-1045.
2. Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. J Bone Joint Surg [Br] 1992;74-B:525-527.
3. Sim-Fook L, Hodgson AR. A comparison of foot forms among the non shoe and shoe wearing chinese population. J Bone Joint Surg [Br] 1958;40:1058-1062.


Harris N

Leeds, United Kingdom