Quality of Life in Patients With Untreated and Symptomatic Hallux Valgus

Cross-sectional data from a representative sample of the general population in Japan were analyzed to test the validity of Japanese SF-36 Health Survey scales as measures of physical and mental health. Results from psychometric and clinical tests of validity were compared. Principal components analyses were used to test for the hypothesized physical and mental dimensions of health and the pattern of scale correlations with those components. To test the clinical validity of SF-36 scale scores, self-reports of chronic medical conditions and the Zung Self-Rating Depression Scale were used to create mutually exclusive groups differing in the severity of physical and mental conditions. The pattern of correlations between the SF-36 scales and the two empirically derived components generally confirmed hypotheses for most scales. Results of psychometric and clinical tests of validity were in agreement for the Physical Functioning, Role-Physical, Vitality, Social Functioning, and Mental Health scales. Relatively less agreement between psychometric and clinical tests of validity was observed for the Bodily Pain, General Health, and Role-Emotional scales, and the physical and mental health factor content of those scales was not consistent with hypotheses. In clinical tests of validity, the General Health, Bodily Pain, and Physical Functioning scales were the most valid scales in discriminating between groups with and without a severe physical condition. Scales that correlated highest with mental health in the components analysis (Mental Health and Vitality) also were most valid in discriminating between groups with and without depression. The results of this study provide preliminary interpretation guidelines for all SF-36 scales, although caution is recommended in the interpretation of the Role-Emotional, Bodily Pain, and General Health scales pending further studies in Japan.

Foot problems are common in older people and are associated with impaired balance and functional ability. Few prospective studies, however, have been undertaken to determine whether foot problems are a risk factor for falls. One hundred seventy-six people (56 men and 120 women, mean age 80.1, standard deviation 6.4 years) residing in a retirement village underwent tests of foot and ankle characteristics (including foot posture, range of motion, strength, and deformity) and physiological falls risk factors (including vision, sensation, strength, reaction time, and balance) and were followed for 12 months to determine the incidence of falls. Seventy-one participants (41%) reported falling during the follow-up period. Compared to those who did not fall, fallers exhibited decreased ankle flexibility, more severe hallux valgus deformity, decreased plantar tactile sensitivity, and decreased toe plantarflexor strength; they were also more likely to have disabling foot pain. Discriminant function analysis revealed that decreased toe plantarflexor strength and disabling foot pain were significantly and independently associated with falls after accounting for physiological falls risk factors and age. Foot and ankle problems increase the risk of falls in older people. Interventions to address these factors may hold some promise as a falls prevention strategy.

To investigate the prevalence of foot pain in older people and its association with pathological conditions of the feet and with disability in basic and instrumental activities of daily living. Cross-sectional survey of a community-dwelling older population. A total of 459 subjects, 73% of the population aged 65 years and older living in Dicomano, Florence, Italy. A standardized medical examination was performed by a geriatrician to collect information on the presence of pain, specific problems of the feet, gait, and several indicators of physical health status. Disability in basic and instrumental activities of daily living was evaluated by self-report. The prevalence of foot pain was very high, especially in subjects affected by calluses or corns, hallux deformities, hammer toes, pes planus, and edema and among those who complained of difficulty in looking after the basic needs of the feet. Patients with foot pain needed a greater number of steps and longer time to walk the same distance. Foot pain was associated with a higher prevalence of disability in instrumental activities of daily living, particularly those related to standing and ambulation capacities, but it was not related to higher prevalence of disability in basic activities of daily living. Foot pain is associated with specific conditions of the feet and disability in instrumental activities of daily living. Adequate assessment and treatment of foot problems may prevent foot pain and potentially reduce risk of disability. This hypothesis needs to be tested in longitudinal studies and specific intervention trials.