Early effects of hallux valgus surgery on balance and gait in middle aged and older adults

Podiatrists are playing a major role in fall prevention as foot problems are estimated to affect 30% of community-dwelling older adults (1-4), and are associated with reduced walking speed (1), difficulty performing activities of daily living (1,4,5), and impaired balance (6-9). Hallux valgus specifically is associated with poorer performance during balance and functional tests in older adults (7,8). Patients with bunions demonstrate increased postural sway, decreased maximum balance range, increased time needed to perform alternate step test, increased time for sit-to-stand, and decreased walking speed (7,8). Hallux valgus may also contribute to less rhythmic movements of the upper body when walking on uneven ground (9). Hallux valgus deformity has long been recognized as an important risk factor for falling (10,11-12). Tinetti et al. (10) found that the presence of a “serious foot problem” (which included a moderate to severe bunion deformity) doubled the risk of falling in 336 older adults. Similarly, a prospective study of 979 people older than 70 years in Finland found that hallux valgus was associated with a 2-fold increased risk of falling (11). Using a cross sectional study design, our group also recently reported that early improvements in balance control may be observed after hallux valgus surgery in middle aged patients (8). In this presentation, we describe for the first time the early effects of hallux valgus surgery on balance and gait using an older adult population with 3 months of longitudinal follow up.