A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2000. / The purpose of this prospective, randomised, placebo controlled study was to determine the efficacy of strain counterstrain mobilization in patients suffering with painful Hallux Abducto Valgus Bunions (HAVB). The mobilization group received strain counterstrain mobilization while the placebo group received placebo laser. The study involved sixty patients; thirty in each group, which were selected from the general population. Each patient was treated five times within a three week period. / M

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2003. 1 v. (various pagings) / The purpose of this study was to compare two forms of mobilization in the treatment of symptomatic Hallux abductovalgus (bunions).

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to compare two forms of mobilization in the treatment of symptomatic Hallux abductovalgus (bunions). The study was a prospective, randomized clinical trial involving sixty subjects, thirty in each group, which were selected by means of convenience sampling from the general population within the greater Durban area. Group A received a Strain counter-strain mobilization (SCSM) of the first metatarso- phalangeal joint, used in conjunction with cryotherapy. Group B received Brantingham's mobilization (BM) of the first metatarso-phalangeal joint, used in conjunction with cryotherapy. Each group received five treatments over a two-week period and were required to attend a one-week follow up consultation for data collection. Subjective assessment was carried out by means of the Numerical Rating Scale-101 (NRS-101) and the Foot Function Index (FFI). Objective assessment included measuring the pain pressure threshold using a digital algometer, the hallux valgus angle and passive dorsiflexion and plantarflexion of the first metatasal phalangeal joint were also measured using a goniometer. The Hallux-metatarsophalangeal-interphalangeal Scale (HAL) included assessment of both subjective and objective measurements. Subjective and objective assessments were performed and data collected on the first, third, fifth and one week follow up consultations. Statistical analysis was completed at a 95% confidence interval. Inter-group analysis was done, using the Mann-Whitney U-test for subjective data and the unpaired t-test for objective data. Intra-group analysis was carried out using Friedman’s test and Dunn’s procedure. In terms of subjective findings, both groups revealed a statistically significant improvement in terms of pain perception (NRS-101) over the treatment period. Both groups experienced a significant improvement in the Foot Function Index (FFI) in terms of pain and disability. Despite both groups improving, it seemed that Group B (Brantingham’s Mobilization) improved considerably more that Group A ( Strain counter-strain mobilization) when comparing the percentage improvement over the treatment period. / M

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Technikon Natal, 2002. / The purpose of this study was to determine the efficacy of a conservative chiropractic management approach in the treatment of symptomatic hallux abductovalgus (bunions). The study was a prospective, randomised clinical trial involving sixty subjects, thirty in each group, which were selected from the general population. Group A received a conservative chiropractic management approach, encompassing progressive mobilization of the first metatarsophalangeal joint, used in conjunction with cryotherapy and adjustment of all other fixations found in the foot and ankle. Group B received a placebo treatment by means of de-tuned Action Potential Therapy administered to the involved foot. Each group received six treatments over a two-week period and attended a one-week follow up consultation for data collection. Objective assessment was performed by measuring the pressure pain threshold using a digital algometer. Subjective assessment was by means of the Numerical Rating Scale-101 (NRS-101) and the Foot Function Index (FFI). The Hallux-metatarsophalangeal-interphalangeal Scale (HAL) incorporated assessment of both objective and subjective measurements. Assessments were taken at the first, third, sixth and one week follow-up consultations, for all the subjective and objective data. Statistical analysis was completed under the supervision of Mr K. Thomas at . the Technikon Natal, at a 95% confidence interval. The parametric two-sampled paired t-test, the Friedman's test and the Dunn's post test were used to analyse the data within each group (intra-group analysis), whilst the parametric two-sampled unpaired t-test and the non-parametric Mann Whitney unpaired U-test were used to analyse the data between the two groups (inter-group analysis). / M

[Truncated abstract] Limitation of sagittal plane dorsiflexion, or hallux limitus (HL), represents the second most commonly encountered pathomechanical disorder affecting the first metatarsophalangeal joint, after hallux valgus (HV). The kinematic role of the first metatarsophalangeal joint represents an integral component of the gait cycle. It has often been reported that for adequate leverage and propulsion to occur during normal gait, the hallux must be able to dorsiflex approximately 65° on the head of the first metatarsal. Secondary gait compensation mechanisms have often been observed clinically as a result of HL. The effect of HL on gait can be reflected in transverse plane alteration of the foot in relation to the line of progression during gait, defined as the angle of gait (AOG). The first purpose of this study served to investigate potential differences in dynamic angle of gait AOG in subjects with HL compared to a control group. A validated technique using coloured powdered footprints was used to quantify AOG. Furthermore, it was required to establish whether the relative amount of transverse plane motion observed in the AOG was related to factors intrinsic or extrinsic to the foot. Intrinsic factors such as the amount of forefoot to rearfoot abduction was considered, and achieved by measuring the rearfoot to forefoot axis (RFA) angle using a weight bearing composite (COMP) view radiograph. The remaining objectives of the study served to investigate other common aetiological factors associated with HL and their potential influence on AOG in subjects with HL ... Results further indicated that the amount of first metatarsophalangeal joint dorsiflexion did not appear to influence AOG in the two groups, and that AOG did not reflect the iii amount of forefoot to rearfoot abduction in a foot with HL compared to the control group. When comparing foot type, as indicated by CIA, it appeared AOG did not significantly alter between the HL and control groups. Finally, the results indicated AOG did not differ significantly between subjects with unilateral HL. This thesis study indicated that with the current sample population, the wide variability in AOG prevented detection of any subtle differences that may exist in subjects with HL. Results also emphasised the need to incorporate other variables such as symptomology and foot dominance when considering the effects first metatarsophalangeal joint pathology might have on HL, such as AOG.

[Truncated abstract] Hallux valgus (HV) is one of the most common foot deformities encountered in clinical practice. This complex deformity primarily affects the first metatarsophalangeal joint (MPJ), leading to altered foot structure and function. By virtue of the lateral displacement of the hallux on the first metatarsal, HV has the potential to influence adjacent joints of the foot. In doing so, function of the foot may be altered, and clinically this may result in abduction of the foot during the stance phase of gait. However the relationship between an abducted angle of gait (AOG) and HV has never been substantially examined. The purpose of this study is to investigate the relationship between HV and AOG, and determine if specific radiographic features are associated with the deformity or with a particular AOG. Such information would assist in understanding aetiological factors and the effects of intervention to treat the deformity ... Length and elevation of the first metatarsal were associated in subjects with HV, implying that length of the metatarsal may be related to whether or not it becomes elevated (R: 0.50, CI: 0.21, 0.71, P< 0.05). Similarly, an association was found between length of the first metatarsal and the amount of first MPJ dorsiflexion, suggesting perhaps length of the metatarsal has implications for first MPJ range of motion (R: -0.37, CI: -0.62, -0.04, P<0.05). However the amount of first MPJ dorsiflexion did not influence the AOG in HV subjects when compared to the control group. First MPJ dorsiflexion was also associated with the first intermetatarsal angle. Interestingly, the HV group alone did not show an association between the hallux abductus angle and the first intermetatarsal angle. The findings of this study are contrary to those suspected in clinical practice and alluded to in the literature. Despite the documented support for the biomechanical causes of HV, an abducted AOG was not significantly different in HV subjects when compared to controls. Possible explanations may have related to limitations of the present study including the size and gender demographics of the sample population, and greater variability in normal AOG ranges than reported in the literature. The present study indicated a possible need to gather information regarding foot dominance and leg length; factors extrinsic to the foot capable of influencing transverse plane orientation of the foot; and, the influence of symptoms and subsequent compensatory mechanisms adopted during gait.