Effects of Kinesio Taping and Stretching on Hallux Valgus Angle and Balance in Female Hallux Valgus Patients

 

Jung-Hyun Choi

Department of Physical Therapy, Namseoul University, 31020 Korea

 

ABSTRACT:

Background/Objectives: This study analyzed the effects of kinesio taping and stretching on changes and balance in patients with hallux valgus deformity.

Methods/Statistical analysis: A total of 24 female participants in 20s were divided into 3 groups: stretching (SG; n=8), taping (TG; n=8), and stretching with taping (STG; n=8). Taping and elastic band were used for 6 weeks to reduce hallux valgus angle, and changes in the hallux valgus angle and balance were observed.

Findings: Hallux valgus angle significantly decreased in stretching group, taping group, and stretching with taping group. YMean values were significantly increased in the group with simultaneous stretching and taping.

Improvements/Applications: The application of stretching exercise using taping and elastic band at the hallux valgus angle is thought to be an effective method to reduce the hallux valgus deformity.

 

 

 

 

1. INTRODUCTION:

Walking is the most basic action for the body to move. Also, walking maintains necessary speed in a specific direction. Hallux valgus deformity has radiographic findings of intermetatarsal angle between the first and second metatarsals that is greater than 10° and hallux abductus angle greater than 15°. It is a disease that causes medial hypertrophy of metatarsophalangeal joints and pain¹.

 

Causes of hallux valgus deformity are divided into external, internal, and anatomical factors. External factors include high-heeled shoes, long-term weight bearing, and most importantly tight shoes that compress the toes.

 

Internal factors include genetic factor and gender. Anatomical factors include flexible ligament, age, primary matatarsalvarus, shape of the foot arch, flat feet, functional hallux catalepsy, and shortened achilles tendon².

 

Hallux valgus deformity is one of the leading foot diseases that is often neglected, because it is not a life threatening disease and such cases with hallux abductus angle greater than normal are not always symptomatic. However, hallux valgus deformity is a complicated, potentially painful and debilitating condition that is associated with lateral deviation of the hallux on the first metatarsal, which could be observed in other toes, and medial rotation of the first metatarsal away from the second metatarsal³. In addition, the big toe’s flexor tends to behave as an abductor and internally rotate the big toe or cause side subluxation of sesamoids. As a result, 2nd, 3rd, and 4th metatarsals to move down while 1st and 5th metatarsals to move up. The collapse of the transverse arch places increased pressure on the interdigital nerve, leading to the formation of Morton neuroma or callus involving the skin of the metatarsal heads. Therefore, hallux valgus deformity warrants a timely prevention and treatment².

 

Clnar-Medeni et al. (2016) reported that patients with hallux valgus compared to those without the deformity had more negative effect on balance⁴ and Lee and Lee (2016) reported that the limitation of the big toe flexor negatively influences the ability to balance on one leg⁵.

 

Treatment options for hallux valgus include orthosis, surgery, and correction through insole adjustment and shoes⁶. However, surgery is limited in that it is not applicable to patients with arthritis and it is associated with high cost, long recovery period, and high recurrence rate⁷. Correction with insole or brace is inconvenient, because it must be worn inside the shoe and it is one of the main causes of ulcers, nails, and herpes on the soles of feet. In order to overcome these drawbacks, Kim et al. reported that muscle strength and stretching exercises are effective in reducing the anteroposterior angle of the knee in patients with hallux valgus⁸.Karabicak et al. (2015) stated that taping therapy is effective in reducing the nonunion angle⁹.

 

Various treatment modalities for hallux valgus have been proposed as methods of intervention. However, there is a lack of studies comparing the effects of intervention methods and analyzing the influence on the ability to balance. The purpose of this study is to investigate the effects of taping therapy and stretching exercises on changes in valgus angle and the ability to balance. This study also aims to provide basic data for effective intervention method after comparing outcomes with various intervention methods

 

2. MATERIALS AND METHODS:

2.1. Study design:

Independent variables are elastic band-assisted stretching exercise and kinesio taping. Dependent variables are measurements of valgus angle and balance. Study design is collective design.

 

2.2. Subjects:

This study was conducted from April 4th, 2016 to May 15th, over a total of 6 weeks. Study subjects of 24 female students in their 20s were selected from N University in the Chungnam region. The criteria for subject selection were as follows: hallux valgus angle greater than 15 degrees, individuals without severe neurologic or musculoskeletal diseases, those who have not undergone any operation for hallux valgus, those lacking experience in exercises related to hallux valgus, and those not affected by other podiatric disease. The purpose and methods of the study were explained to the participant and informed consent was obtained according to the principles of the Declaration of Helsinki. Eight study subjects were randomly assigned to each group and their general characteristics were paired.

 

Independent variables are elastic band-assisted stretching exercise and kinesio taping. Dependent variables are measurement of hallux valgus angle and balance. The following three groups were established: Stretching group (SG; n=8), Taping group (TG; n=8), and Stretching with Taping group (STG; n=8). A total of 24 subjects were distributed randomly into 3 groups, which is shown in Table 1.

 

Table 1. General characteristics of the subjects

Item	SG (n=8)	TG(n=8)	STG (n=8)
Age(yrs)	20.93±1.73	21.02±1.57	20.83±2.04
Height(cm)	165.20±7.47	166.27±8.17	167.19±10.23
Weight(kg)	56.49±9.40	55.13±8.47	58.74±10.34
dominant hand	right:8, left:0	right:8, left:0	right:8, left:0

SG : Stretching group, TG : Taping group, STG : Stretching with Taping group

 

2.3. Research Method:

2.3.1. Stretching exercise using the elastic band:

Elastic band-assisted stretching exercise was performed 3 times a week for 6 weeks. An elastic band with the intensity great enough to perform a certain exercise routine more than 15 times was selected to be used for stretching exercise. For 4 to 6 weeks, a color elastic band with a higher level of elasticity than the first exercise band was used¹⁰.

 

(1) Warm-up and Finishing Exercise:

Warm-up and finishing exercises are essential to prevent injury and reduce pain. In order to prevent the compensatory action of the ankle during exercise, it is important to perform three sets of ankle exercise 10 times each and learn the movement of toe abductors and adductors instead of ankle muscles.

 

(2) AC Exercise Technique (Agonist Contraction Exercise):

After seating the subject, the seraband customized to the length of the subject’s 5th toe is applied to both big toes in order to provide constant resistance in the direction of the 5th toe. Subject is made to resist the resistance and induce contraction of the thumb abductors. The exercise is performed for 30 seconds with a 15 second break for a total of 10 sets that last for 7 minutes and 30 seconds.

 

(3) HR-AC Exercise Technique (Hold-relax with Agonist Contraction Exercise):

After seating the subject, the seraband customized to the length of the subject’s big toe is applied to both big toes in order to provide constant resistance. The subject shrinks thumb adductors against resistance and maintains isometric contraction and then actively opens the thumb to extend the thumb muscles. The exercise is performed for a total of 10 sets that last for 7 minutes and 30 seconds with maintenance of isometric contraction for 25 seconds, active stretching for 5 seconds, and rest for 15 seconds. Foot support should be placed between two feet to ensure that the range of motion of thumb opening is sufficient.

 

2.3.1. Stretching exercise using the elastic band:

The taping method used in this study is conducted by researchers who learned the taping method directly from the taping specialist. Total duration of taping therapy is 6 weeks, and it is replaced every 7 days for a total of 6 times. The tape is applied directly by the researcher before the research subjects start their daily lives. However, taping is reapplied if it falls during the application period. To allow elasticity of the tape, each tape was cut into ¼ of the measured length and then applied. Detailed method is described as follows¹¹.

 

Start from the outer edge of the foot, stretch the tape across the sole of the foot, and attach the tape to the front of the big toe interphalangeal joint. From the outer edge of the foot, stretch below the toe metatarsal, and then pull in the big toe by going between the big and second toes. At this time, cut the tape into the width that corresponds to the size of the big toe, in order to not invade the big toenail. While keeping the big toe as straight as possible, attach from the outside, attach the tape by stretching it from the outer edge of the big toe to the front of the ankle. To finish, wrap the area under the big toenail with a narrow tape. Ensure to not cover the toenail when attaching the tape

 

2.4. Experiment methods:

2.4.1. Hallux valgus angle:

Radiographs (Diagnostic table–KOB, Donga X-ray, Korea) were used to measure the degree of foot deformity. The radiologist measured the angle of the big toe flexion on the radiographs. Centricity PACS RA1000 (2.1.0 version, GE Healthcare Integrated IT Solutions, Barrington, USA) software was used to analyze the radiographs of the feet of subjects taken in foot arch-sole direction and calculate the flexion angle between the bisecting line of the first metatarsal and the big toe.

 

2.4.2. Balance:

In this study, measurements were made using BT4 (Hur Laps Oy, Tampere, Finland) to determine the ability to balance. We conducted the One Leg of Romberg Test to determine static balance ability and the Limits of Stability Test to determine dynamic balance ability.

 

(1) One Leg of Romberg Test:

To determine the static balancing ability, we set the sampling frequency to 50Hz and performance time to 30 seconds. We measured the value of C90 Area (mm²) and used is as a data value. All research subjects used the following order to measure the value. First, measurements are taken while the subject is instructed to position the center of the dominant plantar foot at the center of BT4 and the knee joint of the non-dominant foot at 90° angle. The measurement is carried out with a preparation period of 5 seconds and a measurement period of 30 seconds. Subjects take the One Leg of Romberg Test during the preparation period of 5 seconds. With eyes open and eyes closed, subjects are instructed to perform this test three times each and the average of three measurements is used for analysis.

 

(2) Limits of Stability Test:

To determine the dynamic balance ability, we set the sampling frequency to 50Hz and performance time to 8 seconds. We measured the Lean Forward, Rearward, Leftward, and Rightward values and used them as data values. All research subjects used the following order to measure the value. Subjects are instructed to position both feet in shape “11” with middle point of inner foot bone positioned parallel to the front, align two feet along the dotted line on the arrow, and fix the sight to the front. Subjects are instructed to lean as much as possible to the front, back, left, and right, then Lean Forward, Rearward, Leftward, and Rightward values are measured. These measurements are performed three times and the average of the three measurements is used for analysis.

 

2.5. Statistical analysis:

The SPSS version 18.0 program was used to analyze the study data. Kolmogorov-Smirnov was performed for normality test and normal distribution was established. In order to investigate the effect of intervention on the change of toe flexion angle and body balance among different groups, Multivariate Analysis of Variance (MANOVA) was used for analysis, followed by Tukey for post-analysis. A corresponding t test was conducted to investigate the effects of changes in the flexion angle of the big toe before and after intervention. The significance level for the statistical significance test was 𝑎=.05.

 

3. RESULTS AND DISCUSSION:

3.1. Comparison of change in the big toe flexion angle:

In the study, the change in big toe flexion angle before and after intervention was significantly reduced in the stretching group, taping group, and stretching and taping group in Table 2,3 (p<.05). This result is in agreement with prior studies that reported that 17 subjects with hallux valgus angle had a significantly reduced mean angle of deviation of 6.5° after wearing New Foot-Toe Orthosis for 3 months⁶. Karabicak et al. (2013) reported that application of adhesive taping in 20 patients four times over 10 days to reduce hallux valgus deformity resulted in a significant reduction of angle from 22.6° to 19.3°⁹. Jeon et al. (2004) reported that in a total of 15 trials conducted once every 2 days for 4 weeks in 20 subjects (36 feet), the hallux valgus angle significantly decreased from 21.95° to 18.75° ¹². These results are similar to the result of current study. However, in this study, the reduction of hallux valgus angle was observed less than that of prior studies, even though same type of intervention was used and taping period was longer. Such difference is likely because taping was applied once a week whereas taping was applied every 2 days in prior studies. It is considered that the elasticity of taping decreases and cannot perform properly as the attachment period gets longer. More research is needed to study the effect of frequency of taping attachment on hallux valgus angle.

 

 

In a previous study where the Hold and Relax-agonist contraction technique was applied for 3 weeks (3 times per week) to 15 college students with shortened hamstrings, there was a statistically significant improvement in stretching among subjects using the maintenance-relaxation technique compared to the control group¹³. Also, Ostering et al. (1990) applied the Hold and Relax-agonist contraction technique on athletes, which demonstrated a significant increase in muscle activity and range of motion¹⁴. Etnyre and Abraham (1986) studied the effects of the Hold and Relax-agonist contraction on the joint range of motion and showed that the technique was effective¹⁵. Although the applied muscle is different from the previous study, similar exercise was applied to strengthen the thumb abductors and adductors. This result is thought to be due to the combined effect of thumb muscle strengthening and the effect of Hold and Relax-agonist contraction exercise on self-inhibition and counteraction inhibition^14-16.

 

3.2. Comparison of body balance changes:

Lee et al. (2015) reported that the body balance ability significantly improved in 20 patients with hallux valgus deformity after use of elastic band and short foot exercises¹⁰.

 

Table 2. Comparison of changes in big toe flexion angle within groups based on intervention       (Unit : Angle)

Group	Pre	Post	t	p
SG	15.57±3.61	13.46±4.12	5.002	.002*
TG	15.02±2.61	12.56±2.80	2.854	.025*
STG	16.56±4.01	14.00±3.97	4.071	.005*

*Expressed as p<0.05, SG: Stretching group, TG: Taping group, STG: Stretching and Taping group

 

Table 3. Comparison of changes in big toe flexion angle among groups  (Unit: Angle)

group	Pre	Post	post-pre	F	p
SG	15.57± 3.61	13.463± 4.12	-2.11± 1.19	0.099	0.906
TG	15.02± 2.61	12.56± 2.80	-2.46± 2.44
STG	16.56± 4.01	14.00± 3.97	-2.12± 1.47

SG: Stretching group, TG: Taping group, STG: Stretching and Taping group

 

 

Moon et al. also reported a significant increase in dynamic balance changes in all left, front, and rear areas after short foot exercises while positioned within the limits of LOS¹⁷.Çınar-Medeni Ö et al. (2016) reported that the hallux valgus angle negatively affects the overall postural stability⁴. However, in the present study, there was no significant difference in the balance values or between groups, except for a significant increase in YMean in the stretching and taping group in Table 4,5. The reason for this result is thought to be that performance is determined by the coordination ability of the entire lower limb, not solely by the deformation and injury of the foot¹⁸. It is also thought that balance disorder is affected not only by the disability of any specific part of the body, but also by various factors such as body sensation and vestibular system^19,20. Therefore, in this study, it is thought to be difficult to improve the ability to balance only by the change in hallux valgus angle.

 

 

 

 

Table 4. Comparison of body balance before and after intervention                                  (Unit : mm², deg)

*Expressed as p<0.05, SG : Stretching group, TG : Taping group, STG : Stretching with Taping group, Area: area of the 95% confidence ellipse, RArea:area of the 95% confidence ellipse in Romberg test, Ymean: average anterior-posterior displacement, Xmean: average medial-lateral displacement.

 

Table 5. Comparison of body balance changes                                 (Unit : mm², deg)

SG : Stretching group, TG : Taping group, STG : Stretching and Taping group, Area: area of the 95% confidence ellipse, RArea:area of the 95% confidence ellipse in Romberg test, Ymean: average anterior-posterior displacement, Xmean: average medial-lateral displacement.

 

This study was limited to women in their twenties, so generalization of the study result is limited. Due to limitations of the study period and the number of study participants, there were many aspects to this study that limited generalization of the results. Therefore, future studies should increase the accuracy of the study by increasing the age range of study participants and the number of subjects. Based on the result of this study, we should continue to try to overcome previously stated limitations and investigate various intervention methods that affect hallux valgus angle and stability.

 

4. CONCLUSION:

The purpose of this study was to investigate the effects of stretching and kinesio taping on the hallux valgus angle and balancing ability. Twenty-four healthy women in their twenties were divided into stretching exercise group, taping group, and simultaneous stretching and taping group, and then the following results were obtained. Hallux valgus angle significantly decreased in stretching group, taping group, and stretching and taping groups. The YMean value was significantly increased in the simultaneous stretching and taping group.

 

Therefore, stretching exercise and taping are considered to be effective intervention methods in reducing the hallux valgus angle. If these two methods are used together, it may be a more effective method for reducing the hallux valgus angle.

 

5. ACKNOWLEDGMENT:

Funding for this paper was provided by Namseoul University

 

6. REFERENCES:

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Accepted on 03.09.2017        © RJPT All right reserved