Increased hallux angle in children and its association with insufficient length of footwear: a community based cross-sectional study

BMC Musculoskelet Disord. 2009 Dec 17:10:159. doi: 10.1186/1471-2474-10-159.


Background: Wearing shoes of insufficient length during childhood has often been cited as leading to deformities of the foot, particularly to the development of hallux valgus disorders. Until now, these assumptions have not been confirmed through scientific research. This study aims to investigate whether this association can be statistically proven, and if children who wear shoes of insufficient length actually do have a higher risk of a more pronounced lateral deviation of the hallux.

Methods: 858 pre-school children were included in the study. The study sample was stratified by sex, urban/rural areas and Austrian province. The hallux angle and the length of the feet were recorded. The inside length of the children's footwear (indoor shoes worn in pre-school and outdoor shoes) were assessed. Personal data and different anthropometric measurements were taken. The risk of hallux valgus deviation was statistically tested by a stepwise logistic regression analysis and the relative risk (odds ratio) for a hallux angle > or = 4 degrees was calculated.

Results: Exact examinations of the hallux angle could be conducted on a total of 1,579 individual feet. Only 23.9% out of 1,579 feet presented a straight position of the great toe. The others were characterized by lateral deviations (valgus position) at different degrees, equalling 10 degrees or greater in 14.2% of the children's feet.88.8% of 808 children examined wore indoor footwear that was of insufficient length, and 69.4% of 812 children wore outdoor shoes that were too short. A significant relationship was observed between the lengthwise fit of the shoes and the hallux angle: the shorter the shoe, the higher the value of the hallux angle. The relative risk (odds ratio) of a lateral hallux deviation of > or = 4 degrees in children wearing shoes of insufficient length was significantly increased.

Conclusions: There is a significant relationship between the hallux angle in children and footwear that is too short in length. The fact that the majority of the children examined were wearing shoes of insufficient length makes the issue particularly significant. Our results emphasize the importance of ensuring that children's footwear fits properly.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aging
  • Anthropometry
  • Biomechanical Phenomena / physiology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cross-Sectional Studies
  • Equipment Design / methods
  • Female
  • Hallux Valgus / diagnosis
  • Hallux Valgus / etiology*
  • Hallux Valgus / physiopathology*
  • Humans
  • Male
  • Mass Screening
  • Metatarsophalangeal Joint / pathology
  • Metatarsophalangeal Joint / physiopathology
  • Models, Anatomic
  • Movement
  • Pliability
  • Range of Motion, Articular / physiology
  • Risk Factors
  • Sex Distribution
  • Sex Factors
  • Shoes / adverse effects*
  • Shoes / standards*
  • Toes / pathology
  • Toes / physiopathology*