Prevalence of hallux valgus in the general population: a systematic review and meta-analysis

Sheree Nix, Michelle Smith, Bill Vicenzino, Sheree Nix, Michelle Smith, Bill Vicenzino

Abstract

Background: Hallux valgus (HV) is a foot deformity commonly seen in medical practice, often accompanied by significant functional disability and foot pain. Despite frequent mention in a diverse body of literature, a precise estimate of the prevalence of HV is difficult to ascertain. The purpose of this systematic review was to investigate prevalence of HV in the overall population and evaluate the influence of age and gender.

Methods: Electronic databases (Medline, Embase, and CINAHL) and reference lists of included papers were searched to June 2009 for papers on HV prevalence without language restriction. MeSH terms and keywords were used relating to HV or bunions, prevalence and various synonyms. Included studies were surveys reporting original data for prevalence of HV or bunions in healthy populations of any age group. Surveys reporting prevalence data grouped with other foot deformities and in specific disease groups (e.g. rheumatoid arthritis, diabetes) were excluded. Two independent investigators quality rated all included papers on the Epidemiological Appraisal Instrument. Data on raw prevalence, population studied and methodology were extracted. Prevalence proportions and the standard error were calculated, and meta-analysis was performed using a random effects model.

Results: A total of 78 papers reporting results of 76 surveys (total 496,957 participants) were included and grouped by study population for meta-analysis. Pooled prevalence estimates for HV were 23% in adults aged 18-65 years (CI: 16.3 to 29.6) and 35.7% in elderly people aged over 65 years (CI: 29.5 to 42.0). Prevalence increased with age and was higher in females [30% (CI: 22 to 38)] compared to males [13% (CI: 9 to 17)]. Potential sources of bias were sampling method, study quality and method of HV diagnosis.

Conclusions: Notwithstanding the wide variation in estimates, it is evident that HV is prevalent; more so in females and with increasing age. Methodological quality issues need to be addressed in interpreting reports in the literature and in future research.

Figures

Figure 1
Figure 1
Selection process for inclusion of articles in the review.
Figure 2
Figure 2
HV prevalence estimates by gender. Diamonds indicate prevalence estimates by male (black diamonds) and female (white diamonds) subgroups, with bars representing 95% confidence intervals. a Study reported more than one prevalence estimate based on different diagnostic methods in the same sample population (self-reported vs. clinically diagnosed HV).
Figure 3
Figure 3
Potential sources of bias in reported HV prevalence in the overall population (based on 24 studies). Clear diamonds indicate pooled random effects estimate by subgroup; error bars represent 95% confidence intervals; dotted line represents an overall pooled estimate, although there was significant heterogeneity across the 24 studies.

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