A comparative investigation into the effectiveness of two mobilizations in the treatment of symptomatic Hallux abductovalgus (bunions)

Abstract

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.