HAV Articles (4)

Question 1

Kilmartin, 1994
“A controlled prospective trial of a foot orthosis for juvenile HAV”

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Article: Good/Bad 
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Answer 1

Hierarchy: Level 4 Quasi experimental
Paradigm: Root
Aim: To assess whether orthoses are effective as a conservative treatment to correct, or prevent the progression of juvenile HAV.
Methods: Performed a prospective, RCT to measure effect of the use of an orthosis on juvenile HAV.
Results: Orthoses shown to increase the rate at which juvenile HAV progresses compared to control group. HAV deteriorates regardless of the use of biomechanical orthoses or well-fitting, lace up shoes.
Stats:
Article: Good RCT, randomisation, large sample size, control group, assessor blind.
Weakness: compliance issues with orthotic use

Question 2

Klein, 2009
“Increased hallux angle in children & its association with insufficient length of footwear- a community based cross-sectional study”

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Answer 2

Hierarchy: level 5
Paradigm: Own- adds to Root’s
Aim: To investigate the relationship between footwear length & HAV disorders in children & gauge risk factors of a more pronounced lateral deviation of the hallux. Poor fitting shoe wear has been shown to contribute to an increase in hallux angle, contributing to pathology.
Methods: 858 pre-school children in Austria included in study, grouped by sex & georgraphical location. Hallux angle & foot length recorded. Inside length of indoor & outdoor footwear recorded.
Results: Significant relationship observed between length of shoe and hallux angle: shorter the shoe, higher hallux angle. Odds ratio of hallux angle increased in children wearing insufficient length shoe.
Stats: Power calculation of 90%, Inter-rater reliability of measuring hallux angle r=0.982
Article: Good, face validity, external validity, reproducible method, blinding

Question 3

Nix, 2010
“Prevalence of HAV in the general population: a systematic review & meta-analysis”

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Answer 3

Hierarchy: Level 1
Paradigm: Root
Aim: Investigate the prevalence of HAV in general population, incl. age & gender subgroups.
Methods: 3 Databases & unique sources searched, 78 articles included in review. Quality of papers assessed & ages grouped into subgroups.
Results: HAV more common in females with increasing age.
Stats: Validity present, using validated tools, Inter-rater reliability is present, 2 independent assessors used
Article: Good.
Database & key words stated, grey literature searched, reproducible methodology, study not restricted to english, limitations stated.
Weaknesses: Heterogeneity= lots of data couldn’t be pooled together for prevalence estimates. Estimates not accurate, due to large variations between studies (HAV diagnosis, sampling method, study quality).

Question 4

Perera, 2011, “The pathogenesis of HAV”

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Answer 4

Hierarchy: Level 6 Respectble opinion
Paradigm: Root
Aim: To investigate the pathogenesis & predisposing intrincic & extrinsic factors causing HAV
Methods: No study/ experiment undertaken
Results: N/a
Stats: No statistics 
Article: BAD
Weaknesses: Writing bias, (no methodological process, lack of statistics, referencing own work). Articles referenced not quality assessed, poor quality & outdated articles referenced.