Resea ch A icle
No mal Values o Me a a sal Pa abola A ch
in Male and Female Fee
Gab iel Domínguez-Maldonado,1,2 Ped o V. Munue a-Ma inez,1,2
José Manuel Cas illo-López,1,2 Ja ie Ramos-O ega,1,2 and Manuel Albo noz-Cabello1,2
1Depa men o Podia ics,Uni e si yo Se ille,Se ille,Spain
2Teaching Cen e o Physio he apy and Podia y. Calle A icena s/n, 41009 Se ille, Spain
Co espondence should be add essed o Gab iel Dom´
ınguez-Maldonado; gdo[email p o ec ed]
Recei ed 20 Augus 2013; Accep ed 31 Decembe 2013; Published 6 Feb ua y 2014
Academic Edi o s: B. Du gun, J. Gonz´
alez-So iano, M. Kl¨
uppel, and A. P esche
Copy igh © 2014 Gab iel Dom´
ınguez-Maldonado e al. This is an open access a icle dis ibu ed unde he C ea i e Commons
A ibu ion License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is
p ope ly ci ed.
The e is no any me hod o measu e me a a sal p o usion in he whole me a a sal. The aim o his esea ch is o know he no mal
me a a sal pa abola in male and emale ee . The sys em o measu emen de ised by Ha dy and Clapham o e alua e he p o usion
be ween me a a sals I and II was adap ed o s udy he whole me a a sal pa abola and applied o he i e me a a sals o 169 no mal
ee , 72 emale ee and 97 male ee . Au ho s measu ed all me a a sal p o usion ela i e o me a a sal II. The esul s ob ained show
a emale me a a sal p o usion ela i e o me a a sal II o +1.27% o me a a sal I, −3.36% o me a a sal III, −8.34% o me a a sal
IV, and −15.54% o me a a sal V. Da a ob ained o male me a a sal pa abola we e +0.5% o me a a sal I, −3.77 o me a a sal III,
−9.57 o me a a sal IV, and −17.05 o me a a sal V. Di e ences be ween bo h me a a sal pa abola we e signi ican .
1. In oduc ion
The me a a sal pa abola has been he objec o s udy by
a ious au ho s [1]. Mos o he s udies published on he
alues o me a a sal p o usion e e exclusi ely o he ela-
ionship be ween me a a sals I and II, using he dis ance
(exp essed in mm) be ween he angen s o he wo me a a sal
headsasp o usion alue.Thesewo ksinclude hoseo
Mo on [2], Ha is and Bea h [3,4], Ha dy and Clapham
[5], and LaPo a e al. [6], in which he di e en au ho s
ci e a ious sys ems o measu ing me a a sal I-II p o usion
and es ablish a ious alues o no mali y. Valley and Reese
[7] designed h ee di e en sys ems o measu emen o
e alua e he p o usion o he lesse me a a sals, al hough
none o hem independen ly achie ed comple e analysis o
he me a a sal pa abola.
On he o he hand, an h opome ic di e ences ci ed by
a ious au ho s ega ding he alignmen o he lowe ex em-
i y sugges he need o compa e he mean alues o he me a-
a sal a ch in men and women. Tes ud and La a je [8]es ab-
lished 16 di e ences be ween he pel is in men and women,
such as di e ences in he ce icodiaphyseal angle o he
emu . The e a e also e e ences conce ning he di e ence o
angula ion o emo al an e e sion [9–11] and o physiological
genu algo depending on gende [12–14]. Wi h ega d o
he oo , signi ican di e ences we e ound by S eele [15]in
he size o as agalus and calcaneus, by Smi h [16]in he
size o me a a sals and oes, and by Fe a i e al. [17]in he
o ien a ion o he i s ay in he ans e se plane.
Gende -dependen di e ences ha e been desc ibed e-
ga ding he unc ionali y o he lowe ex emi y. S aheli e al.
[18] ound signi ican di e ences in he in e nal o a ion o
he hip, he in e nal o a o pa e n [19], and he angle o gai
[20–25], and e en in plan a p essu es du ing gai [26,27].
The aims o he p esen s udy we e (1) o ob ain he mean
alues o me a a sal p o usion—wi h espec o me a a sal
II— o all he me a a sals, using he me hod desc ibed by
Ha dy and Clapham, (2) o compa e he mean alues o me a-
a sal p o usion ob ained wi h ha sys em be ween men and
women, and (3) o e alua e he eliabili y o he adiological
measu emen s, made using compu e p og ams. These alues
a e impo an o unde s and he biomechanics o he o e oo
Hindawi Publishing Co po a ion
e Scien ific Wo ld Jou nal
Volume 2014, A icle ID 505736, 5 pages
h p://dx.doi.o g/10.1155/2014/505736
2The Scien i ic Wo ld Jou nal
and o know he no mal shape and unc ion o he oo on
o hopedics and su ge y ea men s.
2. Ma e ials and Me hods
This one is an obse a ional esea ch, o measu e me a a sal
p o usion in male and emale ee and s a e no mal alues.
Do soplan a adiog aphic pla es, made unde load wi h
a ocal inclina ion o 15∘wi h espec o e ical, a e used.
The s udy consis s o 169 ee (87 igh ee and 82 le ee ; 72
emale ee and 97 male ee ) o 105 olun ee s (63 men and
42 women), podia y s uden s a Se ille Uni e si y. In se e al
cases only one oo was used. All subjec s p o ided w i en
consen .
The c i e ia o inclusion we e as ollows: mo e han 20
yea s old, wi hou de o mi ies o he o e oo (HL, ex ension
MTF I >65∘; HAV, claw oes, e c.), wi hou degene a i e
os eoa icula diseaseo muscula imbalance,wi hou signs
o al e a ions in he o e oo load dis ibu ion, wi h absence
o oo pain, wi hou p e ious su ge y o he oo , and wi hou
auma o he oo in he p e ious 12 mon hs.
The mean age o he subjec s aking pa in he s udy was
23.6 ±2.7 yea s old, wi h no subjec being unde 20 yea s old
(and he skele on o he oo s ill de eloping).
The adiological pla es we e scanned using a adiological
scanne and digi ized, and adiological measu emen s we e
made wi h he p og am AUTOCAD 2006.
The me a a sal p o usion is measu ed using he me hod
Ha dy and Clapham [5] desc ibed o de e mine MTT I-
II p o usion, applying i in ou case o he es o he
me a a sals. This consis s o de e mining he p o usion o
MTT I, III, IV, and V ela i e o he leng h o MTT II. We
use MTT II as e e ence o a ious easons:
(a) i is conside ed he longi udinal axis o he me a a sus,
commonly used as a e e ence o di e en adiologi-
cal measu emen s o he o e oo [28].
(b) Due o he con o ma ion o he second me a a so-
cunei o m join , he i o he me a a sal be ween
he i s and hi d cunei o ms, and he esul ing
limi a ion o he mobiliza ion o his join , i is he
mos s able me a a sal, wi h li le capaci y o become
malaligned, a ec ing i s p o usion.
(c) I is no a ec ed by b achyme a a sia usually [29].
B achyme a a sia is an abno mal sho ness o he
me a a sals ha can a ec any o he i e me a a sal,
bu heonemos equen lyin ol edis he4 h.The
de o mi y is no e y common, and i s incidence has
been de e mined as be ween 1 in 1820 and 1 in 4586 o
he popula ion [29].
Fi s ly, we ace he ans e se axis o he a sus, wi h a
line joining he mos pos e io poin o he scaphoid ube cle
wi h he pos e io su ace o he p oximal a icula ace o
he cuboid.
We use he in e sec ion be ween he diaphyseal axis o
MTT II and he ans e se axis o he a sus as poin o
o a ion o p ojec he angen o he me a a sal heads on he
axis o ay II (Figu e 1).
Figu e 1: The in e sec ion be ween he diaphyseal axis o MTT II
and he ans e se axis o he a sus was conside ed as poin o
o a ion o p ojec he angen o he me a a sal heads.
Figu e 2: Values o me a a sal p o usion was measu ed as he
dis ances be ween he a cs o ci cum e ence angen o he mos
dis al poin s o each me a a sal head and he mos dis al poin o
he head o MTT II.
The dis ances be ween he a cs o ci cum e ence angen
o he mos dis al poin s o he me a a sal heads a e exp essed
as pe cen age o he dis ance be ween he mos dis al poin o
heheado MTTIIand helineo he ans e seaxiso he
a sus ( ay II leng h) (Figu e 2).
The diaphyseal axes we e aced as indica ed by Coughlin
e al. [30], using he midpoin s o he p oximal and dis al
me aphyseal zones, in an a ea be ween 0.5 and 1 cm om he
a icula su ace in he case o he phalanges, and be ween 1
and 2 cm in ha o he me a a sals.
We s udied main alues o all a iables (me a a sal
p o usion angle o I, III, IV, and V me a a sals) and he
S uden ’s - es o compa e male and emale g oups.
To es he eliabili y o he measu emen s, hey we e
made h ee imes in 8 ee selec ed a andom, a in e als o
The Scien i ic Wo ld Jou nal 3
Table 1: Mean alues o me a a sal p o usion ela ed o II ay (in millime e s). Whole specimen.
𝑁 = 169 II-I II-III II-IV II-V
Mean∗±SD 0.94 ± 2.71 −4.44±1.63 −11.17 ± 2.21 −20.21 ± 3.77
Uppe LIM 1.35 −4.20 −10.75 −19.63
Lowe LIM 0.53 −4.69 −11.58 −20.78
∗IC 95%.
Posi i e alues o me a a sal p o usion mean leng hening o he me a a sal ela ed o II ay exp essed in millime e s.
Nega i e alues o me a a sal p o usion mean sho ening o he me a a sal ela ed o II ay exp essed in millime e s.
one week be ween obse a ions. In o de o de e mine he
in a eliabili y,weused hese h eeobse a ions oob ain
in aclass coe icien o co ela ion o all a iables.
All measu emen s we e made by one e alua o . The
s a is ical analysis o he da a was pe o med using he
p og am SPSS 12.0 o WINDOWS.
3. Resul s and Discussion
The s a is ical analysis es ablished he mean alue and he
s anda d de ia ions o he p o usions o MTT I, III, IV, and
V ela i e o MTT II. The esul s a e displayed in Tables 1and
2.
The alues o he me a a sal p o usion angle showed
signi ican di e ences (P<0.05) depending on gende (Tables
3and 4).
The esul s o he es o in aclass co ela ion a e p e-
sen ed in Table 5.
Wi h he sys em o measu emen o me a a sal p o usion
p oposed and es ed in his s udy, he au ho s ha e ound
mean alues o +0.83% ±2.19 and +0.94 ±2.71 mm o
me a a sal p o usion be ween MTT II and I. The pa e n o
me a a sal p o usion e lec ed in he s udy con adic s he
da a om Nilsonne’s s udy in 1930 [31]o 497 ee included
in a con ol g oup, which de e mined ha 52.2% p esen ed a
sho e MTT I, agains 34.4% showing Index Plus.
Vilado [32] also e e s o he Index Minus me a a sal
o mula, wi h an MTT I ana omically sho e han MTT II
in 56% o he popula ion, and 16% in he Index Plus o mula.
The mean alues o absolu e p o usion ound by he
au ho s a e in ag eemen wi h he alues o no mali y
es ablished as ±2mmbyWeissmanin1989[33], Palladino
in 1990 [34], and Heden and So o J . in 1994 [35]. The da a
ob ained in he p esen s udy a e also simila o hose ci ed
byHa dyandClaphamin1951[5], Munue a-Ma ´
ınez e al.
in 2004 [29], and Dom´
ınguez e al. in 2006 [36].
Munue a-Ma ´
ınez e al. [29]es ablishedinacon ol
g oup o 252 subjec s a mean alue o MTT I-II p o usion
o 2 mm, inc easing o 4 mm in he HAV-a ec ed g oup
s udied. The la e ound a mean alue o MTT II–IV ela i e
p o usion o –13.74 mm o men and –10.24 mm o women
in he con ol g oup, agains he –12.33 mm o men and
−9.60 mm o women ound in he p esen s udy. In 2006,
he au ho s [36] ound mean alues o me a a sal p o usion
inaspecimeno 52 ee o +1.22% o me a a salI,−3.84%
o me a a sal III, −9.66% o me a a sal IV, and –16.91%
o me a a sal V ( he e we e no di e ences be ween male
and emale ee ).Thesemean aluesa eclose oda a om
he cu en s udy showing mean alues o me a a sal p o u-
sion o +0.94% o me a a sal I, −4.44% o me a a sal III,
−11.17% o me a a sal IV, and −20.21% o me a a sal V.
The au ho s ha e ound highe alues o me a a sal
p o usion han hose epo ed by Valley and Reese in 1991
[7]. Due o he di e ence be ween he sys em o measu -
ing me a a sal p o usion p oposed he e and he sys ems
desc ibed by Valley and Reese, he esul s ob ained in he wo
s udies canno be conside ed compa able.
The ana omical di e ences be ween he male and emale
skele ona eno onlydue osizedi e ences ha canbe
p esen ed by speci ic osseous pa s— o ins ance he male
c anium is la ge , wi h mo e-ma ked osseous elie s (glabella,
cilia y a ches, inion, occipi al condyles, mas oid and s yloid
apophyses, e c.) [8]— he emale pel is is b oade [8], and
men p esen la ge bones o he ea oo [15] and me a a sals
and phalanges [16]. The e a e also in e gende di e ences
ega ding he alignmen o ce ain os eoa icula segmen s,
as in he angle o he knee [12–14]o in heangleo emo al
an e e sion [9–11], bo h wi h highe alues in women.
Fe a i e al. [17] demons a ed in hei s udy on 53
male and 54 emale skele ons a g ea e p edisposi ion o he
a icula su aces o he i s ay o adduc ion mo emen s
in women, wi h an o ien a ion o he i s me a a sal in
adduc ion.
The gende -dependen di e ences ound by a ious
au ho s ega ding he o a ional unc ionali y o he lowe
ex emi y, and mo e speci ically, he angle o gai , ha e been
o li le clinical signi icance acco ding o he s udies e iewed.
Au ho s such as Mu ay e al. [20,21] and La uen e e al.
[19] ound a di e ence o be ween app oxima ely 1 and 1.5∘,
ob aining highe alues in he g oup o men. The s udies o
Sebe e al. [22]andDougan[23] on he angle o gai in
men,and ha ca iedou byPa ek[24] on he angle o gai
in women, independen ly no e in e gende di e ences o he
same sense and magni ude.
The e a e, howe e , di e en pa ame e s o he emale
skele on ha de e mine a unc ionali y o he lowe ex emi y
wi h in e nal alignmen , such as he g ea e angle o emo al
an e e sion [9–11] and he g ea e in e nal o a ion o he
hip [18]. These an h opome ic di e ences, compa ed and
e alua ed by physical explo a ion, do no p esen a signi ican
clinical impac ega ding a educ ion in he angle o gai
o women wi h espec o ha o men, so he e mus be
o he pa ame e s wi hin he emale skele on ha de e mine
an ex e nal alignmen o he ex emi y. The mo e ans e se
me a a sophalangeal join line o he emale o e oo , as
shown by he esul s o his s udy, could be unde s ood
4The Scien i ic Wo ld Jou nal
Table 2: Mean alues o me a a sal p o usion ela ed o II ay (in pe cen age e ms). Whole specimen.
𝑁 = 169 II-I II-III II-IV II-V
Mean∗±SD 0.83 ±2.19 −3.60± 1.22 −9.05 ± 1.89 −16.40 ± 2.52
Uppe LIM 1.16 −3.41 −8.76 −16.02
Lowe LIM 0.50 −3.78 −9.33 −16.79
∗IC 95%.
Posi i e alues o me a a sal p o usion mean leng hening o he me a a sal ela ed o II ay exp essed in pe cen age e ms.
Nega i e alues o me a a sal p o usion mean sho ening o he me a a sal ela ed o II ay exp essed in pe cen age e ms.
Table 3: Gende di e ences in me a a sal p o usion. Mean alues
o me a a sal p o usion exp essed in millime e s ela ed o II ay.
Female (𝑁=72)Male(𝑁=97) Signi icance
II-I leng h 1.43± 2.17 0.58± 3.00 0.034∗
II-III leng h −3.87± 1.27 −4.87± 1.73 <0.0005∗∗
II-IV leng h −9.60± 2.08 −12.33± 2.54 <0.0005∗∗
II-V leng h −17.88± 2.65 −21.93± 3.55 <0.0005∗∗
∗Signi ican di e ence (𝑃 < 0.05).
∗∗Signi ican di e ence (𝑃 < 0.001).
Table 4: Gende di e ences in me a a sal p o usion. Mean alues
o me a a sal p o usion exp essed in pe cen age e ms ela ed o II
ay.
Female (𝑁=72)Male(𝑁=97) Signi icance
II-I Leng h 1.27 ± 1.88 0.50± 2.35 0.023∗
II-III Leng h −3.36± 1.04 −3.77 ± 1.31 0.029∗
II-IV Leng h −8.34± 1.69 −9.57± 1.87 <0.0005∗∗
II-V Leng h −15.54± 2.07 −17.05± 2.64 <0.0005∗∗
∗Signi ican di e ence (𝑃 < 0.05).
∗∗Signi ican di e ence (𝑃 < 0.001).
Table 5: In aclass coe icien o co ela ion alues.
𝑁=8 CCI∗Lowe LIM Uppe LIM
HV angle (∘) 0.986 0.952 0.997
In e -MTT I-II angle (∘) 0.973 0.908 0.994
MTT ADD angle (∘) 0.927 0.765 0.984
II RAY leng h (mm) 1.000 0.999 1.000
II-I leng h (mm) 0.983 0.945 0.996
II-III leng h (mm) 0.976 0.922 0.995
II-IV leng h (mm) 0.977 0.925 0.995
II-V leng h (mm) 0.996 0.986 0.999
∗IC 95%.
as a de e mining elemen in opening he angle o gai in
women. As Rueda [37] s a es, oblique me a a sal pa abola
may de e mine in e nal o a ion o he hip as a compensa ion
mechanism. This in e nal o a ion o he hip ac s closing
he angle o gai . Howe e , ano he ype o s udy would be
necessa y o e alua e he ela ionship be ween he alignmen
o he o e oo in he ans e se plane and he angle o gai in
men and women.
Finally, he eliabili y o measu emen s using Au ocad
(Table 5) shows he p op ie y o using his so wa e o
adiog aphic measu emen s.
4. Conclusions
The e a e hus su icien s udies demons a ing ana omical
di e ences in he lowe ex emi y be ween men and women.
The esul s o he p esen s udy should be con i med wi h
u he esea ch in a la ge sample, and in which his possible
di e ence o he me a a sal pa abola be ween men and
women is co ela ed wi h di e ences in he unc ionali y o
he lowe ex emi y.
Di e en me a a sal pa abola be ween men and women
should be conside ed when designing oo o hoses and
shoes. This ana omical di e ence could be ela ed wi h lowe
limb unc ion in male and emale biomechanics.
No mal da a o me a a sal p o usion con ained in his
pape a e help ul in oo s udies in o de o se an o hopaedic
o su gical ea men o o e oo de o mi ies and pa hologies.
Con lic o In e es s
The au ho s decla e ha he e is no con lic o in e es s
ega ding he publica ion o his pape .
Re e ences
[1] G. Dom´
ınguez, P. V. Munue a, G. La uen e, S. Benham´
u, and A.
Gue e o, “Re isi´
on bibliog ´
a ica de los m´
e odos de medici´
on
de la p o usi´
on me a a sal,” Re is a Espa˜
nola de Podolog´
ıa, ol.
16, no. 2, pp. 72–77, 2005.
[2] D. J. Mo on, “S uc u al ac o s in s a ic diso de s o he oo ,”
The Ame ican Jou nal o Su ge y, ol.9,no.2,pp.315–328,1930.
[3] R. I. Ha is and T. Bea h, “Repo 15 h, a my oo su ey,” Tech.
Rep., Na ional Resea ch Council o Canada, O owa, Canada,
1947.
[4] R. I. Ha is and T. Bea h, “The sho i s me a a sal; i s inci-
dence and clinical signi icance,” The Jou nal o Bone and Join
Su ge y, ol.31,no.3,pp.553–565,1949.
[5] R.H.Ha dyandJ.C.R.Clapham,“Obse a ionsonhallux al-
gus; based on a con olled se ies,” The Jou nal o Bone and Join
Su ge y, ol.33,no.3,pp.376–391,1951.
[6] G.LaPo a,T.Melillo,andD.Olinsky,“X aye alua iono hal-
lux abduc o algus de o mi y,” Jou nal o he Ame ican Podia y
Associa ion, ol. 64, no. 8, pp. 544–566, 1974.
[7] B. A. Valley and H. W. Reese, “Guidelines o econs uc ing he
me a a sal pa abola wi h he sho ening os eo omy,” Jou nal o
he Ame ican Podia ic Medical Associa ion, ol.81,no.8,pp.
406–413, 1991.
[8] L. Tes ud and A. La a je , T a ado de Ana om´
ıa Humana,Sal a
Edi o es SA, Ba celona, Spain, 9 h edi ion, 1988.
The Scien i ic Wo ld Jou nal 5
[9] A.Solano,W.B ill,M.Tey,andT.X.Espiga,“No moalineaci
´
on
de las ex emidades in e io es en el adul o,” in Desalineaciones
To sionales de las Ex emidades In e io es. Implicaciones Clinico-
pa ol´
ogicas,J.Balles e ,Ed., ol.2o Monog a ´
ıas SECOT, p. 11,
Masson, Ba celona, Spain, 2001.
[10] M. B a en, T. Te jesen, and I. Ross oll, “Femo al an e e sion
in no mal adul s: Ul asound measu emen s in 50 men and 50
women,” Ac a O hopaedica Scandina ica, ol.63,no.1,pp.29–
32, 1992.
[11] K. J. B ouwe , J. C. Molenaa , and B. Van Linge, “Ro a ional
de o mi iesa e emo alsha ac u esinchildhood.A e o-
spec i e s udy 27–32 yea s a e he acciden ,” Ac a O hopaedica
Scandina ica, ol.52,no.1,pp.81–89,1981.
[12] A. I. Kapandji, Fisiolog´
ıa A icula . Miemb o In e io ,Edi o ial
M´
edica Paname icana, Mad id, Spain, 5 h edi ion, 1999.
[13]N.Palas anga,D.Field,andR.Soames,Ana omy and Human
Mo emen , Bu e wo h Heinemann, Ox o d, UK, 4 h edi ion,
2002.
[14] R. C. Mi alles, I. Mi alles, and M. Puig, “Rodilla,” in
Biomec´
anica Cl´
ınica de los Tejidos y las A iculaciones del
Apa a o Locomo o ,R.C.Mi allesandI.Mi alles,Eds.,p.233,
Masson, Ba celona, Spain, 2nd edi ion, 2005.
[15] D. G. S eele, “The es ima ion o sex on he basis o he alus and
calcaneus,” Ame icanJou nalo PhysicalAn h opology, ol.45,
no. 3, pp. 581–588, 1976.
[16] S. L. Smi h, “A ibu ion o oo bones o sex and popula ion
g oups,” Jou nal o Fo ensic Sciences, ol. 42, no. 2, pp. 186–195,
1997.
[17] J. Fe a i, D. A. Hopkinson, and A. D. Linney, “Size and shape
di e ences be ween male and emale oo bones: is he emale
oo p edisposed o hallux abduc o algus de o mi y?” Jou nal
o he Ame ican Podia ic Medical Associa ion, ol.94,no.5,pp.
434–452, 2004.
[18] L. T. S aheli, M. Co be , C. Wyss, and H. King, “Lowe -
ex emi y o a ional p oblems in child en. No mal alues o
guide managemen ,” Jou nal o Bone and Join Su ge y, ol.67,
no. 1, pp. 39–47, 1985.
[19]G.La uen e,G.Dom
´
ınguez, P. V. Munue a, and R. B. Ma ´
ıa,
“Pa ´
on o ado de la ex emidad in e io : concep o, alo es
no males y elaci´
on con el ´
angulo de la ma cha y la mo ilidad
del p ime dedo,” Re is a Espa˜
nola de Podolog´
ıa, ol.16,no.1,
pp. 6–12, 2005.
[20] M.P.Mu ay,R.C.Ko y,andS.B.Sepic,“Walkingpa e nso
no mal women,” A chi es o Physical Medicine and Rehabili a-
ion, ol. 51, no. 11, pp. 637–650, 1970.
[21] M. P. Mu ay, A. B. D ough , and R. C. Ko y, “Walking pa e ns
o no mal men,” The Jou nal o Bone and Join Su ge y, ol.46,
pp. 335–360, 1964.
[22] S. Sebe , B. Haze , N. K¨
ose, E. G¨
ok ¨
u k, I. G¨
unal, and A.
Tu gu , “Ro a ional p o ile o he lowe ex emi y and oo
p og ession angle: compu e ized omog aphic examina ion o
50 male adul s,” A chi es o O hopaedic and T auma Su ge y,
ol. 120, no. 5-6, pp. 255–258, 2000.
[23] S. Dougan, “The angle o gai ,” Ame icanJou nalo Physical
An h opology, ol.7,no.2,pp.275–279,1924.
[24] S. D. Pa ek, “The angle o gai in women,” Ame ican Jou nal o
Physical An h opology, ol. 9, no. 3, pp. 273–2291, 1926.
[25] J. Fe a i and D. Wa kinson, “Foo p essu e measu emen di -
e ences be ween boys and gi ls wi h e e ence o hallux algus
de o mi y and hype mobili y,” Foo and Ankle In e na ional, ol.
26,no.9,pp.739–747,2005.
[26] E. M. Hennig, A. S aa s, and D. Rosenbaum, “Plan a p essu e
dis ibu ion pa e ns o young school child en in compa ison
o adul s,” Foo and Ankle In e na ional, ol.15,no.1,pp.35–40,
1994.
[27] E. M. Hennig and D. Rosenbaum, “P essu e dis ibu ion pa -
e nsunde he ee o child enincompa isonwi hadul s,”Foo
and Ankle, ol. 11, no. 5, pp. 306–311, 1991.
[28] J. Mon agne, A. Che o , and J. M. Galmiche, A las de Radi-
olog´
ıa del Pie, Masson, Ba celona, Spain, 1984.
[29] P. V. Munue a-Ma ´
ınez,G.La uen e-So illos,G.Dom
´
ınguez-
Maldonado, J. L. Salcini-Mac´
ıas, and L. Ma ´
ınez-Camu˜
na,
“Mo pho unc ional s udy o b achyme a a sia o he ou h
me a a sal,” Jou nal o he Ame ican Podia ic Medical Associ-
a ion, ol.94,no.4,pp.347–352,2004.
[30] M. J. Coughlin, C. L. Sal zman, and J. A. Nunley II, “Angula
measu emen s in he e alua ion o hallux algus de o mi ies: a
epo o he Ad Hoc Commi ee o he Ame ican O hopædic
Foo & Ankle Socie y on angula measu emen s,” Foo and
Ankle In e na ional, ol.23,no.1,pp.68–74,2002.
[31] H. Nilsonne, “Hallux igidus and i s ea men ,” Ac a
O hopaedica Scandina ica, ol.1,p.295,1930.
[32] A. Vilado , “The me a a sals,” in Diso de s o he Foo ,M.H.
Jahss, Ed., ol. 1, p. 659, Saunde s, Philadelphia, Pa, USA, 1982.
[33] S. D. Weissman, Radiology o he Foo , Williams & Wilkins,
Bal imo e, Md, USA, 2nd edi ion, 1989.
[34] S. J. Palladino, “P eope a i e e alua ion o he bunion pa ien :
e iology, biomechanics, clinical and adiog aphic assessmen ,”
in Tex Book o Bunion Su ge y,J.Ge be ,Ed.,p.1,Fu u a
Publishing Company, New Yo k, NY, USA, 2nd edi ion, 1991.
[35] R. I. Heden and L. A. So o J ., “The Buckle poin and he
me a a sal p o usion’s ela ionship o hallux algus,” Jou nal o
he Ame ican Podia y Associa ion, ol.71,no.4,pp.200–208,
1981.
[36] G. Dom´
ınguez, P. V. Munue a, and G. La uen e, “Rela i e
me a a sal p o usion in he adul : a p elimina y s udy,” Jou nal
o he Ame ican Podia ic Medical Associa ion, ol.96,no.3,pp.
238–244, 2006.
[37] M. Rueda, Los Desequilib ios del Pie, Paido ibo, Ba celona,
Spain, 2004.

Submi you manusc ip s a
h p://www.hindawi.com
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Ana omy
Resea ch In e na ional
Pep ides
In e na ional Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com
In e na ional Jou nal o
Volume 2014
Zoology
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Molecula Biology
In e na ional
Genomics
In e na ional Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
The Scien i ic
Wo ld Jou nal
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Bioin o ma ics
Ad ances in
Ma ine Biology
Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Signal T ansduc ion
Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
BioMed
Resea ch In e na ional
E olu iona y Biology
In e na ional Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Biochemis y
Resea ch In e na ional
A chaea
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Gene ics
Resea ch In e na ional
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Ad ances in
Vi ology
Hindawi Publishing Co po a ion
h p://www.hindawi.com
Nucleic Acids
Jou nal o
Volume 2014
S em Cells
In e na ional
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Enzyme
Resea ch
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
In e na ional Jou nal o
Mic obiology