{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:00:00Z","timestamp":1791201600025,"version":"4.2.0"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2009,12,1]],"date-time":"2009-12-01T00:00:00Z","timestamp":1259625600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"published-print":{"date-parts":[[2009,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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 \u2265 4 degrees was calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><jats:p>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 \u2265 4 degrees in children wearing shoes of insufficient length was significantly increased.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1186\/1471-2474-10-159","type":"journal-article","created":{"date-parts":[[2009,12,18]],"date-time":"2009-12-18T17:18:09Z","timestamp":1261156689000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["Increased hallux angle in children and its association with insufficient length of footwear: A community based cross-sectional study"],"prefix":"10.1186","volume":"10","author":[{"given":"Christian","family":"Klein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Groll-Knapp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kundi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wieland","family":"Kinz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2009,12,17]]},"reference":[{"key":"737_CR1","first-page":"151","volume-title":"Sugery of the Foot and Ankle","author":"MJ Coughlin","year":"1999","unstructured":"Coughlin MJ, Mann RA: Sugery of the Foot and Ankle. 1999, Philadelphia: Mosby, 1: 151-168. 7","edition":"7"},{"key":"737_CR2","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1302\/0301-620X.33B3.376","volume":"33-B","author":"RH Hardy","year":"1951","unstructured":"Hardy RH, Clapham JCR: Observations on Hallux valgus. J Bone Joint Surg [Br]. 1951, 33-B: 376-391.","journal-title":"J Bone Joint Surg [Br]"},{"key":"737_CR3","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1302\/0301-620X.62B2.7364833","volume":"62-B","author":"MK Glynn","year":"1980","unstructured":"Glynn MK, Dunlop JB, Fitzpatrick D: The Mitchell distal metatarsal osteotomy for Hallux valgus. J Bone Joint Surg [Br]. 1980, 62-B: 188-191.","journal-title":"J Bone Joint Surg [Br]"},{"key":"737_CR4","first-page":"146","volume":"8","author":"O Johnston","year":"1956","unstructured":"Johnston O: Further studies of the inheritance of hand and foot anomalies. Clin Orthop. 1956, 8: 146-160.","journal-title":"Clin Orthop"},{"key":"737_CR5","volume-title":"Orthopade","author":"A Wanievenhaus","year":"2009","unstructured":"Wanievenhaus A, Bock P, Gruber F, Ivanic G, Klein C, Siorpaes R, Schneider W, Steinb\u00f6ck G, Trieb K, Trnka HJ: Deformity associated treatment of the hallux valgus complex. Orthopade. 2009,"},{"key":"737_CR6","doi-asserted-by":"publisher","first-page":"759","DOI":"10.3113\/FAI.2007.0759","volume":"28","author":"MJ Coughlin","year":"2007","unstructured":"Coughlin MJ, Jones CP: Hallux Valgus: demographics, etiology and radiographic assessment. Foot Ankle Int. 2007, 28: 759-777. 10.3113\/FAI.2007.0759.","journal-title":"Foot Ankle Int"},{"key":"737_CR7","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/00003086-198106000-00008","volume":"157","author":"RA Mann","year":"1981","unstructured":"Mann RA, Coughlin MJ: Hallux valgus: etiology, anatomy treatment and surgical considerations. Clin Orthop. 1981, 157: 31-","journal-title":"Clin Orthop"},{"key":"737_CR8","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1177\/107110079501601104","volume":"16","author":"MJ Coughlin","year":"1995","unstructured":"Coughlin MJ: Juvenil hallux valgus: etiology and treatment. Foot Ankle Int. 1995, 16: 682-697.","journal-title":"Foot Ankle Int"},{"key":"737_CR9","doi-asserted-by":"crossref","first-page":"553","DOI":"10.2106\/00004623-194931030-00012","volume":"31-Am","author":"RI Harris","year":"1949","unstructured":"Harris RI, Beath T: The short first metatarsal: its incidence and clinical significance. J Bone Joint Surg [Am]. 1949, 31-Am: 553-565.","journal-title":"J Bone Joint Surg [Am]"},{"key":"737_CR10","volume-title":"The human Foot","author":"DJ Morton","year":"1935","unstructured":"Morton DJ: The human Foot. 1935, New York: Columbia University Press"},{"key":"737_CR11","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1302\/0301-620X.36B2.272","volume":"36-B","author":"R Wheeler Haines","year":"1954","unstructured":"Wheeler Haines R, McDougall A: The anatomy of hallux valgus. J Bone Joint Surg [Br]. 1954, 36-B: 272-293.","journal-title":"J Bone Joint Surg [Br]"},{"key":"737_CR12","first-page":"326","volume":"3","author":"CH Mayo","year":"1920","unstructured":"Mayo CH: The surgical treatment of bunions. Minn Med J. 1920, 3: 326-331.","journal-title":"Minn Med J"},{"key":"737_CR13","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1136\/bmj.2.4839.749","volume":"2","author":"A Craigmile Doris","year":"1953","unstructured":"Craigmile Doris A: Incidence, origin and prevention of certain foot defects. Br Med J. 1953, 2: 749-752. 10.1136\/bmj.2.4839.749.","journal-title":"Br Med J"},{"key":"737_CR14","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.2106\/00004623-195840050-00007","volume":"40","author":"L Sim-Fook","year":"1958","unstructured":"Sim-Fook L, Hodgson AR: A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. J Bone Joint Surg [Am]. 1958, 40: 1058-1062.","journal-title":"J Bone Joint Surg [Am]"},{"key":"737_CR15","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1080\/00325481.1984.11698000","volume":"75","author":"MJ Coughlin","year":"1984","unstructured":"Coughlin MJ: Hallux valgus Causes, evaluation and treatment. Postgrad Med. 1984, 75: 174-187.","journal-title":"Postgrad Med"},{"key":"737_CR16","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1159\/000086373","volume":"51","author":"HB Menz","year":"2005","unstructured":"Menz HB, Morris ME: Footwear characteristics and foot problems in older people. Gerontology. 2005, 51: 346-351. 10.1159\/000086373.","journal-title":"Gerontology"},{"key":"737_CR17","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/S0169-8141(98)00098-5","volume":"25","author":"FT Cheng","year":"1999","unstructured":"Cheng FT, Perng DB: A systematic approach for developing a foot size information system for shoe last design. Int J Ind Ergon. 1999, 25: 171-185. 10.1016\/S0169-8141(98)00098-5.","journal-title":"Int J Ind Ergon"},{"key":"737_CR18","first-page":"384","volume":"97","author":"H Timm","year":"1963","unstructured":"Timm H: Measurement of the length of children's shoes with shoe-measurement cards. Z Orthop Ihre Grenzgeb. 1963, 97: 384-386.","journal-title":"Z Orthop Ihre Grenzgeb"},{"key":"737_CR19","volume-title":"Supplement to no. 99 of the Z Orthop","author":"HU Debrunner","year":"1965","unstructured":"Debrunner HU: Wachstum und Entwicklung des Fu\u00dfbes beim Jugendlichen (Growth and development of the juvenile foot). Supplement to no. 99 of the Z Orthop. 1965, Stuttgart: Ferdinand Enke Verlag"},{"key":"737_CR20","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1007\/s001320050028","volume":"25","author":"R Bauer","year":"1996","unstructured":"Bauer R, Frischhut B: Der Vorfu\u00df. Orthopade. 1996, 25: 301-10.1007\/s001320050028.","journal-title":"Orthopade"},{"key":"737_CR21","volume-title":"PhD thesis","author":"G Eckstein","year":"1990","unstructured":"Eckstein G: Der nicht passende Schuh und das Problem erworbener Vorfu\u00dfsch\u00e4den bei Kindern (Poorly-fitting shoes and the problem of acquired forefoot damage). PhD thesis. 1990, Erlangen-N\u00fcrnberg"},{"key":"737_CR22","volume-title":"Kinderfu\u00df und Kinderschuh. Entwicklung der kindlichen Beine und F\u00fc\u00df und ihre Anforderungen an fu\u00dfgerechte Schuhe","author":"E Maier","year":"2003","unstructured":"Maier E, Killmann M: Kinderfu\u00df und Kinderschuh. Entwicklung der kindlichen Beine und F\u00fc\u00df und ihre Anforderungen an fu\u00dfgerechte Schuhe. 2003, M\u00fcnchen: Verlag Neuer Merkur"},{"key":"737_CR23","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1097\/00003086-198106000-00014","volume":"157","author":"T Kato","year":"1981","unstructured":"Kato T, Watanabe S: The etiology of hallux valgus in Japan. Clin Orthop Relat Res. 1981, 157: 78-81.","journal-title":"Clin Orthop Relat Res"},{"key":"737_CR24","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1007\/BF00415251","volume":"59","author":"O Stracker","year":"1966","unstructured":"Stracker O: Child's foot and child's shoe. Arch orthop Unfallchir. 1966, 59: 286-294. 10.1007\/BF00415251.","journal-title":"Arch orthop Unfallchir"},{"key":"737_CR25","first-page":"318","volume":"3","author":"H Kristen","year":"1968","unstructured":"Kristen H: The child's foot in Austria. Z Orthop Ihre Grenzgeb. 1968, 3: 318-333.","journal-title":"Z Orthop Ihre Grenzgeb"},{"key":"737_CR26","first-page":"3","volume-title":"Sozialp\u00e4diatrie in Praxis und Klinik","author":"T Hellbruegge","year":"1980","unstructured":"Hellbruegge T: Zur Prophylaxe erworbener Fu\u00dfsch\u00e4den. Kinderschuh-Seminare f\u00fcr Kinder\u00e4rzte (Preventing acquired foot damage. Seminars on children's footwear for pediatricians). Sozialp\u00e4diatrie in Praxis und Klinik. 1980, 3-"},{"key":"737_CR27","first-page":"297","volume":"6","author":"E Maier","year":"1982","unstructured":"Maier E: Erworbene Fu\u00dfsch\u00e4den bei Kindern und Jugendlichen (Acquired foot damage of childrens and juveniles). Sozialp\u00e4diatrie in Praxis und Klinik. 1982, 6: 297-307.","journal-title":"Sozialp\u00e4diatrie in Praxis und Klinik"},{"key":"737_CR28","volume-title":"PhD thesis","author":"G Dhom","year":"1984","unstructured":"Dhom G: Das Zugabeproblem bei fu\u00dfgerechten Kinderschuhen (The problem of extra length in correctly fitting children's shoes). PhD thesis. 1984, Johannes Gutenberg Universit\u00e4t Mainz"},{"key":"737_CR29","volume-title":"PhD thesis","author":"C Schmidt","year":"1989","unstructured":"Schmidt C: Die optimale L\u00e4ngenzugabe in Sport- und Freizeitschuhen bei Kindern (The optimal length of sport shoes and recreational footwear for children). PhD thesis. 1989, Erlangen-N\u00fcrnberg"},{"key":"737_CR30","first-page":"355","volume":"89","author":"NA Barnicot","year":"1955","unstructured":"Barnicot NA, Hardy RH: The position of the hallux in West Africans. Am J Anat. 1955, 89: 355-361.","journal-title":"Am J Anat"},{"key":"737_CR31","volume-title":"Fu\u00dfchirurgie","author":"G Pisani","year":"1988","unstructured":"Pisani G: Fu\u00dfchirurgie. 1988, Georg Thieme Verlag Stuttgart"},{"key":"737_CR32","doi-asserted-by":"publisher","first-page":"1648","DOI":"10.1136\/bmj.1.5451.1648","volume":"1","author":"IB Shine","year":"1965","unstructured":"Shine IB: Incidence of hallux valgus in a partially shoe-wearing community. Br Med J. 1965, 1: 1648-1650. 10.1136\/bmj.1.5451.1648.","journal-title":"Br Med J"},{"key":"737_CR33","volume-title":"Hallux valgus-hallux rigidus","author":"N W\u00fclker","year":"1997","unstructured":"W\u00fclker N: Hallux valgus-hallux rigidus. 1997, Stuttgart: Ferdinand Enke Verlag"},{"key":"737_CR34","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1055\/s-2008-1054225","volume":"136","author":"J Jerosch","year":"1998","unstructured":"Jerosch J, Mamsch H: Deformities and misalignment of feet in children - a field study of 345 students. Z Orthop Ihre Grenzgeb. 1998, 136: 215-220. 10.1055\/s-2008-1054225.","journal-title":"Z Orthop Ihre Grenzgeb"},{"key":"737_CR35","first-page":"63","volume-title":"Jahrbuch der Orthop\u00e4die","author":"R Forst","year":"1993","unstructured":"Forst R: Spreizfu\u00df und Hallux valgus des Jugendlichen (Juvenile splay foot and hallux valgus). Jahrbuch der Orthop\u00e4die. Edited by: Venbrocks R, Salis-Soglio G. 1993, Z\u00fclpich: Biermann, 63-72."},{"key":"737_CR36","first-page":"2","volume":"109","author":"W Schilling","year":"1982","unstructured":"Schilling W: Morphologische und funktionelle Entwicklung des Kinderfu\u00dfes (Morphological and functional development of children's feet). Medizinische Orthop\u00e4dietechnik. 1982, 109: 2-6.","journal-title":"Medizinische Orthop\u00e4dietechnik"},{"key":"737_CR37","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1302\/0301-620X.73B6.1955440","volume":"73-B","author":"TE Kilmartin","year":"1991","unstructured":"Kilmartin TE, Barrington RL, Wallace WA: Metatarsus Primus Varus. A statistical study. J Bone Joint Surg [Br]. 1991, 73-B: 937-940.","journal-title":"J Bone Joint Surg [Br]"},{"key":"737_CR38","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1007\/s001120170107","volume":"149","author":"K Krohmeyer-Hauschild","year":"2001","unstructured":"Krohmeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Gei\u00df HC, Hesse V, von Hippel A, Jaeger U, Johnsen D, Korte W, Menner K, M\u00fcller G, M\u00fcller JM, Niemann-Pilatus A, Remer T, Schaefer F, Wittchen HU, Zabransky S, Zellner K, Ziegler A, Hebebrand J: Perzentile f\u00fcr den Body-mass Index f\u00fcr das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben (Percentiles of body mass index in children and adults evaluated from different regional German studies). Monatsschr Kinderheilkd. 2001, 149: 807-818. 10.1007\/s001120170107.","journal-title":"Monatsschr Kinderheilkd"},{"key":"737_CR39","unstructured":"AGA (Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter). [http:\/\/www.a-g-a.de\/aga_content.html]"},{"key":"737_CR40","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1177\/107110079801900805","volume":"19","author":"W Schneider","year":"1998","unstructured":"Schneider W, Knahr K: Metatarsophalangeal and Intermetatarsal Angle: Different Values and Interpretation of Postoperative Results Dependent on the Technique of Measurements. Foot and Ankle Int. 1998, 19: 532-536.","journal-title":"Foot and Ankle Int"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2474-10-159.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1471-2474-10-159\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2474-10-159","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2474-10-159.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T23:15:54Z","timestamp":1685229354000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmusculoskeletdisord.biomedcentral.com\/articles\/10.1186\/1471-2474-10-159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,12]]},"references-count":40,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2009,12]]}},"alternative-id":["737"],"URL":"https:\/\/doi.org\/10.1186\/1471-2474-10-159","relation":{},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,12]]},"assertion":[{"value":"20 May 2009","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 December 2009","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 December 2009","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"159"}}