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Genetic Influences on Hallux Valgus in Koreans: The Healthy Twin Study

  • Chang-Hyung Lee (a1), Sooji Lee (a2), HyoJeong Kang (a3) (a4), Da-Eun Jung (a2), Yun-Mi Song (a5), Kayoung Lee (a6), Kyungtai Lee (a7), JiHye Hwang (a3) and Joohon Sung (a2) (a8)...

Hallux valgus (HV) is a common foot deformity of multifactorial etiology, but knowledge about the relative importance of genetics and environments on HV has been limited. In order to estimate genetic influences on HV, 1,265 adults, including 175 monozygotic twin (MZ) pairs, 31 dizygotic twin (DZ) pairs, and 853 first-degree singleton family members of the twins were included from the Healthy Twin study, a population-based twin-family cohort in Korea. All participants underwent foot examination and weight-bearing radiographic assessment (anterior-posterior and lateral) in addition to a general health survey. Of the subjects, 208 (16.4%) were classified as HV (as HV angle >20°). The genetic influence on HV was estimated to be substantial; the heritability of HV was 0.51 (95% CI 0.42–0.59) and the heritability of HV angle was 0.47 (0.38–0.56), while contributions from shared environmental effects were negligible. These findings suggest that genetic factors play an important role in determining HV deformity.

Corresponding author
address for correspondence: Joohon Sung, Complex Disease & Genome Epidemiology Branch, Department of Epidemiology, School of Public Health, Seoul National University. #704, Bldg 220 1st GwanAk-Ro, GwanAk-Gu, Seoul 151-742, South Korea. E-mail:
co-correspondence: JiHye Hwang, Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea. E-mail:
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Almasy, L., & Blangero, J. (1998). Multipoint quantitative-trait linkage analysis in general pedigrees. American Journal of Human Genetics, 62, 11981211.
Cho, N., Kim, S., Kwon, D.-J., & Kim, H. (2009). The prevalence of hallux valgus and its association with foot pain and function in a rural Korean community. Journal of Bone & Joint Surgery, British Volume, 91, 494498.
Coughlin, M. (1995). Juvenile hallux valgus: Etiology and treatment. Foot & Ankle International, 16, 682697.
Coughlin, M. (1997). Hallux valgus in men: Effect of the distal metatarsal articular angle on hallux valgus correction. Foot & Ankle International, 18 (8), 463470.
Coughlin, M. J., & Jones, C. P. (2007). Hallux valgus: Demographics, etiology, and radiographic assessment. Foot & Ankle International, 28 (7), 759777.
Ferrari, J., Higgins, J., & Prior, T. (2004). Interventions for treating hallux valgus and bunions. Cochrane Database of Systematic Reviews, 2004 (1). CD000964.
Hannan, M. T., Menz, H. B., Jordan, J. M., Cupples, L. A., Cheng, C. H., & Hsu, Y. H. (2013). High heritability of hallux valgus and lesser toe deformities in adult men and women. Arthritis Care & Research (Hoboken), 65, 15151521.
Hardy, R., & Clapham, J. (1951). Observations on hallux valgus based on a controlled series. Journal of Bone and Joint Surgery, 33, 376391.
Kato, T., & Watanabe, S. (1981). The etiology of hallux valgus in Japan. Clinical Orthopaedics and Related Research, 157, 7881.
Krauss, I., Grau, S., Mauch, M., Maiwald, C., & Horstmann, T. (2008). Sex-related differences in foot shape. Ergonomics, 51 (11), 16931709.
Nix, S., Smith, M., & Vicenzino, B. (2010). Prevalence of hallux valgus in the general population: A systematic review and meta-analysis. Journal of Foot and Ankle Research, 3, 2130.
Owoeye, B., Akinbo, S., Aiyegbusi, A., & Ogunsola, M. (2011). Prevalence of hallux valgus among youth population in Lagos, Nigeria. The Nigerian Postgraduate Medical Journal, 18, 5155.
Pique-Vidal, C., Sole, M. T., & Antich, J. (2007). Hallux valgus inheritance: Pedigree research in 350 patients with bunion deformity. Journal of Foot and Ankle Surgery, 46, 149154.
Song, Y. M., Lee, D., Lee, M. K., Lee, K., Lee, H. J., Hong, E. J., & Sung, J. (2010). Validity of the zygosity questionnaire and characteristics of zygosity-misdiagnosed twin pairs in the Healthy Twin Study of Korea. Twin Research and Human Genetics, 13, 223230.
Sung, J., Cho, S. I., Lee, K., Ha, M., Choi, E. Y., Choi, J. S., & Song, Y. M. (2006). Healthy Twin: A twin-family study of Korea — Protocols and current status. Twin Research and Human Genetics, 9, 844848.
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Twin Research and Human Genetics
  • ISSN: 1832-4274
  • EISSN: 1839-2628
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