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While America is preoccupied with threats from the Middle East and China, Ilan Berman of the American Foreign Policy Council argues that a monumental transformation is underway in the most massive nation on earth – nuclear-armed Russia. He posits that Russia's first crisis will be a social one: a demographic collapse of the Slavic population, gutted by alcoholism, early death, and abortions that historically have outnumbered live births. Filling the void is a rising Muslim population, including radical Islamists who seek to subvert the nature of the Russian state. In the background is an emerging strategic rivalry with neighboring China, which has growing designs on Russia's resource-rich east. But that's just the beginning, according to Berman. He paints a troubling picture of Russia's precarious future, how the former superpower might unravel, and how a collapsing Russian state will impact America and the world.
Ilan Berman is Vice President of the American Foreign Policy Council, a columnist for Forbes.com, and the Editor of The Journal of International Security Affairs. He is also a regular columnist for the Washington Times and a frequent contributor to the Wall Street Journal, the International Herald Tribune, and other leading publications. An expert on regional security in the Middle East, Central Asia, and the Russian Federation, he has consulted for both the U.S. Central Intelligence Agency and the U.S. Department of Defense and provided assistance on foreign policy and national security issues to a range of governmental agencies and congressional offices. Berman is also a member of the Associated Faculty at Missouri State University's Department of Defense and Strategic Studies. He has authored or edited four previous books: Winning the Long War (2009), Taking on Tehran (2007), Dismantling Tyranny (2005), and Tehran Rising (2005).
Ilan Berman
Director, Lectures & Seminars
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Shweta Taneja is a tantrist masquerading as an author, graphic novelist and journalist. She is known to hex people who annoy her, or order a hit on them through underworld hitmen. Just kidding. She's just a very prolific writer, churning out books, blogs, graphic novels and articles at the speed of light. We suspect that she gets some supernatural help considering the speed and variety in her writing. We probed a little into Shweta Taneja's life with our questions, and this is what we came out with.
Formats may change, the medium may change, but people will want to express themselves.
If your work is true to you, you will find that speaks for itself
The parents were right. We screwed up.
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While growing up, everyone has ideas and dreams about their first job, their first foray into the professional world. Internships, which were optional a few years back, have now become the norm for youngsters to get the hang of their chosen profession. Your first internship is like being born all over again, as you leave the comfortable world of your college and are thrust into the bright, shiny world of professional adults. Your first internship is a memorable experience, and we're calling all bloggers to relive your internship memories with the #MyInternTheory activity in association with Intern Theory.
Every relationship is different, but there are some essentials that form the foundation for every single one of them. They are love, trust, commitment and promises. Every couple makes some promises to each other, and we're not talking just about wedding vows. These promises are unique to every couple, and that's the beauty of them! So ladies, this is your chance to tell your partner/ future knight in shining armour the kasams you'd like him to make! Participate in the SetWet #SadaSexy activity and get assured vouchers and a chance to win vouchers worth Rs. 1000 each!
It's that time of the year again, where we will scream and shout, "Holi Hai"! As India's most colourful and fun-filled festival is back, gulaal will blast from pichkaris around every corner, delicious gujiya will be washed down with thandai, and everyone will jump and dance with 100% masti!
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Yemen: 44 killed in al-Qaida clashes
SANAA, Yemen Yemeni military officials say they have pushed back al-Qaida militants from taking control of a key city after a lengthy battle that left 44 people dead.
The clashes erupted Monday after the militants attacked a Yemeni army post in the city of Lawder in Abyan province, where al-Qaida fighters are active.
Residents and military officials say 24 militants and 14 soldiers, including a colonel, were killed in the clashes. The officials spoke on condition of anonymity in line with military rules.
Jihad Hafeez, a member of an anti-al-Qaida civilian committee in Lawder, says six of his men were also killed.
Al-Qaidas branch in Yemen has exploited a year of political turmoil to seize territory in the south of the impoverished Arab nation.MORE IN Wire NewsWASHINGTON (AP) Two months, 31 arguments and 18 decisions since the death of Justice Antonin... Full StoryWASHINGTON Congress accomplished relatively little in a short work period, missing deadlines on... Full StoryWASHINGTON Human error, violations of combat rules and untimely equipment failures led to the... Full Story
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Latest on Lisa del Giocondo »
(REOPENS DEl 68) TOIEarlier, Royal Challengers Bangalore were unable to take full advantage of a fine start and were restricted by Mumbai Indians to 170 for 7 after being put into bat. RCB powered their way to 49 for 1 in the first six overs and 89 for 1 after first 10
(REOPENS DEL37) TOIAccording to Nashik district collector Dipendrasinh Kushwah, water stock in 23 reservoirs stood at 7,994 mcft while the Gangapur dam, Kashyapi and Gautami, Godavari dams, which are main sources of drinking water for Nashik city, have 22 per cent stor
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Daily Archives: 13 December 2005
The Priesthood and Weakness
Well, I probably should have let Todd make the 1,000th post here. As he recuperates, I can redirect your attention to his commentary on Optatum Totius (Vatican II's Decree on Priestly Training) below. There has been a lot of discussion … Continue reading
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1001 Posts
That's what the blog tracker says, anyway. Posting should be slowed down somewhat in the next few weeks, for obvious reasons. I'm adjusting to some strong medications for a back problem, hence my absence the past few days. I'll be … Continue reading
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Ravensworth ES Announcements
2015-2016 FCPS Guide to Go, A Handbook for Parents, Students, and Staff Members
School Hours Posted for 2015-2016
Monday-Friday 8:25 a.m. - 3:10 p.m.
First Bell rings at 8:15 a.m.
Students may arrive in the cafeteria no earlier than 8:05.
Registering a Student
New to Ravensworth Elementary, click here to find information about registering your student.
Reading Connection
Students need to read well to succeed. Your child's teacher works on this in class each day here at Ravensworth. Have you been wondering what you can do at home to improve your children's literacy skills and boost comprehension? We have subscribed to Reading Connection (Intermediate Edition) to help you with this. The monthly newsletter will provide you with tips and activities to support children's reading, writing, and language development. Articles emphasize comprehension skills, vocabulary development, fluency, and more. Monthly issues will be posted on our school website between now and June. We hope you find these helpful as you work with your children at home.
See the Reading Connection button on the sidebar for the monthly newsletters.
Home/School Connection
Family Reading Activities with MyOn
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Internet Safety Recommendations for Parents
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Internet Safety: What Parents, Grandparents, and Caregivers Need to Know Need to Know
Student High Fives
Ravensworth students, Here's your opportunity to say thank you to another student for demonstrating respect, kindness, compassion, or courage. Notes will be read during the morning announcements.
FCPS Summer Arts Program for Students
Registration is open for the Elementary Institute for the Arts (E-IFTA), a 2-week program for students currently in grades 3-5. The program provide students the opportunity to participate in comprehensive and engaging arts classes during the summer. E-IFTA is a tuition-based, self-supporting program that is overseen by the fine arts office.
Elementary Institute for the Arts


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Utah football notebook: Center Vyncent Jones is the new man in the middle for the Utes
Mike Terry, Deseret News
SALT LAKE CITY — There's a new man in the middle for Utah. Vyncent Jones is ticketed to be the Utes' next starting center, stepping into a position held by Tevita Stevens the past two seasons.
"Right now the job is his," said Utah coach Kyle Whittingham. "He's a guy that has not been in a lot of starting situations for us over the years, but has played a lot of good football for us."
Whittingham added that the 6-foot-3, 305-pound senior from Jordan High School is a versatile player who can play all five spots on the offensive line. However, he said Jones is best suited for the interior.
"Right now he's the No. 1 center," Whittingham said. "And as long as he continues to play at the level he is, then that will be his job."
It's a role Jones enjoys. He likes making the calls.
"It's a fun position," Jones said. "You've got to be vocal. So I'm working on that."
Jones admits he's been a bit timid in that regard over his first few years with the program. Watching former teammates like Stevens, though, has helped inspire him to make a little more noise.
"So I'm just trying to work on that and make sure everybody knows where to go," Jones said. "I'm just in there trying to do my best to get those guys going and be a leader."
Starting quarterback Travis Wilson noted that things are going well. Wilson and Jones have worked together a lot in the offseason and are getting comfortable with one another.
"I definitely think he's going to be the guy," Wilson said. "I definitely believe he's the smartest guy out there, so he's going to be a great, great center for us."
LIFE OF REILLY: Senior Trevor Reilly spent most of practice working on individual drills and running. The starting linebacker/defensive end is staying out of contact situations this spring after having a torn ACL and meniscus surgically repaired in December. He's expected to be 100 percent by summer.
Reilly suffered the injury in spring ball last April, but went on to play in all 12 games last season — leading the Utes with 69 tackles.
"Somehow with my leg I was able to do it," said Reilly, who wore a brace to protect his ailing right knee.
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There are no Upcoming Shows listed for this comedian.
John Roy
John Roy began his comedy career in Chicago, where he studied Improv at Second City and the Annoyance Theater.
He moved to Los Angeles in 2004. He has appeared on numerous television programs including Conan, The Tonight Show, The Late Late Show, Last Comic Standing, and CBS' Star Search, where he was the first comedy champion.
John is a regular performer on the most prestigious independent shows in comedy, including Meltdown, Comedy at The Knitting Factory, and Whiplash, as well as the best comedy clubs in North America, such as the Laugh Factory, The Hollywood Improv, and the Comedy Attic. John has performed in the Just For Laughs Festival in Chicago, the HBO Comedy Arts Festival in Aspen, the Limestone Festival in Bloomington, and the Bridgetown Comedy Festival in Portland, Oregon.
Together with James Adomian, John wrote and performed, along with Marc Maron, in the web series "Maron in Space" for Funny or Die and IFC in 2013. He is frequently heard on satellite radio and his AST Records release "Alexander Hamilton" was named one of the Ten Best Comedy Releases of 2013 by the LA Weekly. John's podcast "Don't Ever Change" has comedians talk about their high school years and has featured Dan Harmon, Kumail Nanjiani, and Kyle Kinane.
In 2014, John will perform at the Just For Laughs Festival in Montreal. He is managed by Dave Rath at Generate.
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How Do I Love Me? 10 Questions to Ask Yourself
How Do I Love Me? 10 Questions to Ask Yourself
So many of us were taught to put everyone else's needs before our own. People even quote the Bible as proof—Mark 12:31 to be exact, where we are told the second greatest Commandment is: You shall love your neighbor as yourself. Indeed, we must love our neighbors, but the real problem starts when you forget the last two words of that verse, "as yourself." If you treat yourself shabbily, well, your neighbor doesn't stand a chance.
Patrice Gaines is an author, motivational speaker, spiritual counselor and intuitive. Please visit her on the web at www.PatriceGaines.com, on YouTube at TheLightChanneler or on Twitter, @PatriceGaines.com.
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The 05/01/16 FBC Hammond bulletin is up at Baptist City!
Wednesday, 4/20/16 2 Chron 36:1, Then the people of the land took Jehohaz the son of Josiah, and made him king in his father's stead in Jerusalem. Are you willing and able to stand in your father's stead (place, spot, in general)? No, your heavenly Father's stead: as the Father hath sent me, so send I you. I and my Father are one. Heb 5:2, Who can have compassion on the ignorant, and on them that are out of the way; for that he himself also is compassed with infirmity. Wherever you are in your Christian life, Christ HAS COMPASSION ON YOU!! Remember: whatever you're facing He did too. So quit with the defeated attitude: you're "more than a conqueror!!" 'Tween you and Him...you've got this
- A Valley or a Well?
- Look at the Whole Picture
- The Disciples Prayer
- Trumpet Judgements
The great sermons for the week of 04/24/16 are now up at Baptist City.


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Understanding Today's Financial Environment
Our clients enjoy something rare: the personal, attentive service of a boutique firm, coupled with institutional-level investment solutions. We'll create a personalized financial plan based upon your unique life, then manage your portfolio to match your plan.
We're not pushing sales quotas. We're investing in you. Because with us—it's personal.
Retirement Planning
Learn how our Retirement RoadMap can help ensure your money will last.Learn more
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We can help reduce your taxes and expenses, protect your assets, preserve your business's legacy, and keep you from going back to work after you retire.Learn more
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VICE host and medical marijuana patient Damian Abraham tries to find out if a weed soda or a chronic cookie can really be considered medicine as more customers are coming through the doors of their local Toronto dispensary looking for edibles.
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text:
Foot pain and functional limitation in healthy adults with hallux valgus: a cross-sectional study
- Sheree E Nix1_1537, 2_1537Email author,
- Bill T Vicenzino1_1537 and
- Michelle D Smith1_1537
© Nix et al.; licensee BioMed Central Ltd. 2012
Received: 9 March 2012
Accepted: 11 October 2012
Published: 16 October 2012
Hallux valgus (HV) is a very common deformity of the first metatarsophalangeal joint that often requires surgical correction. However, the association between structural HV deformity and related foot pain and disability is unclear. Furthermore, no previous studies have investigated concerns about appearance and difficulty with footwear in a population with HV not seeking surgical correction. The aim of this cross-sectional study was to investigate foot pain, functional limitation, concern about appearance and difficulty with footwear in otherwise healthy adults with HV compared to controls.
Thirty volunteers with HV (radiographic HV angle >15 degrees) and 30 matched controls were recruited for this study (50 women, 10 men; mean age 44.4 years, range 20 to 76 years). Differences between groups were examined for self-reported foot pain and disability, satisfaction with appearance, footwear difficulty, and pressure-pain threshold at the first metatarsophalangeal joint. Functional measures included balance tests, walking performance, and hallux muscle strength (abduction and plantarflexion). Mean differences (MD) and 95% confidence intervals (CI) were calculated.
All self-report measures showed that HV was associated with higher levels of foot pain and disability and significant concerns about appearance and footwear (p < 0.001). Lower pressure-pain threshold was measured at the medial first metatarsophalangeal joint in participants with HV (MD = −133.3 kPa, CI: -251.5 to −15.1). Participants with HV also showed reduced hallux plantarflexion strength (MD = −37.1 N, CI: -55.4 to −18.8) and abduction strength (MD = −9.8 N, CI: -15.6 to −4.0), and increased mediolateral sway when standing with both feet with eyes closed (MD = 0.34 cm, CI: 0.04 to 0.63).
These findings show that HV negatively impacts on self-reported foot pain and function, and concerns about foot appearance and footwear in otherwise healthy adults. There was also evidence of impaired hallux muscle strength and increased postural sway in HV subjects compared to controls, although general physical functioning and participation in physical activity were not adversely affected.
KeywordsHallux valgus Foot pain Physical function Footwear
Hallux valgus (HV) is a progressive foot deformity presenting with lateral deviation of the hallux and medial deviation of the first metatarsal head. Increasing HV severity is associated with subluxation of the first metatarsophalangeal joint (MTPJ) and presence of osteoarthritis (OA) [1]. HV is very common, affecting approximately 23% of adults [2], and surgical correction is frequently sought, making HV the most common indication for orthopaedic forefoot surgery [3].
While HV is basically regarded as a structural deformity, there is debate surrounding the association between abnormal foot structure and related pain and disability. Several studies in elderly populations have found no association between HV and self-reported foot pain and disability [4–9]; whereas, another study reported a significant association between HV and disabling foot pain in older adults [10]. Although fewer studies have investigated these associations in populations with a wide age range, recent studies have linked HV to greater self-reported foot pain and functional limitation in adults aged 40 to 69 years [11], and big toe pain in adults aged over 30 years [12]. Furthermore, there is evidence for impaired quality of life associated with HV and big toe pain in adults aged over 30 years [13], and poorer health-related quality of life and greater foot pain and disability with increasing HV severity in adults aged over 50 years [14].
In addition to self-reported pain and disability, the impact of HV on functional performance has been investigated with inconsistent findings. Impaired balance and gait patterns, toe muscle weakness, and an increased risk of falls in elderly individuals with moderate or severe HV have been reported by several studies [8, 15–21]; however, other studies have shown no association between HV and postural sway [22], walking performance [4, 6] or history of falls [5]. No previous studies have reported on physical measures of functional performance in adults of all ages with HV.
Two additional factors considered most important by patients and orthopaedic surgeons are concerns about cosmetic appearance and difficulty with footwear [23, 24]. While a few population studies have investigated footwear factors such as past usage of high-heeled shoes [9] and shoe fit [5, 25], no previous studies have investigated self-reported difficulty with footwear or concerns about foot appearance in individuals with HV not seeking surgical correction. Therefore, the primary aim of this cross-sectional study was to investigate differences in foot pain, functional limitation, concerns about appearance and difficulty with footwear in a group of adults with HV compared to matched controls. A secondary aim was to explore possible associations between these variables and severity of deformity in HV subjects.
Thirty volunteers with HV (aged 20 years and older) and 30 controls matched for age (± 5 years), gender, and body mass index (BMI) (± 5 kg/m2) were recruited for participation in this study through community advertisements. Exclusion criteria were: history of foot or ankle surgery or fractures, hallux limitus (self-reported or first MTPJ passive dorsiflexion range of motion < 50 degrees) [26], inflammatory disease, neurological conditions, and a history of falls. Because radiographs were required to measure HV angle and determine inclusion into HV or control groups, pregnant or breastfeeding women were also excluded from this study. Weight-bearing dorsoplantar radiographs of both feet were obtained for all eligible participants by the same radiographer using a GE Definium 6000 Digital X-ray system. The HV angle (measured as the angle between the first metatarsal and proximal phalanx) [27] was determined from digital radiographs using computer software developed for telemedical applications [28], and HV cases were defined as an angle greater than 15 degrees. To be eligible for the control group, participants were required to have a radiographic HV angle less than 15 degrees on both feet. Radiographs were further examined by another examiner for signs of osteophytes and joint space narrowing with reference to a radiographic atlas developed by Menz et al. [29]. The case definition defined by these authors was used to classify cases of first MTPJ OA. Ethical approval was gained from the institutional Medical Research Ethics Committee, and all subjects gave written informed consent prior to participation.
Measurement procedure
Height, weight and body mass index (BMI) were recorded in order to match HV participants with controls, and demographic data were obtained via questionnaire. All examinations and questionnaires were administered by a single examiner (SN). Intra-rater reliability for physical measures was determined from pilot work. Refer to Additional file 1: Table S1 for intraclass correlation coefficients (ICC3,1), standard error of measurement (SEM), and minimum detectable change at the 90% confidence limit. Reliability was considered good for ICCs greater than 0.75, and very good for ICCs greater than 0.9 [30].
General health and physical activity
General health and well-being were assessed using the Short Form 36 Health Survey (SF-36v2®), which includes eight subscales [31]. Habitual physical activity levels were assessed using the Baecke Questionnaire [32] to calculate a work index, sport index, and leisure index.
Self-reported foot pain and disability
To investigate functional disability related to foot pain, participants completed the Foot Health Status Questionnaire (FHSQ) [33] and Manchester Foot Pain and Disability Index (FPDI) [34]. The FHSQ contains four domains: foot pain (4 items), foot function (4 items), footwear (3 items), and general foot health (2 items). This questionnaire has been validated and shown to have good test-retest reliability [33]. FHSQ subscale scores are converted to a scale ranging from 0 to 100, with higher scores indicating better foot health. The original FPDI contained 19 items [34]; however, recent psychometric evaluation [35, 36] has shown that 17 items cluster around three main constructs: functional limitation (10 items), pain intensity (5 items), and appearance (2 items). While different methods have been used for FPDI scoring [36], we used the approach described by Menz et al. [37]. Responses to questionnaire items were coded as follows: "none of the time" = 0, "some days" = 1, "on most/every day" = 2. A total score was calculated as the sum of item responses, resulting in an ordinal scale ranging from 0 to 34, and subscales were calculated for pain (score range 0 to 10) and function (score range 0 to 20).
Visual analogue scales (VAS) were used to investigate foot pain intensity and concerns about appearance. Worst and average foot pain intensity over the past four weeks were evaluated using a 100 mm VAS, with 0 mm described as "no pain" and 100 mm described as "worst pain ever," and the pain location was identified on a foot diagram. The pain VAS has well-established reliability and validity in lower limb musculoskeletal research [38]. Participants were also asked to indicate how satisfied they were with the appearance of their feet on a 100 mm VAS, with 0 mm representing "completely satisfied with appearance" and 100 mm representing "completely dissatisfied with appearance." This method was adapted from a technique described by Saro et al. [39].
Participants were asked to wear their regular footwear to the examination session. Shoes were assessed using a steel ruler to measure relative heel height (the difference between heel height and forefoot sole thickness) [25] and using digital callipers for relative ball width (the difference between forefoot width across the widest point of the MTPJs and the width of the shoe upper at the same point). A positive value for relative ball width indicated that the shoe upper was wider than the forefoot. Participants who wore sandals that were unable to be measured in this manner (n = 12) were excluded from this analysis. Finally, participants were asked whether they had ever regularly worn shoes with a heel height greater than two inches (yes/no), and how often they currently wore this style of shoe (never, seldom, sometimes, often, always) [25].
Pressure-pain threshold
In order to obtain a quantifiable measurement of tenderness around the first MTPJ, as a surrogate for clinical palpation, pressure-pain threshold (PPT) was measured at the medial and plantar aspects of the joint. A digital pressure algometer (Somedic AB, Farsta, Sweden) was used to measure the pressure applied at a rate of 40kPa/s by a rubber-tipped probe (area 1cm2) [40]. An average of three measurements from each site was used for analysis.
Functional performance and muscle strength
Sample size determination
Sample size was based on a priori power calculations. Using standard deviations obtained from preliminary data analysis (n = 26), we determined that 29 subjects in each group would provide 80% power to detect a difference of 11 mm between groups on the 100 mm pain VAS (alpha 0.05) [42, 43].
Statistical analysis
Age and BMI were first compared using independent t-tests to ensure that there were no significant differences between HV and control groups. For variables measured bilaterally (appearance VAS, hallux strength, PPT, and postural sway in single leg stance), data from only one limb was analysed [44]. For HV subjects the foot with a greater HV angle was chosen (16 right feet and 14 left feet used for analysis), while for control subjects the right or left foot was chosen at random using a random number generator (15 right feet and 15 left feet used for analysis). All variables were examined for normality of distribution using boxplots, histograms, and quantile-normal plots. Continuous variables showing a skewed distribution were transformed wherever possible using log, square root, or inverse square root transformations, as appropriate. Differences between groups were then examined using independent t-tests for continuous variables, Wilcoxon rank-sum tests for ordinal variables and continuous variables for which no adequate transformation was available, and Chi-squared statistics for categorical data. In the HV group (n = 30), the relationship between HV angle and other variables was investigated using Spearman's correlation coefficient. Correlations are reported for variables showing statistically significant correlations with HV angle. Spearman's rho was interpreted as follows: low correlation (rho = 0.26 to 0.49), moderate correlation (rho = 0.5 to 0.69) or high correlation (rho > 0.7) [45]. Results for continuous variables are presented as means, standard deviations (SD), mean differences (MD), and 95% confidence intervals (CI), while ordinal data are presented as medians (min – max). All analyses were conducted using STATA version 10 [46], and the level of significance was set at p < 0.05.
Characteristics of HV and control groups with comparison of SF-36v2® subscales and physical activity levels (mean ± SD, unless otherwise stated)
HV group (n = 30)
Control group (n = 30)
Mean difference (95% CI)
Subject characteristics
Men/Women (n)
Age (years)
0.3 (−7.6 to 8.2)
BMI (kg/m2)
−0.5 (−2.5 to 1.5)
HV angle (°)†
19.3 (16.2 to 22.4)**
First MTPJ OA (n (right/left))
1 (1/1)
2 (2/1)
SF-36v2® (score range 0 – 100)
Physical functioning
−6.6 (−14.5 to 1.3)
−5.8 (−14.1 to 2.4)
−0.83 (−6.7 to 5.0)
Bodily pain
−6.8 (−15.4 to 1.8)
−7.7 (−15.6 to 0.11)
Mental health
−3.9 (−9.5 to 1.8)
Social functioning
2.1 (−5.2 to 9.4)
General health
−0.3 (−8.2 to 7.6)
Physical activity (score range 1 – 5)
0.17 (0.0 to 0.34)*
0.69 (0.28 to 1.1)*
−0.01 (−0.32 to 0.30)
General health and physical activity
There were no significant differences between HV and control groups for SF-36v2® subscales, although the difference between groups on the vitality subscale (MD = −7.7, CI: -15.6 to 0.11) approached statistical significance (p = 0.05). HV participants reported significantly higher sporting activity (MD = 0.69, CI: 0.28 to 1.1) and physical activity levels at work (MD = 0.17, CI: 0.0 to 0.33), while the leisure index was not significantly different between groups (Table 1).
Foot pain and disability
Comparison between HV and control groups for self-reported foot pain, disability and concern about appearance (mean ± SD for all tests except FPDI presented as median (min – max))
HV group (n = 30)
Control group (n = 30)
Mean difference (95% CI)
FHSQ (score range 0 – 100)
Foot pain scale
−18.1 (−25.3 to −11.0)**
Foot function scale
−12.5 (−19.0 to −5.9)**
Footwear scale
−47.5 (−60.0 to −34.9)**
General foot health
−37.5 (−49.3 to −25.7)**
VAS (0 – 100 mm)
Worst pain VAS
25.5 (14.3 to 36.6)**
Average pain VAS
12.3 (6.2 to 18.3)**
Appearance VAS
38.1 (23.8 to 52.3)**
Pressure-pain threshold (kPa)
Medial first MTPJ
−133.3 (−251.5 to −15.1)*
Plantar first MTPJ
−90.8 (−201.8 to 20.3)
Footwear examination (mm)
Relative heel height
−0.96 (−7.3 to 5.4)
Relative ball width†
−0.22 (−3.1 to 2.6)
Wilcoxon rank-sum Z
Function (score range 0 – 20)
2 (0 – 14)
0 (0 – 5)
Pain (score range 0 – 10)
3 (0 – 8)
0 (0 – 2)
Total (score range 0 – 34)
5.5 (0 – 24)
0 (0 – 9)
Analysis of foot pain locations showed that 25 HV subjects (83%) reported pain in the first MTPJ or hallux, eight subjects (27%) reported pain in the lesser toes or MTPJs, and six subjects (20%) reported pain in the heel or midfoot area. There were 12 HV subjects who reported foot pain in more than one location, and only two who reported no foot pain. Control subjects reported the following distribution of foot pain: pain under the first MTPJ (one subject, 3%), pain in the lesser toes or MTPJs (nine subjects, 30%), and pain in the heel or midfoot (13 subjects, 43%). Three control subjects reported pain in more than one location, and nine reported no foot pain.
Concerns about appearance and footwear
Participants with HV had significant concerns about foot appearance (VAS: MD = 38.1 mm, CI: 23.8 to 52.3) and more difficulty fitting footwear (FHSQ footwear score: MD = −47.5, CI: -60.0 to −34.9) than control subjects. On the FPDI item which states "I feel self-conscious about my feet", 19 participants with HV (63%) responded "on some days" or "on most/every day", compared to five participants (17%) in the control group (Chi-squared p = 0.001). Similarly, 13 HV participants (43%) responded positively to the statement "I get self conscious about the shoes I have to wear", compared to one participant (3%) in the control group (Chi-squared p = 0.001). Fifteen participants in the HV group and 16 control participants reported a history of regularly wearing high heeled shoes (> 2 inches). Eight participants in each group reported wearing high heels "sometimes," while high heels were worn "often" by four control participants and two HV participants, and "always" by one person with HV. Examination of footwear worn to the examination session showed no significant differences between groups in relative heel height or relative ball width measures (p > 0.05) (Table 2).
Functional performance and muscle strength
Comparison between HV and control groups for functional performance and muscle strength (mean ± SD)
HV group (n = 30)
Control group (n = 30)
Mean difference (95% CI)
Walking tests (sec)
Timed 10m walk
−0.04 (−0.37 to 0.29)
Stair ascent
0.11 (−0.11 to 0.32)
Stair descent
0.12 (−0.11 to 0.35)
Postural sway (COP range, cm)
AP sway, both feet eyes open
0.0 (−0.37 to 0.38)
ML sway, both feet eyes open
0.15 (−0.13 to 0.43)
AP sway, both feet eyes closed
0.05 (−0.58 to 0.68)
ML sway, both feet eyes closed
0.34 (0.04 to 0.63)*
AP sway, foam eyes open
0.28 (−0.26 to 0.82)
ML sway, foam eyes open
0.20 (−0.33 to 0.73)
AP sway, foam eyes closed
1.1 (−0.24 to 2.4)
ML sway, foam eyes closed
1.2 (−0.06 to 2.4)
AP sway, single leg stance†
0.47 (−0.07 to 1.0)
ML sway, single leg stance†
0.98 (−0.16 to 2.1)
Muscle strength (N)
Plantarflexion strength
−37.1 (−55.4 to −18.8)**
Abduction strength
−9.8 (−15.6 to −4.0)**
Correlations with HV angle
A significant inverse correlation was found between greater HV angles and lower FHSQ scores indicating poorer general foot health (rho = −0.41, p = 0.03). Greater HV angles were correlated with higher appearance VAS scores indicating less satisfaction with appearance (rho = 0.43, p = 0.02). There was also a significant inverse correlation between greater HV severity and poorer hallux abduction strength (rho = −0.41, p = 0.03). Across the SF-36v2® subscales, low correlations were found between HV angle and bodily pain (rho = 0.39, p = 0.04) and social functioning (rho = 0.49, p = 0.01), indicating that in our sample, HV subjects with more severe deformity reported less bodily pain and better overall social functioning. No significant correlations were found for other SF-36v2® subscales, and HV angle was not correlated with footwear difficulty or any other measure of foot pain and function (i.e. FHSQ, FPDI, VAS, PPT).
This study investigated self-reported foot pain and disability, functional performance, concerns about appearance and difficulty with footwear experienced by healthy adults with HV. We secondarily explored possible associations between severity of HV angle and other variables in participants with HV.
Our results show that the presence of HV deformity is associated with self-reported foot pain and disability. Significant differences were found between HV and control groups for FHSQ and FPDI subscales, as well as worst and average pain VAS (Table 2). With reference to the minimal important difference for the FHSQ and VAS previously reported by Landorf et al. [43], these differences between groups can be considered clinically meaningful. Our findings are similar to those reported by Cho et al. [11] who showed that HV was associated with more self-reported foot pain and poorer self-reported physical functioning in adults aged 40 years and older (n = 563). Abhishek et al. [13] further highlighted the importance of big toe pain accompanying HV, reporting that health-related quality of life was progressively impaired in adults aged 30 years and older (n = 3082) with HV alone, big toe pain alone, and HV with big toe pain. In our study there was also some evidence of mechanical hyperalgesia around the medial aspect of the first MTPJ, as indicated by a lower PPT in HV subjects (p < 0.05). However, this result should be interpreted with caution as the difference between groups (MD = −133.3, CI: -251.5 to −15.1) did not reach the calculated MDC90 (255.2) (Additional file 1: Table S1) and therefore may not represent a meaningful difference.
In addition to self-reported foot pain and functional limitation, participants with HV in our study presented with hallux plantarflexion and abduction weakness and increased mediolateral postural sway. Our finding of decreased hallux plantarflexion strength in people with HV is consistent with that of Mickle et al. [21]. However, our study also showed a significant inverse correlation between HV angle and an individual's ability to abduct the hallux (rho = −0.41), a finding which has been suggested by electromyographic investigations [47, 48] but previously has not been investigated clinically. With regard to standing balance, results reported by Mickle et al. [22] are in contrast to our findings, as these authors reported no difference in postural sway between older adults with HV and controls. However, other studies in elderly populations have found poorer lateral stability, poorer coordinated stability, and increased postural sway to be associated with HV [17, 19]. Finally, no significant between-group differences were found in walking performance in our study, which is consistent with previous findings in elderly populations [4, 5, 8, 19].
Despite no differences between groups in relative heel height or relative ball width of footwear worn to the examination, participants with HV reported significantly more difficulty with footwear and concerns about foot appearance than controls. Concerns about appearance and general foot health appeared to increase with severity of deformity in the HV group (appearance VAS: rho = 0.43, FHSQ general foot health: rho = −0.41). To our knowledge, this is the first study to investigate self-reported difficulty with footwear and concerns about appearance in a HV population not seeking surgical correction compared to age and gender-matched controls. Our data suggest that clinicians managing HV should place particular priority on footwear concerns. This is supported by Saro et al. [24], who showed that free choice of footwear was significantly associated with health-related quality of life outcomes after HV surgery.
While participants with HV in our study reported significantly more foot-specific functional disability, participation in physical activities, general health and physical functioning were not adversely affected (Table 1). To the contrary HV subjects reported higher levels of habitual physical activity at work and in sports, which may have led to improved performance on other physical parameters such as walking and balance tests. Furthermore, correlations between HV angle and SF-36v2® subscales suggest that in our sample HV participants with more severe deformity experienced less bodily pain and better social functioning. This finding is in contrast to results of a recent study by Menz et al. [14] who found a trend towards poorer scores on all SF-36v2® subscales with increasing HV severity in adults aged 50 years and older (n = 2681). It is possible that general health and functioning may be more impacted by increasing HV severity in populations of older adults; alternatively, it may be that our findings were a consequence of a volunteer sample of HV participants, who were active individuals with a high level of physical functioning. Furthermore, perhaps those with more severe HV in our sample had adapted their lifestyle or footwear choices to accommodate for a severe foot deformity.
Caution must be applied when comparing reports from different studies as varying case definitions (present/absent or mild/moderate/severe) and means of diagnosing HV (i.e. self-reported or diagnosed by an examiner) are used [2]. Studies have used a range of methods to evaluate the presence and severity of HV, including weight-bearing radiographs [11, 49], and the Manchester Scale [10, 17, 19, 22, 50], which includes a series of four standardised photographs used by an examiner to classify HV as "none," "mild," "moderate," or "severe." Other larger studies have used a validated self-report instrument based on five line drawings representing increasing HV severity [12–14, 51]. Our study used standardised weight-bearing radiographs and a widely accepted angular definition to classify HV as being present (HV angle > 15°) [52]. This definition meant that several mild and asymptomatic HV cases were included, which was considered appropriate to address the primary research question of whether the presence of HV was associated with foot pain and disability.
Our study findings should be interpreted with consideration of our recruitment methods and sample, which may affect the generalisability of results. First, volunteers with HV responding to advertisements were likely aware that they had a foot problem. This may have introduced an element of bias to their self-reported foot health measures compared to controls. Second, only ten males participated in this study, and the age range of study participants was relatively wide. Nevertheless, these sample characteristics were considered representative of a clinical population. Third, whilst our sample included participants with mild, moderate and severe HV, the sample size in the current study was not sufficient to examine subgroups according to HV severity. While there is some evidence that increasing HV severity has a greater impact on foot pain and disability [14], further research using large population-based samples is warranted to determine whether HV severity is associated with increased foot pain or poorer functional performance.
Reliability of measurement methods must be considered as a potential limitation in any clinical research. All measurements in our study were performed by the same examiner, and intra-rater reliability was very good for most physical measurements (Additional file 1: Table S1). Inter-rater reliability was not addressed by this investigation. Reported intra-rater reliability for hallux plantarflexion and abduction strength was lower than desirable (ICC3,1 = 0.73 to 0.75), and as a result the calculated values for MDC90 (plantarflexion: 47.8 N; abduction: 14.5 N) were quite large for these measures. While the differences between HV and control groups were statistically significant (plantarflexion: MD = −37.1 N; abduction: -9.8 N), the clinical significance of these results should be interpreted with caution. Methods previously reported to measure hallux plantarflexion strength include the clinical paper grip test [53], strain gauge scales [54], force plate [55] or pressure platform systems [21]. We developed a novel method that would not only give a continuous-scaled quantitative measurement, but would also allow us to examine participants' ability to abduct the hallux.
Finally, some discussion is warranted regarding self-report data obtained in our study. Both foot-specific questionnaires (FHSQ, FPDI) produced significantly skewed data, and consequently non-parametric statistical tests were used. In particular the summed FPDI scores cannot be interpreted as a true interval scale unless a Rasch analysis is performed [36], which was not undertaken for the current study. Potential for recall bias and variation between individuals' interpretation of pain rating scales should also be considered when interpreting self-report data [56, 57]. It is interesting to note that self-report measures of foot-specific pain and disability showed large differences between groups, while self-reported general functioning and physical performance tests were less indicative of limitations in participants with HV. Study participants reported more pain and disability than was evident on physical performance tests, thus it may be that foot-specific questionnaires (FHSQ, FPDI) capture more than typical measures used for physical function. For example, while general physical functioning (SF-36v2®), activity participation and walking performance were not impaired in this sample, HV subjects reported significant functional disability on the FPDI, which considers the influence of foot pain and other aspects such as walking distance and rough or hard surfaces. Future studies could utilise more challenging physical performance tasks to explore functional difficulty experienced by healthy adults with HV.
HV deformity is accompanied by significant foot-specific pain and disability, muscle weakness around the first MTPJ and increased mediolateral postural sway. Concerns regarding appearance and footwear are also important factors to consider for clinicians managing this common deformity. Global physical functioning and participation in activities were not adversely affected in our sample, indicating that HV may not prevent participation in an active lifestyle in otherwise healthy adults.
Body mass index
95% confidence interval
Centre of pressure
Foot Health Status Questionnaire
Manchester Foot Pain and Disability Index
Hallux valgus
Intraclass correlation coefficient (3,1)
Mean difference
Minimal detectable change (90% confidence limit)
Metatarsophalangeal joint
Pressure-pain threshold
Standard deviation
Standard error of measurement
- SF-36v2®:
Short Form 36 Health Survey version 2
Visual analogue scale.
The authors would like to thank Dr Trevor Russell for allowing the use of custom-designed telerehabilitation software for measurement of radiographic HV angle. This research was supported in part by a grant from the Australian Podiatry Education and Research Foundation. SN was supported by a Sir Robert Menzies Memorial Scholarship in the Allied Health Sciences, as a doctoral candidate at The University of Queensland, School of Health and Rehabilitation Sciences.
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Pre-publication history
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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Phoenix Information Systems, LLC
50 - 99
10 - 20 Million
Services->Technology Consulting->Software Consulting
SIC Code:
5045 - Computers, Peripherals, and Software
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Research Article
MECP2 promoter methylation and X chromosome inactivation in autism
Article first published online: 9 JUL 2008
DOI: 10.1002/aur.24
Copyright © 2008, International Society for Autism Research, Wiley Periodicals, Inc.
Autism Research
Volume 1, Issue 3, pages 169–178, June 2008
Additional Information
How to Cite
Nagarajan, R. P., Patzel, K. A., Martin, M., Yasui, D. H., Swanberg, S. E., Hertz-Picciotto, I., Hansen, R. L., Van de Water, J., Pessah, I. N., Jiang, R., Robinson, W. P. and LaSalle, J. M. (2008), MECP2 promoter methylation and X chromosome inactivation in autism. Autism Res, 1: 169–178. doi: 10.1002/aur.24
Publication History
- Issue published online: 29 JUL 2008
- Article first published online: 9 JUL 2008
- Manuscript Accepted: 30 MAY 2008
- Manuscript Revised: 6 MAY 2008
- Manuscript Received: 28 MAR 2008
Funded by
- NIH. Grant Numbers: 1R01HD048799, R01ES015171
- Abstract
- Article
- References
- Supporting Information
- Cited By
The Supplementary materials described in this article can be found at http://www.interscience.wiley.com/jpages/1939-3792/suppmat .
|Supporting Information
Please note: Wiley Blackwell is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.


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National League
Pujols Hits 19th Homer, Cards Win
Albert Pujols, 26, becomes the fastest player in major league history to reach the mark.
Published: Sunday, May 14, 2006 at 12:01 a.m.
Last Modified: Sunday, May 14, 2006 at 8:24 a.m.
ST. LOUIS - Albert Pujols became the fastest player in major league history to reach 19 home runs, leading the St. Louis Cardinals to a 9-1 victory over the Arizona Diamondbacks on Saturday night.
Pujols reached the milestone in his 37th game, beating Mickey Mantle in 1956 and Luis Gonzalez of the Diamondbacks in 2001, by three games. Pujols added RBI singles in the first and fourth, hiking his major league-leading total to 47, and flied out to the warning track in center field in the sixth.
He also struck out with the bases loaded to end the seventh against Brandon Medders, flipping his bat in disgust.
Pujols' heroics overshadowed a resurgent effort by Jason Marquis, who worked seven strong innings to end a four-game losing streak, and a five-RBI game by Scott Rolen.
Padres 4, Cubs 3
CHICAGO - Mike Piazza hit a three-run homer off Ryan Dempster in the ninth inning, and the surging San Diego Padres rallied for their 13th victory in 14 games, beating the slumping Chicago Cubs.
Mike Cameron led off the ninth with a single to center, and Brian Giles followed with a base hit to right. Piazza then hit his fourth homer, pulling an 0-1 pitch over the left-field wall to make it 4-3.
The Cubs have lost 13 of 15 games.
The blown save was the first in eight opportunities for Dempster (0-1). It spoiled a terrific start by Greg Maddux, who allowed an unearned run in 7 1-3 innings. Maddux left to a standing ovation with two runners on and a run in. Scott Eyre relieved, and pinch hitter Eric Young grounded into a double play.
San Diego starter Chris Young allowed three runs -- two earned -- and six hits, walked three and struck out four in seven innings. Cla Meredith (1-0) pitched a scoreless eighth.
Phillies 2, Reds 0
CINCINNATI - Jon Lieber took a perfect game into the seventh inning and gave up two hits in 8 2-3 innings to help the Phillies beat the Reds.
Lieber (3-4) didn't allow a walk and struck out six to earn his third straight win.
The 36-year-old right-hander retired the first 20 batters he faced before Adam Dunn lined a single up the middle past shortstop Jimmy Rollins with two outs in the seventh inning. Lieber regrouped to get Austin Kearns to fly out to right fielder Chris Roberson in foul territory.
The only other hit Lieber gave up was a two-out single to pinchhitter Ken Griffey Jr. in the ninth inning. Tom Gordon got the final out for his 12th save in 13 opportunities.
Pirates 4, Marlins 3
PITTSBURGH - Miguel Cabrera doubled twice and Scott Olsen bounced back from his worst start of the season to strike out nine over six innings, leading the Florida Marlins past the Pittsburgh Pirates in a matchup of the NL's two worst teams.
The Marlins became the last team in the majors to reach double digits in victories, winning their 10th in 34 games and only their second in eight.
Rockies 2, Astros 1
HOUSTON - Luis Gonzalez and Todd Helton hit RBI singles, Aaron Cook pitched 6 1-3 strong innings, and the Colorado Rockies held on for a 2-1 win over the Houston Astros on Saturday night to break a season-high three-game losing streak.
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