## 4 Discussion
These exercises could play an important role in the rehabilitation of individuals suffering from HV, as enhancing the strength of the AH muscle can lead to better foot function, pain reduction, and the prevention of additional deformities. [PERSON] et al. [29] highlight that specific exercises, such as toe curls and SF, effectively enhance muscle activation, suggesting that these could be beneficial pre-operatively. Strengthening the AH supports the medial longitudinal arch, potentially mitigating the severity of HV by maintaining proper foot alignment and reducing excessive pronation. Post-operative rehabilitation could be equally useful in restoring function and minimizing complications. [PERSON] et al. [14] provide evidence that targeted foot exercises lead to substantial improvements in muscle strength and foot stability, which are essential for successful surgical outcomes. By focusing on AH activation, rehabilitation can accelerate recovery and enhance post-surgical satisfaction by reinforcing foot mechanics and preventing recurrence. In line with our results, [PERSON] et al. [30] emphasize the efficacy of FA exercises, which specifically target the AH, contributing to improved dynamic balance and muscle coordination. Incorporating these exercises into rehabilitation protocols can further facilitate muscle conditioning and stabilization of the first metatarsal joint, which are key factors in managing HV deformities. Integrating targeted exercises focused on AH strengthening, both pre- and post-surgery, offers a comprehensive approach to HV management. Additionally, [PERSON] et al. provided valuable insights into the muscle activities associated with the examined exercises [31]. Their findings suggest that different exercises elicit varying degrees of AH activation, which is critical for clinicians when designing tailored rehabilitation programs aimed at maximizing muscle engagement. Moreover, [PERSON] et al. complemented these findings by employing pressure bio-feedback units to investigate AH muscle activity specifically in patients with HV [14]. This approach allows for a more comprehensive analysis of muscle function and engagement during rehabilitation exercises, enhancing the understanding of how targeted interventions can lead to improved clinical outcomes. The results on AH performance in TSO and SF can be explained by considering the instability of the first ray joint. The limitations in its ROM in patients with moderate-to-severe degrees of HV deformity hinder the execution of exercises such as SF and TSO. The compromised ability to move the first ray is influenced not only by muscle imbalances but also by mechanical joint restrictions [32; 33; 34]. The proposed rehabilitation program included exercises such as FA and FM, which are critical for restoring balance and coordination in individuals with HV. These exercises engage the entire musculature of the foot, bypassing the coordination and ROM necessary to correctly perform TSO and SF [35]. Our findings suggest that FA may be easier for patients with severe deformities, leading to improvements in AH activity, primarily because it requires minimal abduction mobility of the first ray, which is typically compromised due to bony issues. Since FA involves a lower degree of mobility and coordination, its incorporation into exercise programs was particularly effective in enhancing the performance and activation of the AH in patients with significant deformities. By integrating FA exercises into rehabilitation protocols, physical therapists can create targeted exercise regimens specifically aimed at addressing deficiencies in muscle function for patients with conditions such as hallux valgus and other forefoot deformities. As patients engage in forefoot adduction exercises, they learn to activate and control key muscle groups effectively, enhancing their overall foot biomechanics, ultimately leading to enhanced outcomes and quality of life [5; 36].