scholarly journals Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore Weight Bearing of the First Ray During the Stance Phase

2009 ◽  
Vol 89 (9) ◽  
pp. 934-945 ◽  
Author(s):  
Reinhard Schuh ◽  
Stefan G. Hofstaetter ◽  
Samuel B. Adams ◽  
Florian Pichler ◽  
Karl-Heinz Kristen ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Plantar Pressure ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Rehabilitation Program ◽  
First Metatarsophalangeal Joint ◽  
Time Integral ◽  
First Ray ◽  
Force Time ◽  
Force Time Integral

Background Operative treatment of people with hallux valgus can yield favorable clinical and radiographic results. However, plantar pressure analysis has demonstrated that physiologic gait patterns are not restored after hallux valgus surgery. Objective The purpose of this study was to illustrate the changes of plantar pressure distribution during the stance phase of gait in patients who underwent hallux valgus surgery and received a multimodal rehabilitation program. Design This was a prospective descriptive study. Methods Thirty patients who underwent Austin (n=20) and scarf (n=10) osteotomy for correction of mild to moderate hallux valgus deformity were included in this study. Four weeks postoperatively they received a multimodal rehabilitation program once per week for 4 to 6 weeks. Plantar pressure analysis was performed preoperatively and 4 weeks, 8 weeks, and 6 months postoperatively. In addition, range of motion of the first metatarsophalangeal joint was measured, and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot questionnaire was administered preoperatively and at 6 months after surgery. Results The mean AOFAS score significantly increased from 60.7 points (SD=11.9) preoperatively to 94.5 points (SD=4.5) 6 months after surgery. First metatarsophalangeal joint range of motion increased at 6 months postoperatively, with a significant increase in isolated dorsiflexion. In the first metatarsal head region, maximum force increased from 117.8 N to 126.4 N and the force-time integral increased from 37.9 N·s to 55.6 N·s between the preoperative and 6-month assessments. In the great toe region, maximum force increased from 66.1 N to 87.2 N and the force-time integral increased from 18.7 N·s to 24.2 N·s between the preoperative and 6-month assessments. Limitations A limitation of the study was the absence of a control group due to the descriptive nature of the study. Conclusions The results suggest that postoperative physical therapy and gait training may lead to improved function and weight bearing of the first ray after hallux valgus surgery.

Clinical and Biomechanical Risk Factors of Patients Diagnosed with Hallux Valgus

2003 ◽  
Vol 93 (2) ◽  
pp. 97-103 ◽  
Author(s):  
Thomas W. Kernozek ◽  
Abdulaziz Elfessi ◽  
Steven Sterriker
Keyword(s):  
Hallux Valgus ◽  
Univariate Analysis ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Stepwise Logistic Regression ◽  
First Metatarsophalangeal Joint ◽  
Time Integral ◽  
Hallux Valgus Deformity ◽  
Force Time ◽  
Force Time Integral

The purpose of this study was to identify the clinical and plantar loading variables related to hallux valgus. Fifty-one healthy control subjects and 40 subjects with a diagnosis of moderate hallux valgus deformity of similar age and body weight were recruited for this study. Clinical measurements of pain, first metatarsophalangeal joint range of motion, and single-leg resting calcaneal stance position were obtained. Biomechanical measurements were obtained using a capacitive pressure platform. Plantar loading variables were calculated for seven regions of the plantar surface. A univariate analysis followed by a stepwise logistic regression was used to analyze the data. The results indicated that high values for pain, single-leg resting calcaneal stance position, hallux region peak pressure and force–time integral, and central forefoot region force–time integral increased the likelihood of hallux valgus. (J Am Podiatr Med Assoc 93(2): 97-103, 2003)

Clinical, Quantitative Assessment of First Tarsometatarsal Mobility in the Sagittal Plane and Its Relation to Hallux Valgus Deformity

1994 ◽  
Vol 15 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Kaj Klaue ◽  
Sigvard T. Hansen ◽  
Alain C. Masquelet
Keyword(s):  
Hallux Valgus ◽  
Sagittal Plane ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Main Concern ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
First Ray

Today, bunion surgery is still controversial. Considering that a bunion deformity in fact may be a result of multiple causes, the rationale of the currently applied techniques of surgical treatment has not been conclusively demonstrated. In view of the known hypermobility syndrome of the first ray that results in insufficient weightbearing beneath the first metatarsal head, the relationship between this syndrome and hallux valgus deformity has been investigated. The results suggest a direct relationship between painful hallux valgus deformity and hypermobility in extension of the first tarsometatarsal joint. A pathological mechanism of symptomatic hallux valgus is proposed that relates this pathology with primary weightbearing disturbances in the forefoot where angulation of the first metatarsophalangeal joint is one of the consequences. The alignment of the metatarsal heads within the sagittal plane seems to be a main concern in many hallux valgus deformities. As a consequence, treatment includes reestablishing stable sagittal alignment in addition to the horizontal reposition of the metatarsal over the sesamoid complex. As an example, first tarsometatarsal reorientation arthrodesis regulates the elasticity of the multiarticular first ray within the sagittal plane and may be the treatment of choice in many hallux valgus deformities.

scholarly journals PREOPERATIVE ANALYSIS OF RADIOGRAPHIC FINDINGS IN 516 PATIENTS WITH HALLUX VALGUS DEFORMITY

2019 ◽  
Vol 27 (1) ◽  
pp. 16-19
Author(s):  
Marco Götze ◽  
Sandra Elisabeth Hasmann ◽  
Ulf Krister Hofmann ◽  
Christian Walter ◽  
Falk Mittag
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Young Patients ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Osteotomy ◽  
First Metatarsophalangeal Joint ◽  
Radiographic Findings ◽  
Plain Radiographs ◽  
Operative Correction

ABSTRACT Objective: This is a descriptive study to report our method of operative correction for patients with hallux valgus deformities. Methods: From 2006 to 2012, 516 consecutive patients (601 feet) with hallux valgus deformities were treated surgically in our department after conservative treatments were exhausted. The hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and degree of osteoarthritis in the first metatarsophalangeal joint were measured on preoperative plain radiographs of the weight-bearing forefoot. Results: Young patients with severe intermetatarsal deviation received a combined proximal and distal osteotomy of the first metatarsal (n = 21). Patients with low intermetatarsal deviation received a distal metatarsal chevron osteotomy (n = 196), whereas patients with severe intermetatarsal deviation and less flexible deformities without osteoarthritis received a basal metatarsal osteotomy with a distal soft tissue procedure (n = 173). Elderly active patients with osteoarthritis in the first metatarsophalangeal joint received an arthrodesis (n = 100) or resection arthroplasty (n = 58). Conclusion: Determining a few simple angles on plain radiographs of the weight-bearing forefoot in combination with the age and level of activity of patients can help simplify the operative correction method by using the schema we developed. Level of evidence IV, case series.

Development and Reliability of a Measurement Device for Flexion Force of the First Metatarsophalangeal Joint

2003 ◽  
Vol 19 (3) ◽  
pp. 271-278 ◽  
Author(s):  
Jaap Swanenburg ◽  
Karel H. Stappaerts ◽  
Bart Tirez ◽  
Daniel Uebelhart ◽  
Geert Aufdemkampe
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Measurement Device ◽  
Good Reliability ◽  
First Metatarsophalangeal Joint ◽  
Healthy Female ◽  
The Right ◽  
Leg Dominance ◽  
Flexion Force

The purpose of this study was to present a method for repeated measurement of flexion force of the hallux in the metatarsophalangeal joint. The reliability of this measurement device was also examined. This device is suitable for situations where weight-bearing is contraindicated or when it is not possible for patients to bear load on their toes, such as hallux valgus patients. Since most such patients are female, the participants in this study were 24 healthy female volunteers. Age, weight, height, and leg dominance were determined for each. Muscle strength was measured using a device with a built-in MicroFET dynamometer. The result for the left hallux was ICC(3,1).89 (95% CI .77–.95). The result for the right hallux was ICC(3,1).94 (95% CI .87–.97). In the Bland and Altman plots, the reliability again appeared to be sufficient. The Pearson product-moment correlations gave poor results for the association between body weight, height, age, and mean force of the four trails. The test results indicate good reliability of the measurement device as used in this study. The advantage of this testing device is that it makes it easier to standardize measurements as opposed to the MicroFET used as a hand-held dynamometer. Also, patients can be tested in a nonload situation, which makes it possible to test hallux valgus at any time, and therefore it is possible to monitor variations in progression (or regression).

Dynamic plantar pressure analysis. Comparing common insole materials

1992 ◽  
Vol 82 (10) ◽  
pp. 507-513 ◽  
Author(s):  
PB Sanfilippo ◽  
RM Stess ◽  
KM Moss
Keyword(s):  
Plantar Pressure ◽  
Human Subjects ◽  
Force Plate ◽  
Vertical Force ◽  
Time Integral ◽  
Pressure Time ◽  
Peak Plantar Pressure ◽  
Force Time ◽  
Dynamic Measures ◽  
Force Time Integral

A comparison of five commonly used insole materials (Spenco, PPT, Plastazote, Nickelplast, and Pelite) was made to evaluate their effectiveness in reducing plantar vertical pressures on human subjects during walking. With the use of the EMED-SF pedograph force plate system, dynamic measures of vertical force, force-time integral, peak plantar pressure, pressure-time integral, and area of foot-to-ground contact were compared with the force plate covered with each of the insole materials and without any interface material.

THE EFFECTS OF CHANGES IN STEP WIDTH ON PLANTAR FOOT PRESSURE PATTERNS OF YOUNG FEMALE SUBJECTS DURING WALKING

2011 ◽  
Vol 11 (05) ◽  
pp. 1071-1083 ◽  
Author(s):  
SU-YA LEE ◽  
CHEN-YU CHOU ◽  
YI-YOU HOU ◽  
YU-LIN WANG ◽  
CHICH-HAUNG YANG ◽  
...  
Keyword(s):  
Ground Reaction Force ◽  
Plantar Pressure ◽  
Reaction Force ◽  
Lateral Side ◽  
Step Width ◽  
Foot Pressure ◽  
Time Integral ◽  
Pressure Time ◽  
Force Time ◽  
Force Time Integral

The aim of this study was to investigate the foot plantar pressure distribution and the effect of different step width during walking. Methods: Nineteen female volunteers who aged 18~30 years old and with no history of lower extremity injury were considered. Subjects walked at a pre-determined set speed with varied step width (5 cm, 10 cm, and 20 cm) for three trials at each step width. This study used an in-sole plantar pressure measurement system to collect the peak pressure, maximum ground reaction force, pressure–time integral, and force–time integral data of eight different foot regions. Results: The data revealed that the peak plantar foot pressure on the medial arch increased with wider step width (p < 0.05). In contrast, maximum ground reaction force, peak plantar pressure, pressure–time integral, and force–time integral on the lateral arch and lateral side of the metatarsals decreased with wider step width (p < 0.05). Conclusion: The results of this study revealed that smaller step width during walking result in decreasing the pressure on the medial arch of the foot. It may have the relieving effect for clients with pes planus and it can be a reference for rehabilitation clinicians while treating the above-mentioned subjects.

Comparison of Plantar Pressure Distribution Between Postoperative Hallux Valgus Feet and Healthy Feet

2019 ◽  
Vol 40 (5) ◽  
pp. 578-585 ◽  
Author(s):  
Seiya Tsujinaka ◽  
Hiroaki Shima ◽  
Toshito Yasuda ◽  
Katsunori Mori ◽  
Momoko Kizawa ◽  
...  
Keyword(s):  
Pressure Distribution ◽  
Hallux Valgus ◽  
Plantar Pressure ◽  
Great Toe ◽  
Level Of Evidence ◽  
Time Integral ◽  
Plantar Pressure Distribution ◽  
Pressure Peak ◽  
Force Time ◽  
Severe Hallux Valgus

Background: Proximal crescentic osteotomy (PCO) in patients with moderate-to-severe hallux valgus (HV) is a well-established and effective procedure for correcting the deformity. However, there are no published studies comparing plantar pressure in postoperative HV feet with healthy feet. This study aimed to compare the plantar pressure distribution in postoperative HV feet with healthy feet. Methods: Twenty-six patients were included in the HV group, and 24 healthy participants were included in the control (C) group. All patients in the HV group underwent unilateral PCO. After undergoing PCO, this group was defined as the OP group. All subjects were women with no significant differences in age, height, weight, and body mass index. There were no significant differences in demographic characteristics between patients in each group. We divided the subjects’ feet into 8 regions and measured the peak pressure (Peak-P), maximum force (Max-F), contact time, contact area, and the force-time integral in each region. Results: All parameters of the great toe were significantly higher in the OP group than in the HV group. All forefoot parameters were not significantly different between the 2 groups. No parameter of the great toe was significantly different between the OP and C groups. However, mean Peak-P and Max-F of the central forefoot were significantly higher in the OP group than in the C group. Conclusion: PCO can improve the plantar pressure of the great toe in patients with moderate-to-severe HV to a level similar to that in healthy subjects. Level of Evidence: Level III, comparative study.

Effect of insole material on force and plantar pressures during walking

1992 ◽  
Vol 82 (8) ◽  
pp. 412-416 ◽  
Author(s):  
TG McPoil ◽  
MW Cornwall
Keyword(s):  
Plantar Pressure ◽  
Vertical Force ◽  
Pressure Data ◽  
Plantar Pressures ◽  
Time Integral ◽  
Force Time ◽  
Force Time Integral

Twelve subjects between the ages of 24 and 35 years walked barefoot over a pressure platform with the following insole materials placed directly on top of the platform: 1) PPT, 2) Spenco, and 3) Viscolas. Maximum vertical force, vertical force-time integral as well as maximum plantar pressure data were collected for the rearfoot, midfoot, and forefoot regions. The results were not significant for maximum vertical force and vertical force-time integral among the three insole materials when compared to barefoot-only walking. There was, however, a significant reduction in forefoot maximum plantar pressure among the three materials compared to barefoot-only walking. In the rearfoot region, a reduction in maximum plantar pressure was seen only with PPT and Spenco.

scholarly journals Intermetatarsal Angle and Hallux Abductus Angle Reduction After First Metatarsophalangeal Joint Arthrodesis in Mild, Moderate, and Severe Hallux Valgus

2021 ◽  
Vol 111 (2) ◽  
Author(s):  
Kimberly S. Cravey ◽  
Ian M. Barron ◽  
Said A. Atway ◽  
Michael L. Anthony ◽  
Erik K. Monson
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
First Ray ◽  
Severe Hallux Valgus ◽  
Preoperative Deformity

Background First metatarsophalangeal joint fusion is a commonly used procedure for treating many pathologic disorders of the first ray. Historically, hallux valgus deformity with severely increased intermetatarsal angle or metatarsus primus adductus indicated need for a proximal metatarsal procedure. However, the effectiveness and reliability of first metatarsophalangeal joint arthrodesis in reducing the intermetatarsal angle has been increasingly described in the literature. We compared findings at our institution with current literature for further validation of this well-accepted procedure in correcting hallux valgus deformity with high intermetatarsal angle. Methods Weightbearing preoperative and postoperative radiographs of 43 patients, 31 women and 12 men, meeting the inclusion and exclusion criteria were identified. Two independent investigators measured the hallux abductus and intermetatarsal angles. Preoperative and postoperative measurements for each angle were compared and average reduction calculated. The data were further analyzed by grouping deformities as mild, moderate, and severe. Mean follow-up was 10 months. Results The overall mean preoperative intermetatarsal and hallux abductus angles decreased significantly (from 13.09° to 9.33° and from 23.72° to 12.19°, respectively; both P &lt; .01). When grouping deformities as mild, moderate, and severe, all of the categories maintained reduction of intermetatarsal and hallux abductus angles (P &lt; .01). Furthermore, the mean reduction of the intermetatarsal and hallux abductus angles seemed to correlate with preoperative deformity severity. Conclusions In patients undergoing correction of hallux valgus deformity, first metatarsophalangeal joint arthrodesis produced consistent reductions in the intermetatarsal and hallux abductus angles. Furthermore, these findings are consistent with those reported by other institutions.

scholarly journals Percutaneous First Metatarsophalangeal Joint Fusion

2017 ◽  
Vol 11 (1) ◽  
pp. 724-731 ◽  
Author(s):  
Thomas Bauer
Keyword(s):  
Simple Procedure ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Full Weight Bearing ◽  
Normal Walking ◽  
First Metatarsophalangeal Joint ◽  
Joint Fusion ◽  
Forefoot Surgery ◽  
First Ray

The first metatarsophalangeal (MTP1) joint fusion is a very useful procedure in forefoot surgery and is still the gold standard for the treatment of severe and painful hallux rigidus. Normal walking and running are possible after MTP1 fusion, the first ray mobility being essentially in the interphalangeal (IP) joint with a compensatory hypermobility in dorsal flexion. Percutaneous MTP1 fusion is a simple procedure providing comparable results to fusions performed with open techniques. Postoperative cares are simplified with an immediate full weight bearing on rigid flat shoes and quick return to normal walking. Bone preparation is an important step and requires an experience in percutaneous forefoot surgery. Arthrodesis positioning and fixation with this percutaneous procedure are simple with possibility of clinical and radiological control. The indications for percutaneous MTP1 fusion are very large and only severe bone loss or osteoporosis represent the limits for this technique.

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