Effect of Physiotherapy on Foot Function During  Treatment of Hallux Valgus

Research background. The present final paper presents an analysis of the effects of physiotherapy on foot function when treating the hallux valgus deformity. The research object was the change of the deformity degree of the great toe, foot pain, muscle strength, load distribution in the sole, trajectory of the sole’s center of gravity and foot’s contact with the movement’s surface in different stages of walking after the treatment. Objectives of the research were to analyze scientific literature about the hallux valgus, the concept of foot function and its treatment; determine the changes in the deformity degree of the great toe, pain intensity and muscle strength prior to and after the physical therapy exercises; assess the load distribution in the soles of the respondents, trajectory of the sole’s center of gravity and foot’s contact with the movement’s surface in different stages of walking prior to and after the physiotherapy exercises. Methods. The study was carried out at the Out-Patient Recuperation Center of the Public Institution Šiauliai National Hospital. The computer-aided pedobarographic assessment of the foot was performed by a representative of the Bauerfeind Company at the Manual Medicine Clinic. The study was carried out from December 2013 to April 2014. Twelve respondents afﬂicted with hallux valgus deformity participated in the study. The duration of the exercise sessions was 11 Results. According to the analysis of the research data, the intensity of pain was inﬂuenced by both the exercises and the use of orthopedic supports. However, the pain decreased more after physiotherapy compared to the use of orthopedic supports. The changes in the deformity degree of the great toe and muscle strength were also positively affected by exercises. In EKt group the muscle strength of the tested muscles changed by 1–2 points. In the EO group the muscle strength and the deformity degree of the great toe remained unchanged after the use of orthopedic supports. Following the analysis of the load distribution in the sole, trajectory of the sole’s center of gravity and foot’s contact with the movement’s surface, it became obvious that the physiotherapy had positive a impact on the decrease of load distribution points in different places of the sole and the trajectory of the sole’s center of gravity for the respondents in the Conclusion. After the exercises the toe of one patient was aligned properly and the remaining patients were close to achieving proper alignment. Also, the exercises had a positive inﬂuence on the foot’s contact with the movement’s surface. The EO group did not observe any positive changes after using the orthopedic supports, i.e. the load distribution points, trajectory of the center of gravity and foot’s contact with the movement’s surface were not altered.Keywords: hallux valgus, foot function, physical therapy.

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The Modified Lapidus Procedure for Hallux Valgus: A Clinical and Radiographic Analysis

Foot & Ankle International ◽

10.1177/107110070502601103 ◽

2005 ◽

Vol 26 (11) ◽

pp. 913-917 ◽

Cited By ~ 60

Author(s):

Franz J. Kopp ◽

Mihir M. Patel ◽

David S. Levine ◽

Jonathan T. Deland

Keyword(s):

Hallux Valgus ◽

Valgus Deformity ◽

Hallux Varus ◽

Hallux Valgus Deformity ◽

Age At Surgery ◽

First Ray ◽

Foot Function ◽

Visual Analog Pain Score ◽

Radiographic Data ◽

Subjective Sensation

Background: Historically, the modified Lapidus procedure has been considered technically challenging, with high rates of complications, including nonunion and malunion. The purpose of this study was to review the clinical and radiographic results of this technique for the treatment of hallux valgus associated with first ray hypermobility, specifically examining patient satisfaction and the incidence of complications. Methods: We retrospectively reviewed the results of the modified Lapidus procedure in 32 patients (38 feet). Evaluation included preoperative and postoperative questionnaires, physical examination, and radiographs. Results: Complete clinical data was available for 29 patients (35 feet) and complete radiographic data for 29 patients (34 feet). Average age at surgery was 54 (range 27 to 84) years. Average followup was 42 months (range 29 to 93) months. Average preoperative visual analog pain score was 7.2 and postoperative 2.3 ( p < 0.001). Average preoperative AOFAS Hallux MTP-IP Score was 44.8 and postoperative 87.3 ( p < 0.001). Average preoperative intermetatarsal (IM) angle was 16 degrees, and the hallux valgus (HV) angle was 34 degrees. Postoperatively, the average IM angle was 6 degrees, the HV angle 11 degrees. There were no cases of nonunion or malunion. Complications included symptomatic hallux varus in two, recurrence of hallux valgus deformity in one, deep venous thrombosis in one, and failure of fixation in one patient. Twenty-four percent of patients (7 of 29) noted the subjective sensation of midfoot stiffness and 34% (10 of 29) noted forefoot stiffness. None of these patients thought that the stiffness was a disability. Ninety percent of patients (26 of 29) were satisfied with their foot function, and 86% (25 of 29) were satisfied with the cosmetic appearance of their foot. Conclusions: The modified Lapidus procedure results in a satisfactory clinical outcome in most patients. With meticulous operative technique, rigid internal fixation, and strict postoperative weightbearing restrictions, successful union can be achieved and complications can be minimized. Care should be taken to avoid hallux varus, and patients need to be counseled regarding a potentially long convalescent period and possible postoperative stiffness.

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Bunion foot

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1208533v ◽

2012 ◽

Vol 140 (7-8) ◽

pp. 533-536

Author(s):

Zoran Vukasinovic ◽

Nadan Mikic

Keyword(s):

Decision Making ◽

Hallux Valgus ◽

Progressive Disease ◽

Standing Position ◽

Valgus Deformity ◽

Great Toe ◽

X Ray ◽

Hallux Valgus Deformity ◽

Chronic Progressive Disease ◽

Single Method

Hallux valgus deformity is a complex chronic progressive disease primarily characterized by a lateral great toe deviation and deformity of the first metatarsophalageal joint. Numerous etiological factors are related with the expression of this disease, and they are divided into two categories: endogenous and exogenous. Complexity of the hallux valgus deformity is reflected with the progression of the disease that gives rise to numerous forefoot deformities. The diagnosis is first of all affirmed by clinical examination and x-ray of the feet in a standing position. Treatment could be either operative or conservative. Conservative treatment has shown to be totally unsuccessful. Before decision making on the type of operative treatment, the patient?s complaints, age, profession, clinical and x-ray findings must be taken into consideration. Until now, over two hundred different operative procedures have been described, which clearly supports the observation that there is no single method which could resolve all clinical varieties of this deformity. Therefore, today, when making a choice on the surgical procedure of hallux valgus deformity, the utilization of surgical algorithm is recommended.

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The corrective ability of the double chevron and Akin osteotomies on medial sesamoid position in Hallux Valgus deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000131 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Jie Chen ◽

Eugene Stautberg ◽

David Spak ◽

Gregory Schneider ◽

Vinod Panchbhavi

Keyword(s):

Hallux Valgus ◽

Recurrence Rate ◽

Lateral Displacement ◽

Weight Bearing ◽

Valgus Deformity ◽

Observer Agreement ◽

P Value ◽

Great Toe ◽

Hallux Valgus Deformity ◽

Akin Osteotomy

Category: Bunion Introduction/Purpose: Recurrence of hallux valgus deformity is a common post-operative complication with rates in the literature ranging from 2.7 – 30%. Lateral displacement of the great toe medial sesamoid is correlated with a high recurrence rate, and failure to reduce sesamoid position has been implicated as a risk factor for recurrence due to an uncorrected deforming force. Sesamoid position has been studied in relation with Scarf osteotomy, but not other corrective osteotomies. The goal of this study is to determine the efficacy of the double chevron and Akin osteotomy in reducing the great toe medial sesamoid. Methods: We retrospectively reviewed all patients in the last five years undergoing hallux valgus correction via the double chevron and Akin osteotomy method with pre-operative and post-operative weight bearing radiographs. We measured sesamoid position pre and post-operatively using the Hardy-Clapham (HC) scale of I-VII with V or greater representing a laterally displaced medial sesamoid. We also measured hallux valgus and inter-metatarsal angles. Measurements were made by three authors in orthopedics and one in radiology. We used intra-class correlation coefficient (ICC) to determine inter-observer agreement and establish reliability. With adequate ICC, we could consider the lead author’s measurements as representative of the group. We examined the percent of hallux valgus cases with displaced sesamoids pre-operatively. Next, we determined how many of those cases did we reduce the sesamoids to grade IV or less. Finally, we performed subgroup analysis for pre-operative HC grades V, VI, and VII to determine correction percentage by severity. Results: There were 49 patients with 53 feet treated with the double chevron and Akin osteotomies for hallux valgus correction. Of these, 39 (73.6%) had significant preoperative lateral displacement of the medial sesamoid characterized by HC grade of V or greater. We corrected 30/39 (77.0%) to a reduced position of HC grade IV or less (p-value 0.048). In sub-analysis, we achieved reduction of the medial sesamoid position in 14/14 feet (100%) with HC grade V, 6/9 feet (66.7%) with HC grade VI, and 10/16 feet (62.5%) with HC grade VII (p-value 0.037). The ICC was 0.91 for pre-operative HC scores and 0.79 for post-operative HC scores. Average pre and post-operative HVA was 29.4° and 8.7°, respectively. Average pre and post-operative IMA was 13° and 5.2° respectively. Conclusion: Our study validates the double chevron and Akin osteotomies as effective in correcting sesamoid position. We achieved correction in 30/39 (77%) cases with initial sesamoid displacement. For mild cases of displacement with HC grade V, sesamoid correction was always achieved, and we were likely to achieve correction in the more severe cases of sesamoid displacement with HC grade VI or VII as well. The technique is also effective at reducing HVA and IMA. We had acceptable inter- observer agreement which supports the reliability of our methods. Future studies should examine recurrence rate following the double chevron and Akin osteotomies prospectively.

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Treatment of Hallux Valgus by Oblique Osteotomy of the First Metatarsal

Foot & Ankle ◽

10.1177/107110079201300803 ◽

1992 ◽

Vol 13 (8) ◽

pp. 447-452 ◽

Cited By ~ 8

Author(s):

Kosaku Mizuno ◽

Masataka Hashimura ◽

Mayako Kimura ◽

Kazushi Hirohata

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Valgus Deformity ◽

X Rays ◽

Great Toe ◽

First Metatarsal ◽

Oblique Osteotomy ◽

Hallux Valgus Deformity ◽

Valgus Angle

This paper describes a simple technique of oblique osteotomy of the first metatarsal for treatment of symptomatic hallux valgus deformity. The osteotomy is performed at a 30° angle from the long axis of the metatarsal shaft. The head of the metatarsal is then displaced laterally to provide correction of the hallux valgus. This is an uncomplicated procedure for the treatment of hallux valgus. From 1984 through 1989, 53 feet in 31 patients were treated with an oblique osteotomy of the first metatarsal. A total of 49 feet in 27 patients were followed up more than 2 years. The follow-up x-rays and clinical examinations revealed a good result in 43 feet. In six feet of three patients, all of whom had simultaneous oblique osteotomies of both the first and second metatarsals, a fair or poor result was obtained. It was learned that oblique osteotomy for hallux valgus greater than 40° provided insufficient correction of the valgus angle or limitation of motion at the metatarsophalangeal joint of the great toe.

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Great toe metatarsophalangeal arthrodesis for hallux valgus deformity in ambulatory adolescents with spastic cerebral palsy

Journal of Children s Orthopaedics ◽

10.1007/s11832-008-0147-4 ◽

2009 ◽

Vol 3 (1) ◽

pp. 47-52 ◽

Cited By ~ 18

Author(s):

Sherif N. G. Bishay ◽

Mustafa H. El-Sherbini ◽

Ashraf A. Lotfy ◽

Hatem M. Abdel-Rahman ◽

Hany N. Iskandar ◽

...

Keyword(s):

Cerebral Palsy ◽

Hallux Valgus ◽

Valgus Deformity ◽

Spastic Cerebral Palsy ◽

Great Toe ◽

Hallux Valgus Deformity

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Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910473 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10473

Author(s):

Yuki Etani ◽

Makoto Hirao ◽

Kosuke Ebina ◽

Takaaki Noguchi ◽

Gensuke Okamura ◽

...

Keyword(s):

Hallux Valgus ◽

Surgical Procedures ◽

Weight Bearing ◽

Varus Deformity ◽

Valgus Deformity ◽

Great Toe ◽

Forefoot Deformity ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity

With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.

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