Elsevier

The Foot

Volume 17, Issue 2, June 2007, Pages 84-93
The Foot

Plantar pressure distribution and pain after distal osteotomy for hallux valgus: A prospective study of 22 patients with 12-month follow-up

https://doi.org/10.1016/j.foot.2006.11.002Get rights and content

Abstract

Background

Elevated pressure under the central forefoot region is common in hallux valgus and this is often associated with metatarsalgia.

Objective

To ascertain whether there was a difference in pain and plantar pressure distribution parameters after correction of the deformity by two distal metatarsal osteotomy techniques.

Methods

Twenty-two patients randomly assigned to distal chevron or Lindgren first metatarsal osteotomy were evaluated prospectively with dynamic plantar pressure measurement, quality of life scores and clinical and radiographic measurements. Data were collected pre-operatively, at 6 and 12 months after surgery. Results of the combined operated group were compared with an age-matched control group.

Results

There were no significant differences in plantar pressure distribution parameters between the two operated groups at any occasion. At 6 months peak pressure was significantly less under the lateral forefoot in the operated feet compared with the non-operated feet and significantly greater under the central forefoot than in the control group and the medial forefoot than under the non-operated feet, although the operated group had normalised after 12 months. The visual analogue scale (VAS) showed significant improvements after both surgical techniques.

Conclusion

Both surgical techniques resulted in significant clinical and radiographic improvements and reduced the level of pain, although the foot pressure recordings demonstrated no biomechanical effect.

Introduction

Radiological and clinical examination is frequently used as a tool to obtain an objective evaluation of hallux valgus surgery [1], [2]. Several studies have used pressure measurement systems to determine forefoot loading distribution during gait in a normal population [3], [4]. Greater loads on the lateral metatarsal heads have been demonstrated in patients with hallux valgus [4], [5], [6], [7], [8], which may lead to metatarsalgia. The load on the hallux appeared to decrease with an increased hallux valgus angle [4], [9].

Changes in the distribution of the loading has been noted after surgery, as well as greater lateral transfer of load and contact time [4], [8]. It seems that the type of procedure influences the postoperative loading pattern. Loading of the central forefoot increased after a distal soft tissue procedure and proximal metatarsal crescentic osteotomy [10] whereas a lower peak pressure under the second and/or third metatarsal head was noted after a modified McBride procedure combined with a proximal metatarsal crescentic osteotomy [6].

The aim of this study was to elucidate whether there was a difference in dynamic plantar pressure distribution under the forefoot after surgery using two different well-established distal procedures: chevron [11], and Lindgren and Turan [12]. Differences in pressure distribution were compared with an age-matched healthy control group. Furthermore, the score on the great toe metatarsophalangeal–interphalangeal scale of the American Orthopaedic Foot and Ankle Society (AOFAS), perceived pain (VAS) during different activities, quality of life (SF-36), and range of motion of the first metatarsophalangeal (MTP) joint were evaluated. Radiographic evaluation was done only in the surgery group.

Section snippets

Subjects

Criteria for study entry were age between 16 and 80 years of age, hallux valgus angle (HVA) greater than or equal to 20° and less than 44°, intermetatarsal 1–2 angle (IMA) less than 21°, distal metatarsal articular angle (DMAA) less than or equal to 25°, no radiographic evidence of MTP arthrosis and persistent symptoms. Patients were not admitted to the study if any of the following criteria were present: (1) previous foot surgery, (2) diabetes, (3) peripheral vascular disease, (4) peripheral

Results

Demographic data for the three groups were similar (Table 1). We found no significant differences between the groups with respect to body mass index (BMI). Frequency histograms were constructed to show the distribution of the age, gender, weight, BMI, and hallux valgus angle. Observations of the data suggested that it was distributed normally, which was confirmed by a one sample Kolmgorov–Smirnof test for normality.

Eighty-six percent of the patients reported that their mothers had complaints

Discussion

Patients with hallux valgus usually develop metatarsalgia as a result of splaying of the foot with displacement of the first metatarsal in a medial and dorsal direction. The head of the first metatarsal moves to a different plane of weightbearing, dorsal to that of the metatarsal heads II–V. Apart from the hallux valgus correction, the goal of a hallux valgus operation should therefore, be the approximation of the first metatarsal head to the original plane of contact [18].

A great variety of

Conflict of interests

The authors ensure that there were no conflicts of interest concerning the work presented in this manuscript. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Acknowledgments

This work was funded in part by a grant from the Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics, at the Karolinska Institute, Stockholm, Sweden. The authors wish to thank Elisabeth Berg, LIME at Karolinska Institutet, for assistance with the statistical analysis and Jan-Olof Ståhl for illustrations.

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