Schuh R, Hofstaetter S G, Kristen K-H, Trnka H-J
Abteilung für Orthopädie, Fusszentrum Wien, Osterreich.
Z Orthop Unfall. 2008 Sep-Oct;146(5):630-5. doi: 10.1055/s-2008-1038800. Epub 2008 Oct 9.
Recent pedobarographic analyses have shown that in spite of acceptable clinical and radiological results after hallux valgus surgery, there is decreased function of the big toe and the first ray, respectively. The aim of this prospective study was to evaluate if physiotherapy can help to increase big toe function and to restore physiological gait patterns after hallux valgus surgery.
33 patients (31 females, 2 males, 34 feet) with a mild to moderate hallux valgus deformity have been included in this study. 22 patients underwent Austin osteotomy and 11 patients underwent Scarf osteotomy, respectively. Postsurgically, the patients wore the Rathgeber postop shoe for 4 weeks. After this period they received physiotherapy. Pedobarographic examinations were performed with the EMED-at platform 4 weeks, 8 weeks and 6 months after surgery. The AOFAS score and ROM of the first MTP joint were evaluated prior to surgery and 6 months after surgery. Also, patient's satisfaction has been evaluated 6 months after surgery.
In the big toe region peak pressure increased from 80.7 kPa 4 weeks after surgery to 171.9 kPa 8 weeks after surgery (p < 0.0001) and 336.1 kPa 6 months after surgery. In the same period maximum force increased from 18.6 N to 47.6 N and 90.9 N, respectively. In the first metatarsal head region peak pressure increased from 141.4 kPa 4 weeks postoperatively to 215.8 kPa 8 weeks postoperatively and 292.7 kPa 6 months after surgery (p < 0.0001). The AOFAS score increased from 60.8 presurgically to 94.0 at 6 months after surgery and ROM of the first MTP joint increased during the same period from 66 degrees to 70 degrees .
The authors conclude that postoperative physiotherapy improves big toe function and pressure distribution in the region of the first metatarsal head. This helps to restore physiological gait patterns after hallux valgus surgery.
近期的足压力分析表明，尽管拇外翻手术后临床和影像学结果可接受，但拇趾和第一跖骨的功能分别有所下降。本前瞻性研究的目的是评估物理治疗是否有助于提高拇趾功能并恢复拇外翻手术后的生理步态模式。
本研究纳入了33例（31例女性，2例男性，34只脚）轻度至中度拇外翻畸形患者。分别有22例患者接受了奥斯汀截骨术，11例患者接受了斯卡夫截骨术。术后，患者穿着拉特geber术后鞋4周。在此期间过后，他们接受物理治疗。在术后4周、8周和6个月时，使用EMED-at平台进行足压力检查。在手术前和术后6个月评估美国足与踝关节协会（AOFAS）评分以及第一跖趾关节的活动度。此外，在术后6个月评估患者的满意度。
在拇趾区域，术后4周的峰值压力从80.7 kPa增加到术后8周的171.9 kPa（p < 0.0001）以及术后6个月的336.1 kPa。在同一时期，最大力分别从18.6 N增加到47.6 N和90.9 N。在第一跖骨头区域，术后峰值压力从术后4周的141.4 kPa增加到术后8周的215.8 kPa以及术后6个月的292.7 kPa（p < 0.0001）。AOFAS评分从术前的60.8分提高到术后6个月的94.0分，并且在同一时期第一跖趾关节的活动度从66度增加到70度。
作者得出结论，术后物理治疗可改善拇趾功能以及第一跖骨头区域的压力分布。这有助于恢复拇外翻手术后的生理步态模式。
