Innsbruck Medical University, Department of Orthopaedic Surgery, Anichstrasse 35, Innsbruck, 6020, Austria.
Foot Ankle Int. 2010 Nov;31(11):980-6. doi: 10.3113/FAI.2010.0980.
Recent pedobarographic studies have demonstrated decreased loading of the great toe region and the first metatarsal head at a short- and intermediate-term followup. The purpose of the present study was to determine if a postoperative rehabilitation program helped to improve weightbearing of the first ray after chevron osteotomy for correction of hallux valgus deformity.
Twenty-nine patients with a mean age of 58 years with mild to moderate hallux valgus deformity who underwent a chevron osteotomy were included. Postoperatively, the patients received a multimodal rehabilitation program including mobilization, manual therapy, strengthening exercises and gait training. Preoperative and one year postoperative plantar pressure distribution parameters including maximum force, contact area and force-time integral were evaluated. Additionally the AOFAS score, ROM of the first MTP joint and plain radiographs were assessed. The results were compared using Student's t-test and level of significance was set at p < 0.05.
In the great toe, the mean maximum force increased from 72.2 N preoperatively to 106.8 N 1 year after surgery. The mean contact area increased from 7.6 cm(2) preoperatively to 8.9 cm(2) 1 year after surgery and the mean force-time integral increased from 20.8 N()sec to 30.5 N()sec. All changes were statistically significant (p < 0.05). For the first metatarsal head region, the mean maximum force increased from 122.5 N preoperatively to 144.7 N one year after surgery and the mean force-time integral increased from 42.3 N()sec preoperatively to 52.6 N()sec 1 year postoperatively (p = 0.068 and p = 0.055, respectively). The mean AOFAS score increased from 61 points preoperatively to 94 points at final followup (p < 0.001). The average hallux valgus angle decreased from 31 degrees to 9 degrees and the average first intermetatarsal angle decreased from 14 degrees to 6 degrees (p < 0.001 for both).
Our results suggest that postoperative physical therapy and gait training with a Chevron osteotomy may help to improve weightbearing of the great toe and first ray. Therefore, we believe there is a restoration of more physiological gait patterns in patients who receive this postoperative regimen.
最近的足压研究表明，在短期和中期随访中，大脚趾区域和第一跖骨头的承重减少。本研究的目的是确定 Chevron 截骨术后的康复计划是否有助于改善拇外翻畸形矫正后的第一跖骨的负重。
共纳入 29 例平均年龄 58 岁的轻度至中度拇外翻患者，均接受 Chevron 截骨术。术后患者接受多模式康复方案，包括活动度训练、手法治疗、强化锻炼和步态训练。评估术前和术后 1 年的足底压力分布参数，包括最大力、接触面积和力-时积分。此外，还评估了 AOFAS 评分、第一跖趾关节活动度和普通 X 线片。使用学生 t 检验比较结果，显著性水平设为 p < 0.05。
在大脚趾，最大力从术前的 72.2 N 增加到术后 1 年的 106.8 N。接触面积从术前的 7.6 cm²增加到术后 1 年的 8.9 cm²，力-时积分从术前的 20.8 Nsec 增加到术后 1 年的 30.5 Nsec。所有变化均有统计学意义（p < 0.05）。对于第一跖骨头区域，最大力从术前的 122.5 N 增加到术后 1 年的 144.7 N，力-时积分从术前的 42.3 Nsec 增加到术后 1 年的 52.6 Nsec（p = 0.068 和 p = 0.055）。AOFAS 评分从术前的 61 分增加到最终随访时的 94 分（p < 0.001）。平均拇外翻角从 31 度减少到 9 度，平均第一跖骨间角从 14 度减少到 6 度（两者均 p < 0.001）。
我们的结果表明，Chevron 截骨术后的物理治疗和步态训练可能有助于改善大脚趾和第一跖骨的负重。因此，我们认为接受这种术后方案的患者的步态模式更接近生理模式。
