Feuerstein Catherine, Weil Lowell, Weil Lowell Scott, Klein Erin E, Argerakis Nicholas, Fleischer Adam E
Associate, South Chicago Foot and Ankle, Chicago, IL.
President and Fellowship Director, Weil Foot and Ankle Institute, Des Plaines, IL.
J Foot Ankle Surg. 2016 Jan-Feb;55(1):76-80. doi: 10.1053/j.jfas.2015.06.023.
Arthrofibrosis is a known complication of hallux valgus surgery. Joint manipulation under anesthesia has been studied for adhesive capsulitis of the shoulder; however, a paucity of published data exists on the use of this modality in the foot and ankle. The purpose of the present study was to investigate the outcomes of first metatarsophalangeal joint manipulation for arthrofibrosis that occurred as a complication of bunion surgery. The study population consisted of patients attending a single foot and ankle specialty clinic who were evaluated for arthrofibrosis after bunion surgery. Patients who underwent joint manipulation under anesthesia were asked to complete a research visit in which a clinical examination was performed and the presence and severity of joint pain were assessed. A total of 38 patients (34 females, 4 males, 53 feet), with a mean age of 55.7 ± 11.8 (range 30 to 83) years, agreed to participate. The mean follow-up period was 6.5 ± 3.4 (range 1 to 17) years. The visual analog scale scores improved significantly from baseline to the final follow-up visit (baseline 6.5 ± 1.5, range 2 to 10; final follow-up visit 2.3 ± 1.5, range 0 to 6; p < .001). Furthermore, joint motion had increased significantly (p < .001) for both dorsiflexion and plantarflexion at the final follow-up examination. The final range of motion (dorsiflexion, r = -0.431, p = .002; plantarflexion, r = -0.494, p < .001) correlated highly with patient self-reported pain in the first metatarsophalangeal joint. Our findings suggest that joint manipulation could be a useful modality for increasing first metatarsophalangeal joint mobility and alleviating pain in patients who experience arthrofibrosis after surgical correction of hallux valgus.
关节纤维化是拇外翻手术已知的并发症。麻醉下的关节手法治疗已针对肩部粘连性关节囊炎进行了研究；然而，关于这种治疗方式在足踝部的应用，公开数据较少。本研究的目的是调查因拇囊炎手术并发症而发生的关节纤维化患者，其第一跖趾关节手法治疗的效果。研究人群包括在单一足踝专科诊所就诊、接受拇囊炎手术后关节纤维化评估的患者。接受麻醉下关节手法治疗的患者被要求完成一次研究访视，期间进行临床检查并评估关节疼痛的存在及严重程度。共有38例患者（34例女性，4例男性，53只足）同意参与，平均年龄为55.7±11.8（范围30至83）岁。平均随访期为6.5±3.4（范围1至17）年。视觉模拟量表评分从基线到最终随访显著改善（基线6.5±1.5，范围2至10；最终随访2.3±1.5，范围0至6；p<.001）。此外，在最终随访检查时，背屈和跖屈的关节活动度均显著增加（p<.001）。最终活动度范围（背屈，r = -0.431，p = .002；跖屈，r = -0.494，p<.001）与患者自我报告的第一跖趾关节疼痛高度相关。我们的研究结果表明，对于拇外翻手术矫正后出现关节纤维化的患者，关节手法治疗可能是增加第一跖趾关节活动度和减轻疼痛的有效方式。
