Vinagre Gustavo, Alfonso Matías, Cruz-Morande Sebastián, Hernández Miguel, Villas Carlos
Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008, Pamplona, Navarra, Spain.
Department of Orthopaedic Surgery and Traumatology, Clínica San Miguel, Pamplona, Navarra, Spain.
Int Orthop. 2017 Nov;41(11):2281-2287. doi: 10.1007/s00264-017-3621-0. Epub 2017 Aug 31.
Proximal medial gastrocnemius recession (PMGR) is a surgical procedure performed in patients with gastrocnemius tightness (GT). The purpose of this study is to evaluate the efficacy of pedobarographic analysis on PMGR in patients with GT and metatarsalgia.
This prospective study included 52 patients diagnosed with GT treated surgically with PMGR and 49 non-operated upon patients (control group). A total of 55 PMGRs (three bilateral) were performed as an isolated or combined procedure in the treatment group. Passive ankle dorsiflexion with knee flexion and extension was evaluated in all patients. In addition, pedobarographic analysis was performed before and after surgery.
Median preoperative ankle dorsiflexion was -10.0° (equinus) with extended knee and 10.0° with flexed knee and postoperative differences in median ankle dorsiflexion was 12.5° (extended knee) (p = 0.000) and 5.0° (flexed knee) (p = 0.002). After the PMGR, the median area of the contact surface (-3.0 cm) (p = 0.009), the maximum (-13,239.0 Pa) (p = 0.019) and mean pressure (-2,942.0 Pa) and the forefoot force (-70.0 N) (p = 0.000) decreased. An increase in hindfoot force (20.0 N), hindfoot bearing time (4.0 ms) (p = 0.005), and forefoot bearing time (1.0 ms) was also observed.
Pedobarographic analysis is an efficient tool to evaluate surgical procedures that assess metatarsal overload. PMGR is an effective surgical procedure to improve passive ankle range of motion and decrease forefoot plantar overload.
近端内侧腓肠肌松解术（PMGR）是针对腓肠肌紧张（GT）患者实施的一种外科手术。本研究旨在评估足底压力分析在患有GT和跖痛症的患者接受PMGR手术中的疗效。
这项前瞻性研究纳入了52例经手术治疗的GT患者（治疗组）和49例未接受手术的患者（对照组）。治疗组共进行了55例PMGR手术（3例双侧手术），手术方式为单独手术或联合手术。对所有患者进行了膝关节屈伸时的被动踝关节背屈评估。此外，在手术前后进行了足底压力分析。
术前膝关节伸直时踝关节背屈的中位数为-10.0°（马蹄足），膝关节屈曲时为10.0°，术后膝关节伸直时踝关节背屈中位数的差异为12.5°（p = 0.000），膝关节屈曲时为5.0°（p = 0.002）。PMGR术后，接触面的中位数面积（-3.0 cm）（p = 0.009）、最大压力（-13,239.0 Pa）（p = 0.019）、平均压力（-2,942.0 Pa）和前足力（-70.0 N）（p = 0.000）均下降。同时观察到后足力增加（20.0 N）、后足承重时间增加（4.0 ms）（p = 0.005）以及前足承重时间增加（1.0 ms）。
足底压力分析是评估手术治疗跖骨过载的有效工具。PMGR是一种有效的外科手术，可改善踝关节被动活动范围并减轻前足底过载。
