足部手术治疗的轴前多指畸形患者与年龄和性别匹配的健康对照组的足部功能比较。

Foot Function in Patients With Surgically Treated Preaxial Polydactyly of the Foot Compared With Age- and Sex-Matched Healthy Controls.

机构信息

1 Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands.

2 Xpert Clinic, Rotterdam, the Netherlands.

出版信息

Foot Ankle Int. 2019 Apr;40(4):414-421. doi: 10.1177/1071100718816733. Epub 2018 Dec 20.

DOI:10.1177/1071100718816733

PMID:30569754

Abstract

BACKGROUND

: Treatment of preaxial foot polydactyly, a duplication of the first ray, consists of excision of an extra ray, aiming to improve shoe fitting and aesthetic appearance, while maintaining foot function. Currently, the effect of excision on foot function and foot-related patient experiences is unclear.

METHODS

: A cross-sectional comparison between 37 children treated for preaxial foot polydactyly and 37 age- and sex-matched healthy controls was performed. Dynamic foot function was assessed using plantar pressure measurements and static foot characteristics by physical examination. Patient-reported outcomes for foot function and footwear were evaluated, using the Oxford Ankle Foot Questionnaire for Children (score, 0-100).

RESULTS

: Compared with controls, patients had significantly lower median peak pressures at the hallux (148 kPa [IQR, 98-245] vs 272 kPa [IQR, 205-381], P < .001) and significantly higher peak pressures at the second metatarsal (217 kPa [IQR, 147-338] vs 166 kPa [IQR, 141-235], P = .002) and third to fifth metatarsals (214 kPa [IQR, 147-290] vs 161 kPa [IQR, 135-235], P < .001). Additionally, patients had a more medially deviated hallux, both while seated (15 degrees (IQR, 11-20) vs 12 degrees [IQR, 10-15], P = .001) and standing (20 degrees [IQR, 15-26] vs 18 degrees [IQR, 15-20], P = .001). No significant correlation between peak pressure distribution and hallux deviation was found. Patients reported minimal problems with foot function (87.5 [IQR, 64.6-100]), but distinct problems with footwear use (50.0 [IQR, 25.0-100]).

CONCLUSION

: Patients with surgically treated preaxial foot polydactyly had a substantially altered plantar pressure distribution with more lateral foot progression than healthy controls. Although an increased hallux deviation was not related to altered foot function, it seemed to be the reason for the patient-perceived problems with footwear. Level of Evidence: Level III, comparative series.

摘要

背景

治疗桡侧足多趾畸形，即第一跖骨的重复，包括切除多余的跖骨，旨在改善鞋的适配性和美观度，同时保持足部功能。目前，切除手术对足部功能和足部相关患者体验的影响尚不清楚。

方法

对 37 例桡侧足多趾畸形患儿和 37 例年龄和性别匹配的健康对照组进行横断面比较。采用足底压力测量评估动态足部功能，通过体格检查评估静态足部特征。使用儿童牛津踝关节-足部问卷（评分范围 0-100 分）评估足部功能和鞋类使用的患者报告结果。

结果

与对照组相比，患儿的拇趾峰值压力明显较低（中位数 148kPa [IQR，98-245] vs 272kPa [IQR，205-381]，P<.001），第二跖骨（中位数 217kPa [IQR，147-338] vs 166kPa [IQR，141-235]，P=.002）和第三至第五跖骨（中位数 214kPa [IQR，147-290] vs 161kPa [IQR，135-235]，P<.001）峰值压力明显较高。此外，患儿的拇趾在坐位（15 度 [IQR，11-20] vs 12 度 [IQR，10-15]，P=.001）和站位（20 度 [IQR，15-26] vs 18 度 [IQR，15-20]，P=.001）时均明显向内侧偏斜。未发现峰值压力分布与拇趾偏斜之间存在显著相关性。患儿报告足部功能存在轻微问题（87.5 [IQR，64.6-100]），但对鞋类使用存在明显问题（50.0 [IQR，25.0-100]）。