Hirai Yoshihiro, Shima Hiroaki, Togei Kosho, Yasuda Toshito, Neo Masashi
Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
J Foot Ankle Surg. 2023 Sep-Oct;62(5):825-831. doi: 10.1053/j.jfas.2023.04.009. Epub 2023 May 7.
Hallux valgus surgery and open reduction of the lesser metatarsophalangeal joints with metatarsal shortening osteotomy help treat severe hallux valgus concomitant with the lesser metatarsophalangeal joint dislocation; however, pre- and postoperative plantar pressure distribution and its effect on the foot remain unclear. The pre- and postoperative groups comprised 16 patients with moderate-to-severe symptomatic hallux valgus with lesser metatarsophalangeal joint dislocation. All feet underwent open reduction and collateral ligament reconstruction of the second metatarsophalangeal joint and proximal metatarsal shortening osteotomy under the second metatarsal with proximal osteotomy of the first metatarsal. Twenty healthy participants (20 feet) were included in the control group. The plantar pressure distribution was determined by measuring the peak pressure, maximum force, contact area, and force-time integral for 12 regions. Under the second toe, all measurements in the preoperative group were significantly lower than those of the control group. The peak pressure, maximum force, and contact area of the postoperative group were significantly greater than those of the preoperative group. However, no differences were observed between the postoperative and control groups. Under the second metatarsal head, the peak pressure of the preoperative group was significantly higher than that of the control group. The peak pressure of the postoperative group was significantly lower than that of the preoperative group and showed no differences from the control group. Open reduction and collateral ligament reconstruction of the lesser metatarsophalangeal joints and proximal metatarsal shortening osteotomy with proximal osteotomy of the first metatarsal in hallux valgus with lesser metatarsophalangeal joints dislocation cases may improve operative outcomes, including favorable foot function.
拇外翻手术以及对小趾跖趾关节进行切开复位并结合跖骨缩短截骨术，有助于治疗伴有小趾跖趾关节脱位的重度拇外翻；然而，术前和术后足底压力分布及其对足部的影响仍不明确。术前组和术后组各有16例中度至重度有症状的拇外翻伴小趾跖趾关节脱位患者。所有足部均接受了第二跖趾关节的切开复位及侧副韧带重建术，以及第二跖骨近端截骨并结合第一跖骨近端截骨的跖骨缩短截骨术。对照组纳入了20名健康参与者（20只脚）。通过测量12个区域的峰值压力、最大力、接触面积和力-时间积分来确定足底压力分布。在第二趾下方，术前组的所有测量值均显著低于对照组。术后组的峰值压力、最大力和接触面积均显著大于术前组。然而，术后组与对照组之间未观察到差异。在第二跖骨头下方，术前组的峰值压力显著高于对照组。术后组的峰值压力显著低于术前组，且与对照组无差异。对于伴有小趾跖趾关节脱位的拇外翻病例，对小趾跖趾关节进行切开复位及侧副韧带重建术，以及第一跖骨近端截骨并结合跖骨缩短截骨术，可能会改善手术效果，包括获得良好的足部功能。
