University Hospitals of Derby & Burton, Uttoxeter Road, Derby DE22 2NE, UK; University of Derby, Kedleston Road, Derby DE22 1GB, UK.
University Hospitals of Derby & Burton, Uttoxeter Road, Derby DE22 2NE, UK.
Gait Posture. 2024 Mar;109:208-212. doi: 10.1016/j.gaitpost.2024.02.010. Epub 2024 Feb 10.
Hallux Rigidus is the result of degeneration of the 1st metatarsophalangeal joint (1st MTPJ). In end-stage hallux rigidus, treatment is mainly surgical with arthrodesis being a favourable option. Although the biomechanical effects of arthrodesis have been examined, a detailed comparison of pre- and post-operative biomechanics has yet to be conducted.
Does 1st MTPJ arthrodesis positively affect foot kinematics and plantar pressure distribution?
Twelve 1st MTPJ arthrodesis were performed in patients with a mean age of 53.5 ± 5.4 years and follow up time of 6.9 ± 1.0 months. Pre- and post-operative data were collected at a CMAS (Clinical Movement Analysis Society) accredited gait laboratory using a BTS motion capture system and pedobarographic pressure plates. Patient outcome measures were also assessed using the MOXFQ. Statistical analysis was conducted using a two-way repeated measures ANOVA.
Significant changes in stride length, cycle duration, cadence and velocity were identified following 1st MTPJ arthrodesis. A significant reduction in forefoot-hallux dorsiflexion at toe-off was identified for the operated foot from the pre-operative (20.23 ± 5.98°) to post-operative (7.56 ± 2.96°) assessment. Post-operative sagittal and transverse plane changes in the operated foot were also identified. Peak pressure and PTI results indicated significant lateralisation of load for the operated foot, but importantly this was not influenced following arthrodesis. Finally, there was a significant improvement in MOXFQ score.
Following 1st MTPJ fusion there is an improvement in overall gait mechanics which accompanied by the improved MOXFQ score indicates a reduction in pain and improved confidence during gait. The lack of post-operative dorsiflexion at forefoot-hallux caused load to remain lateralised and compensatory mechanisms to occur at the more proximal joints within the foot. These results provide valuable information for clinicians and will enable more accurate counselling to be provided to patients with end-stage hallux rigidus.
拇僵硬是第一跖趾关节（1st MTPJ）退化的结果。在晚期拇僵硬中，主要治疗方法是手术融合，融合术是一种有利的选择。尽管已经检查了融合术的生物力学效果，但尚未对术前和术后的生物力学进行详细比较。
第一跖趾关节融合术是否会积极影响足部运动学和足底压力分布？
在平均年龄为 53.5 ± 5.4 岁且随访时间为 6.9 ± 1.0 个月的患者中进行了 12 例第一跖趾关节融合术。使用 BTS 运动捕捉系统和足底压力板在 CMAS（临床运动分析协会）认可的步态实验室中收集术前和术后数据。使用 MOXFQ 评估患者的结果测量值。使用双向重复测量 ANOVA 进行统计分析。
第一跖趾关节融合术后，步长、周期持续时间、步频和速度均发生显著变化。与术前（20.23 ± 5.98°）相比，术后（7.56 ± 2.96°）评估发现，手术足的前脚-拇背屈在足趾离地时显著减少。还发现了术后手术足矢状面和横断面的变化。峰值压力和 PTI 结果表明，手术足的负荷明显向外侧化，但重要的是，融合术后并未受到影响。最后，MOXFQ 评分有显著提高。
第一跖趾关节融合术后，整体步态力学得到改善，同时 MOXFQ 评分的提高表明疼痛减轻，步态时信心增强。前脚-拇背屈的术后缺乏背屈导致负荷仍然向外侧化，并在足部更靠近近端的关节发生代偿机制。这些结果为临床医生提供了有价值的信息，并将使处于晚期拇僵硬的患者能够获得更准确的咨询。
