Lopez Andres, Bakaes Yianni, Porter Giselle, Shi Glenn, Myers Paisley, Jackson J Benjamin, Gonzalez Tyler, Haupt Edward T
Department of Orthopaedic Surgery, University of Florida, Jacksonville, Florida.
School of Medicine Columbia, University of South Carolina, Columbia, South Carolina.
Foot Ankle Spec. 2024 Jul 26:19386400241261129. doi: 10.1177/19386400241261129.
Minimally invasive (MIS) treatment of hallux valgus (HV) deformity is increasing in popularity. A 2-mm diameter burr is used to create a distal first metatarsal osteotomy prior to capital fragment translation and fixation. The metatarsal will shorten by the burr's diameter (2 mm). Plantar or dorsal capital fragment displacement may also cause load transference and possibly transfer metatarsalgia. The purpose of this study is to examine the effect of MIS HV on forefoot loading mechanics with respect to metatarsal shortening and sagittal plane displacement.
Four lower-limb cadaveric specimens were studied. A pedobarography pressure-sensing mat was used to record forefoot plantar pressure in a controlled weight-bearing stance position. Control and postosteotomy measurements were obtained with the capital fragment fixated in 3 possible positions: 0 mm, 5 mm dorsal, and 5 mm plantar displacement. Pedobarography data yielded pressure data within measurable graphical depictions. Raw mean contact pressure measurements were taken under the first and fourth metatarsal heads to establish medial and lateral forefoot loading pressure ratios. An a priori power analysis was performed based on previous peer-reviewed pedobarographic data, and our study was adequately powered.
Around 40 measurements were recorded, and ratios of medial-to-lateral forefoot loading were constructed. Medial forefoot pressure control versus 0 mm displacement, and control versus dorsal displacement were not found to be statistically significant ( = 0.525, = 0.55, respectively). Medial pressure significantly increased when comparing control versus plantar displacement ( = .006). Lateral pressure significantly increased with dorsal displacement of the osteotomy ( = .013).
Our study found that MIS HV correction did not cause an increase in lateral forefoot pressure loading when sagittal plane displacements were controlled. Plantar displacement increased medial loading, and dorsal displacement increased lateral loading. It may be valuable for surgeons to consider metatarsal head position postosteotomy, as a decrease in medial loading and subsequent increase in lateral loading may lead to lateral forefoot pain and transfer metatarsalgia.
IV.
拇外翻（HV）畸形的微创（MIS）治疗越来越受欢迎。在进行跖骨头移位和固定之前，使用直径2毫米的磨钻进行第一跖骨远端截骨术。跖骨将缩短磨钻的直径（2毫米）。跖骨头的跖侧或背侧移位也可能导致负荷转移，并可能引发转移性跖痛症。本研究的目的是研究微创拇外翻手术对前足负重力学的影响，包括跖骨缩短和矢状面移位。
对四个下肢尸体标本进行研究。使用足底压力传感垫在可控的负重站立姿势下记录前足足底压力。在跖骨头固定于三个可能位置时进行对照和截骨术后测量：0毫米、背侧移位5毫米和跖侧移位5毫米。足底压力测量数据在可测量的图形描述中产生压力数据。在第一和第四跖骨头下方进行原始平均接触压力测量，以建立前足内侧和外侧负重压力比。根据之前同行评审的足底压力测量数据进行了先验功效分析，我们的研究具有足够的功效。
记录了约40次测量，并构建了前足内侧与外侧负重的比率。未发现前足内侧压力对照与0毫米移位以及对照与背侧移位之间具有统计学意义（分别为 = 0.525， = 0.55）。与对照相比，跖侧移位时内侧压力显著增加（ = 0.006）。截骨术背侧移位时外侧压力显著增加（ = 0.013）。
我们的研究发现，当矢状面移位得到控制时，微创拇外翻矫正术不会导致前足外侧压力负荷增加。跖侧移位增加内侧负荷，背侧移位增加外侧负荷。外科医生考虑截骨术后跖骨头位置可能很有价值，因为内侧负荷降低和随后外侧负荷增加可能导致前足外侧疼痛和转移性跖痛症。
IV级
