Hallux valgus with and without metatarsalgia in women: a matched-cohort study of plantar pressure measurements

Impact of foot progression angle on spatiotemporal and plantar loading pattern in intoeing children during gait

Intoeing in children is a common parental concern, but our understanding of the impact of foot progression angle (FPA) in these children leaves remains limited. This study examines the relationship between FPA and plantar loading pattern, as well as gait symmetry in children with intoeing. The sample included 30 children with intoeing caused by internal tibial torsion, uniformly divided into three groups: unilateral intoeing, bilateral mild intoeing, and bilateral mild-moderate intoeing. The relationship between FPA and plantar loading pattern, and gait symmetry within and among groups were assessed using dynamic pedobarographic and spatiotemporal data. Results indicated a significant correlation between FPA and peak pressure, maximum force, and plantar impulse in the medial and central forefoot, and also the medial and lateral heel zones for both bilateral intoeing groups. Significant differences were observed only in subdivided stance phase, including loading response, single support, and pre-swing phases, between the unilateral intoeing and bilateral mild intoeing groups. These findings suggest that FPA significantly affects the forefoot and heel zones, potentially increasing the load on the support structures and leading to transverse arch deformation. While children with intoeing demonstrate a dynamic self-adjustment capability to maintain gait symmetry, this ability begins to falter as intoeing becomes more pronounced.

Differences and Similarities in the Feet of Metatarsalgia Patients with and without Rheumatoid Arthritis in Remission

Objectives: Metatarsalgia continues to be a problem in patients with rheumatoid arthritis (RA) in remission (remRA), as well as in the non-rheumatic population, with a mechanical origin. Identify and compare clinical, morphological, disability, synovitis (ultrasound), and radiological osteoarticular damage characteristics in two groups of patients with lesser-ray metar-tarsalgia, with remRA, and without RA. Methods: Cross-sectional study with 84 patients with remRA (mRA) and 60 patients without RA (nmRA). The study evaluated five clinical variables (pain, Foot Function Index (FFI), joint mobility, digital deformities, and foot type), a radiological variable (osteoarticular damage), and an ultrasound variable (metatarsal synovitis). The data were analysed using descriptive and correlational techniques. Results: There were no significant differences in sex, age, body mass index (BMI), or degree of pain. Both groups showed a high prevalence of limited joint mobility for the ankle and first metatarsal phalanx (DF1st MTPJ) and digital deformities, with no statistically significant differences. Similarly, there were no differences in lesser-ray synovitis. On the other hand, there were differences in mRA with greater disability and activity limitation (FFI), LDD (lesser-ray digital deformities) stiffness, first-ray deformities, radiological damage, synovitis in 1st MTPJ, and positive Doppler (five patients). Conclusions: Metatarsalgia presents similarities in both populations. Biomechanical factors may influence the symptoms and presence of synovitis in patients with RA in remission. Other characteristics are more frequent in mRA, which could be related to the disease; thus, future research should include both biomechanical and ultrasound exploration of the foot in the valuation of patients in remission.

Pedobarographic evaluations in physical medicine and rehabilitation practice

The feet are complex structures that transmit loads transferred by other parts of the body to the ground and are involved in many static and dynamic activities, such as standing and walking. The contact area and pressure changes between the feet and the ground surface can be measured using pedobarographic devices. With pedobarographic examinations, it is possible to obtain a wide range of information needed to support clinical evaluation and diagnostic tests in physical medicine and rehabilitation practice. Foot structure and function, postural stability, lower extremity biomechanics, and gait analysis are among the areas that can be further investigated using pedobarography.

Establishment and Validation of a Predictive Nomogram for Hallux Valgus with Pain Under the Second Metatarsal

Objective

To investigate the risk factors for hallux valgus complicated with pain under the second metatarsal and construct an effective model and method for predicting hallux valgus complicated with pain under the second metatarsal based on risk factors.

Methods

A total of 545 patients with hallux valgus who were admitted to our hospital were divided randomly into a training set and a validation set. The demographic characteristics, imaging indices and gait test indices of the patients were collected. The risk factors were identified by univariate and multivariate logistic regression analyses. A risk prediction model for hallux valgus with pain under the second metatarsal was established, and the area under the curve (AUC) of the receiver operating characteristic and a decision curve analysis were used for verification and identification. The value of the model was tested in the verification group.

Results

Second metatarsal length, second metatarsal peak pressure, hallux valgus angle (HVA), intermetatarsal angle 1–2 (IMA1–2) and weight were the risk factors for hallux valgus complicated with pain under the second metatarsal. Based on the weighting of these seven risk factors, a prediction model was established. The AUC of the prediction model was 0.84 (95% confidence interval [CI]: 0.802~0.898, P < 0.05), and the results of a Hosmer–Lemeshow test showed a good degree of calibration (χ² = 10.62, P > 0.05). The internal validation of the AUC was 0.83 (95% CI: 0.737–0.885, P < 0.05). The model had obvious net benefits when the threshold probability was 10%–70%.

Conclusion

Second metatarsal length, second metatarsal peak pressure, HVA, IMA1–2 and weight were the risk factors for hallux valgus combined with second metatarsal pain. The risk prediction model for hallux valgus complicated with pain under the second metatarsal based on these seven variables was proven effective.

Level of Evidence

Level III, retrospective comparative study.

Development of a preoperative questionnaire to improve satisfaction with hallux valgus repair: A Delphi study

BACKGROUND

Satisfaction with hallux valgus repair is often poor, despite good surgical outcomes. Many tools have been developed to assess the outcome of the procedure; however none evaluate the association between the initial motive for repair and the reasons for post-surgical dissatisfaction. The aim of this study was to develop a new tool to analyse the subjective and objective expectations of individuals during a pre-operative consultation for hallux valgus repair in order to improve post-surgical satisfaction.

METHODS

We first collected the reasons for dissatisfaction with repair from the medical files of dissatisfied individuals. Then, a steering committee of 4 French experts in the management of hallux valgus designed a questionnaire based on the reasons for dissatisfaction. We then used the DELPHI method to validate the questionnaire: we submitted the questionnaire to a panel of 34 francophone experts in hallux valgus repair for rating in 4 rounds.

RESULTS

The medical files of 853 individuals were reviewed and a 52-item questionnaire relating to expectations from hallux valgus surgery was drafted. After the 4 rounds, a final 44 item questionnaire reached consensus. Thirteen items related to clinical and psychological profile, 5 to pain, 9 to physical activity, 4 to aesthetics and 13 to footwear.

CONCLUSION

This tool should facilitate gathering of individuals' expectations from hallux valgus repair to ensure realistic goals and reduce post-surgical dissatisfaction.