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Stevens K, Winiger K, DiLiberto F. Foot and Ankle Curricular Guidelines in Entry-Level Physical Therapist Education: How Are We Doing? JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00125. [PMID: 39116394 DOI: 10.1097/jte.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 05/30/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION The Foot and Ankle Curricular Guidelines for Physical Therapist Professional Degree Programs (FACG) provided recommendations regarding essential entry-level content and skills. Eight years later, the extent of its implementation is unknown. This study characterizes entry-level Doctor of Physical Therapy (DPT) programs' foot and ankle curriculum with reference to the FACG. REVIEW OF LITERATURE Curricular guidelines offer recommendations to professional degree programs striving for excellence. Review and revisions of guidelines are important to keep pace with and reflect evolving evidence and practice. SUBJECTS One faculty member from 116 of 250 DPT programs participated (46.6% response rate). Participants were an average of 50.8 years old and taught a mean of 14.5 years. METHODS A cross-sectional 25-item online survey assessed foot and ankle contact hours, coverage of FACG recommended content, coverage of surgical procedures, and the use of FACG for curricular assessment, modification, and development. RESULTS Foot and ankle content was covered in physical therapy curriculum for a mean of 48.2 hours (range 12-120 hours). Eleven of the 25 recommended diagnoses, 29 of the 49 examination skills, 6 of the 7 intervention skills, and 3 of the 14 surgical procedures were covered by most (≥90%) of the programs. Reported use of FACG for curricular processes averaged 50.1-51.5 (0-100 numerical scale). DISCUSSION AND CONCLUSIONS Across a wide range of contact hours, coverage of FACG recommended content was approximately 57% (46/81 recommended elements in ≥90% of programs). Although not specifically recommended by FACG, surgical procedures were less commonly covered by programs. Study findings question FACG implementation and may reflect differences across programs in depth and breadth of content. Identified curricular gaps may warrant addressing in future guidelines.
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Affiliation(s)
- Karen Stevens
- Karen Stevens is an associate professor and assistant program director in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 . Please address all correspondence to Karen Stevens
- Kyle Winiger is a senior assistant athletic trainer in the Sports Medicine Department at the University of Arkansas
- Frank DiLiberto is an associate professor in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science
| | - Kyle Winiger
- Karen Stevens is an associate professor and assistant program director in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 . Please address all correspondence to Karen Stevens
- Kyle Winiger is a senior assistant athletic trainer in the Sports Medicine Department at the University of Arkansas
- Frank DiLiberto is an associate professor in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science
| | - Frank DiLiberto
- Karen Stevens is an associate professor and assistant program director in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 . Please address all correspondence to Karen Stevens
- Kyle Winiger is a senior assistant athletic trainer in the Sports Medicine Department at the University of Arkansas
- Frank DiLiberto is an associate professor in the Department of Physical Therapy at the Rosalind Franklin University of Medicine and Science
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Sabik A, Daszkiewicz K, Witkowski W, Łuczkiewicz P. Comparative analysis of mechanical conditions in bone union following first metatarsophalangeal joint arthrodesis with varied locking plate positions: A finite element analysis. PLoS One 2024; 19:e0303752. [PMID: 38753866 PMCID: PMC11098485 DOI: 10.1371/journal.pone.0303752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND First metatarsophalangeal joint arthrodesis is a typical medical treatment performed in cases of arthritis or joint deformity. The gold standard for this procedure is arthrodesis stabilisation with the dorsally positioned plate. However, according to the authors' previous studies, medially positioned plate provides greater bending stiffness. It is worth to compare the mechanical conditions for bone formation in the fracture callus for both placements of the locking plate. METHODS Two finite element models of the first metatarsophalangeal joint with the dorsally and medially positioned plate were defined in the Abaqus software to simulate differentiation of the fracture callus. A simplified load application, i.e. one single step per each day and the diffusion of the mesenchymal stem cells into the fracture region were assumed in an iterative hardening process. The changes of the mesenchymal stem cells into different phenotypes during the callus stiffening were governed by the octahedral shear strain and interstitial fluid velocity according to Prendergast mechanoregulation theory. Basing on the obtained results the progress of the cartilage and bone tissues formation and their distribution within the callus were compared between two models. FINDINGS The obtained results suggest that after 6 weeks of simulation the healing progress is in general comparable for both plates. However, earlier closing of external callus was observed for the medially positioned plate which had greater vertical bending stiffness. This process enables faster internal callus hardening and promotes symmetrical bridging.
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Affiliation(s)
- Agnieszka Sabik
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering Gdańsk University of Technology, Narutowicza Gdańsk, Poland
| | - Karol Daszkiewicz
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering Gdańsk University of Technology, Narutowicza Gdańsk, Poland
| | - Wojciech Witkowski
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering Gdańsk University of Technology, Narutowicza Gdańsk, Poland
| | - Piotr Łuczkiewicz
- II Clinic of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdansk, Smoluchowskiego, Gdańsk, Poland
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Khan AZ, Patil DS. The Effect of Therapeutic Approaches on Hallux Valgus Deformity. Cureus 2024; 16:e58750. [PMID: 38779237 PMCID: PMC11110493 DOI: 10.7759/cureus.58750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Hallux valgus (HV) is a relatively frequent disease caused by a complicated structural malformation of the primary ray. The bunion or middle projection generated by the hallux's lateral displacement and pronation is merely one element of the three-dimensional abnormality. HV may trigger severe discomfort and affect joint kinematics. The specific kinematic cause is still unknown. Female age, gender, restrictive footwear, and heritage are risk indicators. HV frequently coexists along metatarsal adducts, equines contracture, hammertoe imperfection, and pes planus. HV is a frequent foot ailment with multiple, complicated, unknown etiology and course. HV has a preference for females. It is an ongoing condition for which there is no known treatment to reduce or prevent improvement. Fibrodysplasia ossificans progressiva (FOP) is distinguished by hereditary symmetrical HV deformities or symptoms that begin heterotopic calcification that is either idiopathic or caused by trauma, such as subcutaneous immunizations. Localized heterotopic calcification may be preceded by aggravating, recurring soft-tissue enlargements (flare-ups). Heterotopic calcification may happen anywhere; however, it most commonly impacts locations near the axial bone structure during the early/mild phases until advancing to the appendicular skeleton. As an effect of calcification affecting the flexibility of the joints, it might cause limitations in motion. The initial line of therapy focuses on non-surgical methods including night splinting, orthotics, and larger shoes. The next suggested line of action is surgical intervention if conservative therapy fails. Patients have good postoperative tolerance, and bone union often happens six to seven weeks after surgery. Stretching exercises help to restore function by extending shortened soft tissue and restoring range of motion (ROM). The goal of joint mobilization, a form of manual treatment method, is to extend the ligament, the soft tissue surrounding the limited joint, and the restricting joint capsule by applying modest amplitude passive movement to the joint components.
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Affiliation(s)
- Alfiza Z Khan
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepali S Patil
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Cudejko T, Button K, Al-Amri M. Wireless pressure insoles for measuring ground reaction forces and trajectories of the centre of pressure during functional activities. Sci Rep 2023; 13:14946. [PMID: 37696840 PMCID: PMC10495386 DOI: 10.1038/s41598-023-41622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023] Open
Abstract
Wireless pressure insoles may enable the assessment of movement biomechanics in a real-world setting, and thus play an important role in the recommendation of clinical management, but they are not yet a gold standard due to the unknown accuracy and reliability with respect to different functional activities. Here, we compare novel wireless pressure insoles with force plates and examine the test-retest reliability of the insoles for measuring vertical ground reaction forces (vGRFs) and trajectories of the center of pressure (COP). In this observational study, healthy adults underwent two data collection sessions during one day. The Bland-Altman analysis was used to compare the outcomes measured with the two instruments during squats, jumps, and the sit-to-stand test. Test-retest reliability was assessed by the interclass correlation coefficient and the standard error of measurement for the outcomes during squats, jumps, walking, and stair ambulation. Trajectories of the COP in the anterior-posterior direction were comparable between the two systems during all activities. The insoles consistently measured shorter trajectories of the COP in the medial-lateral direction (except jumps) and lower vGRFs than the force plates. Test-retest reliability of the insoles was fair to high or excellent for all outcomes during all activities. In conclusion, the insoles provide reliable measures of vGRFs and trajectories of the COP during multiple functional activities in healthy adults. Although the insoles do not produce identical results to the force plate, the qualitative similarity and consistency between the two systems confirm the insoles can be used to measure these outcomes, based on the purpose and accuracy required.
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Affiliation(s)
- T Cudejko
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - K Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4EP, UK
| | - M Al-Amri
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4EP, UK.
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Wong DWC, Cheung JCW, Zhao JG, Ni M, Yang ZY. Forefoot Function after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis on Plantar Load Measurement. J Clin Med 2023; 12:jcm12041384. [PMID: 36835920 PMCID: PMC9965975 DOI: 10.3390/jcm12041384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
While hallux valgus (HV) surgeries are useful for correcting skeletal alignment problems, their effects on plantar load, which reflects forefoot functions, are less understood. The objective of this study is to conduct a systematic review and meta-analysis on the plantar load change after HV surgeries. A systematic search of Web of Science, Scopus, PubMed, CENTRAL, EMBASE, and CINAHL was performed. Studies that assessed the pre- and post-operative plantar pressure of HV patients undergoing surgeries and reported load-related parameters over the hallux, medial metatarsal, and/or central metatarsal regions were included. Studies were appraised by using the modified NIH quality assessment tool for before-after study. Studies suitable for meta-analysis were pooled with the random-effects model, using the standardized mean difference of the before-after parameters as an effect measure. Twenty-six studies containing 857 HV patients and 973 feet were included for the systematic review. Meta-analysis was conducted on 20 of them, and most studies did not favor HV surgeries. Overall, HV surgeries reduced the plantar load over the hallux region (SMD -0.71, 95% CI, -1.15 to -0.26), indicating that forefoot function worsened after surgeries. For the other five outcomes, the overall estimates were not statistically significant, indicating that surgeries did not improve them either. There was substantial heterogeneity among the studies, which in most cases could not be resolved by pre-planned subgroup analyses by surgical classification, year of publication, median age of patients, and length of follow-up. Sensitivity analysis removing lower-quality studies showed that the load integrals (impulse) over the central metatarsal region significantly increased (SMD 0.27, 95% CI, 0 to 0.53), indicating that surgeries increased the risk of transfer metatarsalgia. There is no solid evidence that HV surgeries could improve forefoot functions from a biomechanical point perspective. Currently available evidence even suggests that surgeries might reduce the plantar load over the hallux and adversely affect push-off function. The reasons behind and the effectiveness of alternative surgical methods warrant further investigation.
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Affiliation(s)
- Duo Wai-Chi Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - James Chung-Wai Cheung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Jia-Guo Zhao
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Ming Ni
- Department of Science Development, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
- Department of Orthopaedics, Pudong New Area People’s Hospital, Shanghai 201299, China
| | - Zu-Yao Yang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Correspondence: ; Tel.: +852-2252-8739
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Blouin C, Genet F, Denormandie P, Graff W, Perrier A. Development of a preoperative questionnaire to improve satisfaction with hallux valgus repair: A Delphi study. PLoS One 2022; 17:e0276303. [PMID: 36279269 PMCID: PMC9591061 DOI: 10.1371/journal.pone.0276303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Cédric Blouin
- UFR Simone Veil-Santé, UR2020 Erphan, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- ISPC Synergies, Paris, France
- * E-mail:
| | - François Genet
- ISPC Synergies, Paris, France
- Département PARASPORT-SANTE, Unité Péri Opératoire du Handicap, (UPOH-Perioperative Disability Unit), Service de Médecine Physique et de Réadaptation, Hôpital Raymond-Poincaré, Groupe Hospitalo-Universitaire APHP-Université PARIS SACLAY, Garches, France
- UFR Simone Veil-Santé, END: ICAP, Inserm U1179, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
| | - Philippe Denormandie
- Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, APHP, Garches, France
- Groupe Mutuelle Nationale des Hospitaliers (MNH), Paris, France
| | - Wilfrid Graff
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
| | - Antoine Perrier
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- Laboratoire de Recherche Translationnelle et D’Innovation en Médecine et Complexité TIMC, CNRS, Grenoble, France
- Service de Diabétologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Xiang L, Mei Q, Wang A, Fernandez J, Gu Y. Gait biomechanics evaluation of the treatment effects for hallux valgus patients: A systematic review and meta-analysis. Gait Posture 2022; 94:67-78. [PMID: 35247827 DOI: 10.1016/j.gaitpost.2022.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/19/2022] [Accepted: 02/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hallux valgus (HV) is a foot deformity characterized by lateral deviation of the big toe and medial deviation of the first metatarsal. RESEARCH QUESTION This study aimed to shed light on the treatment effects of different interventions and surgical procedures for HV deformity to determine the effectiveness of gait biomechanics correction. METHODS English-language searches of the electronic databases were conducted in the Cochrane Library, Web of Science, PubMed, Scopus, and Embase. Gait biomechanics evaluation before and after conservative or operative treatments was essential for inclusion in this review. Methodological quality was assessed by the Institute of Health Economics (IHE) quality appraisal tool. All pooled analysis was based on the random-effects model. RESULTS Twenty-five articles (1003 participants) were identified in this review. Three studies chose conservative therapies for HV deformity, incorporating foot orthotics and minimalist running intervention, and surgeries were performed in twenty-two studies. For the pressure parameter alteration under the hallux, the effect size (ES) in the conservative treatment subgroup was - 0.95 with 95%CI [- 1.69, - 0.21]. It demonstrated a moderate ES of - 0.44% and 95%CI [- 0.81, - 0.07] in the surgery subgroup. The five operations' peak pressure alteration under the hallux demonstrated a moderate ES of - 0.45% and 95%CI [- 0.54, - 0.36]. SIGNIFICANCE Both non-operative and operative treatments could achieve the forefoot pressure redistribution, decreasing loading beneath the hallux and first metatarsal regions,However, the treatment effects of surgeries were not very robust. The percutaneous DSTR-Akin technique is recommended as an adequate operative treatment, with a large ES and moderate heterogeneity. The negative gait return effect should be noticed while using Scarf osteotomy, despite positive clinical and radiographic outcomes.
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Affiliation(s)
- Liangliang Xiang
- Faculty of Sports Science, Ningbo University, Ningbo, China; Research Academy of Grand Health, Ningbo University, Ningbo, China; Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Qichang Mei
- Faculty of Sports Science, Ningbo University, Ningbo, China; Research Academy of Grand Health, Ningbo University, Ningbo, China; Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Alan Wang
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand; Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Research Academy of Grand Health, Ningbo University, Ningbo, China; Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand; Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China; Research Academy of Grand Health, Ningbo University, Ningbo, China; Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
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Meyr AJ, Doyle MD, King CM, Kwaadu KY, Nasser EM, Ramdass R, Theodoulou MH, Zarick CS. The American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Hallux Valgus. J Foot Ankle Surg 2022; 61:369-383. [PMID: 34706857 DOI: 10.1053/j.jfas.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship - Palo Alto Medical Foundation, Mountain View, CA
| | - Christy M King
- Residency Director, Kaiser San Francisco Bay Area Foot & Ankle Residency Program and Attending Surgeon, Kaiser Foundation Hospital, Oakland, CA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | | | - Roland Ramdass
- Residency Training Committee, INOVA Fairfax Medical Campus, Fairfax, VA
| | - Michael H Theodoulou
- Chief Division of Podiatric Surgery, Cambridge Health Alliance, and Instructor of Surgery, Harvard Medical School, Boston, MA
| | - Caitlin S Zarick
- Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
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Hartenbach F, Höger B, Kristen KH, Trnka HJ. Interdigital vs Transarticular Lateral Release With Scarf Osteotomy. Foot Ankle Int 2022; 43:193-202. [PMID: 34414786 DOI: 10.1177/10711007211035374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We compare the clinical and radiographic outcomes of the interdigital approach vs the medial transarticular approach for lateral release combined with scarf osteotomy. METHODS Seventy-seven feet with moderate to severe hallux valgus underwent scarf osteotomy and lateral soft tissue release, using an interdigital approach (n = 36) vs medial transarticular approach (n = 41). The clinical measurements (range of motion, American Orthopaedic Foot & Ankle Society [AOFAS] score) and radiographic data were evaluated preoperatively and at final follow-up (93-124 months postoperatively). Additionally, the numeric pain rating scale and Foot and Ankle Outcome score [FAOS] were assessed postoperatively. RESULTS The AOFAS score improved from 60 (q1 = 54, q3 = 70) to 93 (q1 = 85, q3 = 98) in the transarticular group, and from 59 (q1 = 50, q3 = 64) to 95 (q1 = 85, q3 = 100) in the interdigital group. The hallux valgus angle improved from 35.7±6.5 degrees to 15.5±7.6 degrees in the transarticular group, and from 36.0±6.8 degrees to 12.9±13.0 degrees in the interdigital group. The intermetatarsal angle improved from 16.5±2.5 degrees to 6.5±2.7 degrees within the transarticular group and from 17.2±2.5 degrees to 7.3±4.3 degrees in the interdigital group. None of the clinical or radiographic parameters showed any significant differences between the treatment groups. CONCLUSION Comparison of outcomes between the interdigital approach and the transarticular approach for lateral soft-tissue release with scarf osteotomy are equally successful. The transarticular approach can thus be considered safe and effective, with the additional benefits of just one scar as opposed to 2. LEVEL OF EVIDENCE Level III, therapeutic.
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Affiliation(s)
- Florian Hartenbach
- Foot & Ankle Centre Vienna, Vienna, Austria
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Brigitta Höger
- Institute of Sport Science, University of Vienna, Vienna, Austria
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Yoshida T, Tanino Y, Nakao T, Yamazaki W, Suzuki T. Examination of gait characteristics and related factors in elderly subjects with and without hallux valgus. Prog Rehabil Med 2021; 6:20210028. [PMID: 34307956 PMCID: PMC8277597 DOI: 10.2490/prm.20210028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/29/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: Elderly people with hallux valgus have decreased gait speed, which can result in
reduced capacity to perform the activities of daily living. Therefore, this study
examined the gait ability and related factors of patients with hallux valgus. Methods: The study participants were 10 patients with hallux valgus and 10 without. Ground
reaction forces were measured as front–rear (X), lateral (Y), and vertical (Z)
components from the early to late stance phases. Three-dimensional motion analysis was
used to measure gait speed; touchdown distance; release distance; the angles of the limb
joints and trunk at heel contact, toe-off, and peak ground reaction force; and the
center of mass (COM) displacement in the sagittal plane. The height of the COM was
calculated as a percentage of the body height. The hallux valgus and control groups were
compared using the Mann–Whitney U-test. Results: In the hallux valgus group, the ground reaction force showed a significant increase in
the Y component in each stance phase and in the Z component in the late stance phase.
The lowest COM position in the hallux valgus group was significantly higher than that in
the control group, resulting in a smaller difference in COM height over a gait
cycle. Conclusions: The hallux valgus group was found to have reduced gait speed because of a shortened
touchdown distance. Moreover, the continued high COM position in the hallux valgus group
meant that potential energy could not efficiently be converted to kinetic energy.
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Affiliation(s)
- Takaki Yoshida
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Osaka, Japan
| | - Yoshitsugu Tanino
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Osaka, Japan
| | - Tetsuya Nakao
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Osaka, Japan
| | - Wataru Yamazaki
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Osaka, Japan
| | - Toshiaki Suzuki
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Osaka, Japan
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Lorkowski J, Gawronska K. Pedobarography in Physiotherapy: A Narrative Review on Current Knowledge. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1375:13-22. [PMID: 33914289 DOI: 10.1007/5584_2021_636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Pedobarography is a modern technology enabling the assessment of the locomotor system based on the plantar pressure distribution. The technic is useful in the rehabilitation of various types of dysfunction of body movement. This chapter aims to describe the application of pedobarography in clinical therapy. The qualitative analysis is based on a review of articles in English, French, German, Polish, Portuguese, Spanish, Turkish, and Chinese in Medline/PubMed, Cochrane Library, Embase, and PEDro databases. The search covered the articles on clinical trials, randomized controlled trials, meta-analyses, and reviews published over 1984-2020. The literature shows that pedobarography is a safe non-invasive method that is useful for the examination of foot biomechanics with a reference to the entire musculoskeletal system. A pedobarographic examination enables insight into a motion disorder, its plausible relation to a systemic pathology, and monitoring the course of treatment and rehabilitation.
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Affiliation(s)
- Jacek Lorkowski
- Clinical Department of Orthopedics, Traumatology and Sports of the Central Clinical Hospital of the Ministry of the Internal Affairs and Administration, Warsaw, Poland.
- Faculty of Health Sciences, Medical University of Mazovia, Warsaw, Poland.
| | - Karolina Gawronska
- Rehabilitation Centre of the Central Clinical Hospital of the Ministry of the Internal Affairs and Administration, Warsaw, Poland
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Ling SKK, Wu YM, Li C, Lui TH, Yung PSH. Randomised control trial on the optimal duration of non-weight-bearing walking after hallux valgus surgery. J Orthop Translat 2020; 23:61-66. [PMID: 32489861 PMCID: PMC7256050 DOI: 10.1016/j.jot.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 10/25/2022] Open
Abstract
Introduction Hallux valgus surgery is one of the most commonly performed operations in Orthopaedics. Multiple surgical techniques have been described including arthrodesis, osteotomies and soft tissue procedures. The endoscopic-assisted distal soft tissue procedure is one of the minimally invasive surgical options with a good long-term outcome. The rehabilitation protocol for this soft tissue procedure consists of 6-weeks of non-weight bearing walking. This prolonged period of non-weight-bearing walking may ensure a good stabilization of the alignment but is difficult for the patient from a social-economical perspective. In addition, earlier mobilisation has other theoretical advantages including less atrophy and better range of motion. The objective of this trial is to investigate the effect of an earlier weight-bearing regime at 2-weeks post-surgery. Methods Randomised control trial of patients undergoing the endoscopic-assisted distal soft tissue procedure. Allocation and randomization of subjects were performed immediately after completion of surgery to avoid intra-operative biases. The control group underwent the usual protocol of 6-weeks of non-weight-bearing walking while the intervention group underwent 2-weeks of post-operative non-weight-bearing walking. Foot function was measured using the Foot and Ankle Outcome Score (FAOS) at the baseline, 12-week post-surgery and 26-weeks post-surgery. The hallux valgus angle, 1,2 inter-metatarsal angle and tibial sesamoid position were also measured during those time-points. Results A total of 51 participants completed the study, 29 in the control group and 22 in the early weight-bearing group. 1 patient form the early weight-bearing group was complicated with hallux varus requiring revision surgery. All the patients had significantly improved radiological angles and foot function in both the control and early weight-bearing group. At the 12-week time point, the radiological angles were the same for both groups but foot function was significantly better in the early weightbearing group. Discussion Early postoperative weight-bearing did not lead to pre-mature implant failures or increased recurrence rates. It actually resulted in fewer symptoms like stiffness, lessened pain, better performance in daily activities and a better quality of life. Conclusion Early weight-bearing walking at 2-week after distal soft tissue reconstruction of hallux valgus is not only safe, it may help accelerate the rehabilitation process and allow patients to return their usual life faster.The translational potential of this article: Being a clinical trial, our results are directly translatable to hallux valgus patients. The results of this study show that a shortened non-weight bearing duration after hallux valgus surgery improves foot function at 12 weeks while not affecting recurrence risks.
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Affiliation(s)
- Samuel K K Ling
- Department of Orthopaedics and Traumatology, Faculty of Medicine, CUHK, Hong Kong
| | - Yuen-Man Wu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, CUHK, Hong Kong
| | - Charles Li
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong
| | - Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong
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Abstract
Postoperative management of hallux valgus varies widely. Setting preoperative expectations is an important aspect of attaining a successful outcome, but this is not routinely reviewed in the literature. This chapter offers suggestions on successfully navigating this area of patient care. Current concepts focus on pain control, immobilization, and return to activities. This chapter also reviews the current literature in these areas and sets out the authors' preferred management in the postoperative setting.
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Affiliation(s)
- William A Hester
- Sidney Kimmel Medical College, Thomas Jefferson University, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
| | - David I Pedowitz
- Foot & Ankle Fellowship, Sidney Kimmel Medical College, Thomas Jefferson University, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
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Puchner SE, Trnka HJ, Willegger M, Staats K, Holinka J, Windhager R, Schuh R. Comparison of Plantar Pressure Distribution and Functional Outcome after Scarf and Austin Osteotomy. Orthop Surg 2018; 10:255-263. [PMID: 30152604 DOI: 10.1111/os.12400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/05/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To investigate the changes of plantar pressure distribution in patients who underwent either Austin or Scarf osteotomy and underwent a postoperative rehabilitation program. METHODS Between September 2006 and December 2007, 50 participants who suffered from mild to moderate hallux valgus deformity were prospectively included in this study. An Austin osteotomy (Austin group) was performed in 25 patients and a Scarf osteotomy (Scarf group) in 25 patients. Indication for the Scarf or Austin technique was made according to the consensus of the Austrian society of foot and ankle surgery. Plantar pressure analysis was performed at 4 weeks, 8 weeks, and 6 months postoperatively. Furthermore, range of motion and the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were evaluated. RESULTS In the big toe and first metatarsal head region in groups, maximum force, peak pressure, and force-time integral increased significantly from 4 weeks to 6 months postoperatively (P ≤ 0.001). The mean AOFAS score increased from 60.7 preoperatively to 93.1 6 months after Austin surgery and from 56.7 preoperatively to 94.4 6 months after Scarf surgery. The Austin group had a mean range of motion (ROM) of 68.5° that increased to a mean ROM of 75.5° 6 months postoperatively, while the Scarf group had a mean ROM of 67.8° that increased to a mean ROM of 68.2° 6 months postoperatively. CONCLUSION Despite different surgical techniques and the degree of deformity, there were no differences in plantar pressure parameters and functional outcomes between both groups.
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Affiliation(s)
- Stephan E Puchner
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | | | | | - Kevin Staats
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | - Johannes Holinka
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | - Reinhard Schuh
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
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Geng X, Huang D, Wang X, Zhang C, Huang J, Ma X, Chen L, Wang C, Yang J, Wang H. Loading pattern of postoperative hallux valgus feet with and without transfer metatarsalgia: a case control study. J Orthop Surg Res 2017; 12:120. [PMID: 28743301 PMCID: PMC5526287 DOI: 10.1186/s13018-017-0622-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/13/2017] [Indexed: 12/02/2022] Open
Abstract
Background Postoperative transfer metatarsalgia is a common complication after hallux valgus surgeries. Shortening of the first metatarsal is traditionally thought to be the primary cause of it. However, we speculate the abnormal loading pattern during gait is the real reason. This study is to determine specific differences in the loading patterns between reconstructive hallux valgus (HV) feet with and without postoperative transfer metatarsalgia, so as to find risky loading characteristics of this complication. Methods Thirty feet with postoperative transfer metatarsalgia were recruited as pain group, while another 30 postoperative feet without pain as controls. All participants were asked to walk barefoot at self-selected speed through a plantar force measuring plate (Rs-Scan Inc.) for three times. Certain plantar load variables were recorded or calculated, and their differences between two groups were compared. Results For pain group, the maximum plantar force and force time integral of the first metatarsal decrease significantly; the force time integral of the central rays (second plus third metatarsal) does not significantly differ with that in the controls, but their cumulative load percentage to the whole foot is higher. In pain group, the time point when central rays reached their peak force during the push-off is significantly later than that in controls. And the regional instant load percentage at this moment presented significantly higher for central rays, while significantly lower for the first metatarsal and the hallux compared to the controls. Conclusions For hallux valgus feet with postoperative metatarsalgia, the load function of the first metatarsal is obviously impaired. But for central rays, indicative difference is not reflected in either peak or cumulative load during the gait cycle, but in the instant load distribution when central rays reach their peak load. So we can conclude that whether the remaining regions can adequately share certain load during walking, especially around the time metatarsalgia often occurs, plays an unnegligible role. So surgeons should pay more attention to reconstruct a foot where load can be evenly distributed.
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Affiliation(s)
- Xiang Geng
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Dichao Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Li Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Junsheng Yang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Heng Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
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Abstract
Hallux valgus is one of the most common deformities of the lower extremity. Multiple etiologies have been discussed, and various techniques have been described. The SCARF osteotomy is indicated for moderate to severe hallux valgus deformities. The technique historically used by carpenters allows immediate postoperative weight bearing and also entails the possibility to correct the distal metatarsal articular angle by rotation of the osteotomy. The SCARF osteotomy has also been successfully used in revision surgeries.
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Affiliation(s)
- H-J Trnka
- Fusszentrum Wien, Alserstraße 43/8d, 1080, Wien, Österreich.
| | - P Bock
- Fusszentrum Wien, Alserstraße 43/8d, 1080, Wien, Österreich
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Chopra S, Moerenhout K, Crevoisier X. Subjective versus objective assessment in early clinical outcome of modified Lapidus procedure for hallux valgus deformity. Clin Biomech (Bristol, Avon) 2016; 32:187-93. [PMID: 26711534 DOI: 10.1016/j.clinbiomech.2015.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/25/2015] [Accepted: 11/24/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies have assessed the outcome of hallux valgus surgeries based on subjective questionnaires, usually the American Orthopaedic Foot and Ankle Society Score, and radiographic results reporting good to excellent outcome at 6-12 months postoperatively. However, contrasting results were reported by gait studies at 12-24 months postoperatively. In a previous study, we found nine gait parameters which can describe the altered gait in hallux valgus deformity. This study aimed, to assess the outcome of modified Lapidus at 6 months postoperatively, using gait assessment method, to determine if the nine specified gait parameters effectively relates with the clinical scores and the radiological results or add information missed by these commonly used clinical assessments. METHOD We assessed 21 participants including 11 controls and 10 patients with moderate to severe hallux valgus deformity. The patient group was followed 6 months postoperatively. The ambulatory gait assessment was performed utilizing pressure insoles and inertial sensors. Clinical assessment includes foot and ankle questionnaires along with radiographic results. Comparison was made using non parametric tests, P<0.05. FINDINGS Altered gait patterns, similar to the preoperative outcome, persisted at 6 months postoperatively when compared to controls. The foot and ankle ability measure score showed an outcome comparable to the gait results. In contrast, the American Orthopaedic Foot and Ankle Society Score and radiographic results showed significant improvement. INTERPRETATION Study supports the reliability of nine defined gait parameters in assessing the outcome of hallux valgus surgeries. The existing clinical assessment overestimates the functional outcome at the early postoperative phase.
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Affiliation(s)
- S Chopra
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland.
| | - K Moerenhout
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland.
| | - X Crevoisier
- Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Department of Orthopaedic Surgery and Traumatology, Pierre-Decker 4, CH-1011 Lausanne, Switzerland.
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18
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Mortka K, Lisiński P. Hallux valgus-a case for a physiotherapist or only for a surgeon? Literature review. J Phys Ther Sci 2015; 27:3303-7. [PMID: 26644698 PMCID: PMC4668189 DOI: 10.1589/jpts.27.3303] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/25/2015] [Indexed: 01/08/2023] Open
Abstract
[Purpose] Hallux valgus is one of the most common deformations of the human foot, and it
causes great difficulties for the patients. The aim of this paper was to review available
medical literature in search of evidence which would justify implementation of
physiotherapy, based on its effectiveness for patients with hallux valgus. [Subjects and
Methods] The following databases were searched for applicable papers: PubMed, Google
Scholar, Clinical Key and UpToDate. Full-text articles from the last 15 years were
subjected to a review, which ultimately selected seven papers about hallux valgus therapy
published over the past 12 years. These studies were grouped according to their design and
level of evidence and classified depending on whether they concerned physiotherapy as
postoperative therapy or as the only treatment. [Results] The studies included in the
present analysis used the following interventions for patients with hallux valgus:
exercise, manual therapy, gait training, taping and orthosis. All the studies showed
beneficial effects and the most frequently observed results were reductions in pain and
improvements in function. [Conclusion] The evidence found in the reviewed materials
clearly indicates that patients with hallux valgus should not only be subject to surgical
procedures but also undergo physiotherapeutic treatment.
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Affiliation(s)
- Kamila Mortka
- Clinic of Rehabilitation, Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences: ul. 28 Czerwca 1956r. nr 135/147, 61-545 Poznań, Poland
| | - Przemysław Lisiński
- Clinic of Rehabilitation, Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences: ul. 28 Czerwca 1956r. nr 135/147, 61-545 Poznań, Poland
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Koller U, Willegger M, Windhager R, Wanivenhaus A, Trnka HJ, Schuh R. Plantar pressure characteristics in hallux valgus feet. J Orthop Res 2014; 32:1688-93. [PMID: 25130961 DOI: 10.1002/jor.22707] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/03/2014] [Indexed: 02/04/2023]
Abstract
Due to the pathoanatomical changes in hallux valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the hallux is decreased during push-off. We assessed loading parameters in hallux valgus feet. Based on dorsal-plantar weight bearing radiographs of 61 feet, the intermetatarsal-, hallux valgus-, distal metatarsal articulation-angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed® system during level walking. We found negative correlations between hallux valgus angle and peak pressure in the great toe (r=-0.301, p<0.023), the maximum force of the hallux (r=-0.481, p<0.001), and contact time of the great toe (r=-0.448, p<0.001), and positive correlations for force time integral (r=0.348, p<0.001), contact area (r=0.307, p<0.020), maximum force (r=0.430, p<0.001), and peak pressure (r=0.361, p<0.006) of the fifth metatarsal head. A positive correlation between the sesamoid and the metatarsal subluxation regarding maximum force (r=0.294, p<0.034), and a negative correlation between the contact area of the hallux (r=-0.232, p<0.020) was shown. Depending on the severity, hallux valgus angle, and sesamoid subluxation, load shows significant lateral transmission in hallux valgus feet.
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Affiliation(s)
- Ulrich Koller
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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20
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Godi M, Turcato AM, Schieppati M, Nardone A. Test-retest reliability of an insole plantar pressure system to assess gait along linear and curved trajectories. J Neuroeng Rehabil 2014; 11:95. [PMID: 24903003 PMCID: PMC4051956 DOI: 10.1186/1743-0003-11-95] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have assessed reliability of insole technology for evaluating foot pressure distribution during linear walking. Since in natural motion straight walking is intermingled with turns, we determined the test-retest reliability of insole assessment for curved as well as linear trajectories, and estimated the minimum number of steps required to obtain excellent reliability for each output variable. METHODS Sixteen young healthy participants were recruited. Each performed, two days apart, two sessions of three walking conditions: linear (LIN) and curved, clockwise (CW) and counter-clockwise (CCW). The Pedar-X system was used to collect pressure distribution. Foot print was analyzed both as a whole and as subdivided into eight regions: medial and lateral heel, medial and lateral arch, I metatarsal head, II-V metatarsal heads, hallux, lateral toes. Reliability was assessed by using intraclass correlation coefficient (ICC) for clinically relevant variables from analysis of 50 steps per trajectory: Peak Force (PF); Peak Pressure (PP); Contact Area (CA); Stance Duration (S). RESULTS When considering whole-foot, all variables showed an ICC >0.80, therefore highly reliable. This was true for both LIN and curved trajectories. There was no difference in ICC of the four variables between left and right foot. When collapsing foot and trajectories, S had a lower ICC than PP and CA, and PP lower than CA. Mean percent error between the values of first and second session was <5%. When separately considering the eight foot regions, ICCs of PF, PP and CA for all regions and trajectories were generally >0.90, indicating excellent reliability. In curved trajectories, S showed smaller ICCs. Since the least ICC value for S was 0.60 in LIN trajectory, we estimated that to achieve an ICC ≥0.90 more than 200 steps should be collected. CONCLUSIONS High reliability of insole dynamic variables (PF, PP, CA) is obtained with 50 steps using the Pedar-X system. On the contrary, high reliability of temporal variable (S) requires a larger step number. The negligible differences in ICC between LIN and curved trajectory allow use of this device for gait assessment along mixed trajectories in both clinical and research setting.
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Affiliation(s)
- Marco Godi
- Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno, (NO), Italy.
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Glasoe WM, Jensen DD, Kampa BB, Karg LK, Krych AR, Pena FA, Ludewig PM. First Ray Kinematics in Women With Rheumatoid Arthritis and Bunion Deformity: A Gait Simulation Imaging Study. Arthritis Care Res (Hoboken) 2014; 66:837-43. [DOI: 10.1002/acr.22241] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/19/2013] [Indexed: 01/13/2023]
Affiliation(s)
| | | | | | - Lara K. Karg
- University of Minnesota Medical School; Minneapolis
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Abstract
This article discusses physical therapy considerations after hallux valgus correction. Hallux valgus is a fairly common occurrence, and corrective surgery is an option when conservative measures fail. Symptoms such as pain, swelling, and difficulty walking may persist after surgical correction of bunion deformity that addresses soft tissue and bone structure. Physical therapy is helpful after corrective hallux valgus surgery to address impairments and continued dysfunction and to improve overall patient outcome expectations. This article describes the benefits of a multifaceted physical therapy program after hallux valgus correction.
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Abstract
The scarf osteotomy has been used and researched extensively for many years for the correction of hallux valgus deformity in both the adolescent and adult populations. It is an inherently stable construct, which allows for early weight bearing and early return to activities of daily living. The scarf procedure has a wide array of surgical indications with great reproducibility and a low complication rate, and it can be performed bilaterally simultaneously, with long-term predictability. Once the scarf procedure is mastered, it is a rewarding and predictable operation for both the surgeon and patient.
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Affiliation(s)
- Lowell Weil
- Department of Podiatry, Weil Foot & Ankle Institute, 1455 Golf Road, Des Plaines, IL 60016, USA
| | - Michael Bowen
- Department of Podiatry, Weil Foot & Ankle Institute, 1455 Golf Road, Des Plaines, IL 60016, USA.
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Abstract
BACKGROUND Although not well understood, foot kinematics are changed with hallux valgus. OBJECTIVE The purpose of this study was to examine tarsal kinematics in women with hallux valgus deformity. DESIGN A prospective, cross-sectional design was used. METHODS Twenty women with (n=10) and without (n=10) deformity participated. Data were acquired with the use of a magnetic resonance scanner. Participants were posed standing to simulate gait, with images reconstructed into virtual bone datasets. Measures taken described foot posture (hallux angle, intermetatarsal angle, arch angle). With the use of additional computer processes, the image sequence was then registered across gait conditions to compute relative tarsal position angles, first-ray angles, and helical axis parameters decomposed into X, Y, and Z components. An analysis of variance model compared kinematics between groups and across conditions. Multiple regression analysis assessed the relationship of arch angle, navicular position, and inclination of the first-ray axis. RESULTS Both the hallux and intermetatarsal angles were larger with deformity; arch angle was not different between groups. The calcaneus was everted by ≥6.6 degrees, and the first ray adducted (F=44.17) by ≥9.3 degrees across conditions with deformity. There was an interaction (F=5.06) for the first-ray axis. Follow-up comparisons detected increased inclination of the first-ray axis over middle stance compared with late stance in the group with deformity. LIMITATIONS Gait was simulated, kinetics were not measured, and sample size was small. CONCLUSIONS There were group differences. Eversion of the calcaneus and adduction of the first ray were increased, and the first-ray axis was inclined 24 degrees over middle stance in women with deformity compared with 6 degrees in control participants. Results may identify risk factors of hallux valgus and inform nonoperative treatment (orthoses, exercise) strategies.
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Galica AM, Hagedorn TJ, Dufour AB, Riskowski JL, Hillstrom HJ, Casey VA, Hannan MT. Hallux valgus and plantar pressure loading: the Framingham foot study. J Foot Ankle Res 2013; 6:42. [PMID: 24138804 PMCID: PMC3819471 DOI: 10.1186/1757-1146-6-42] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/10/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hallux valgus (HV), a common structural foot deformity, can cause foot pain and lead to limited mobility. The purpose of this study was to evaluate differences in plantar pressure and force during gait by HV status in a large population-based cohort of men and women. METHODS A trained examiner performed a validated physical examination on participants' feet and recorded the presence of hallux valgus and other specific foot disorders. Each foot was classified into one of four mutually exclusive groups based on the foot examination. Foot groups were: (i) HV only, (ii) HV and at least one additional foot disorder (FD), (iii) no HV but at least one other FD, and (iv) neither HV nor FD (referent). Biomechanical data for both feet were collected using Tekscan Matscan. Foot posture during quiet standing, using modified arch index (MAI), and foot function during gait, using center of pressure excursion index (CPEI), were calculated per foot. Further, walking scans were masked into eight sub-regions using Novel Automask, and peak pressure and maximum force exerted in each region were calculated. RESULTS There were 3205 participants, contributing 6393 feet with complete foot exam data and valid biomechanical measurements. Participants with HV had lower hallucal loading and higher forces at lesser toes as well as higher MAI and lower CPEI values compared to the referent. Participants with HV and other FDs were also noted to have aberrant rearfoot forces and pressures. CONCLUSIONS These results suggest that HV alters foot loading patterns and pressure profiles. Future work should investigate how these changes affect the risk of other foot and lower extremity ailments.
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Affiliation(s)
- Andrew M Galica
- Institute for Aging Research at Hebrew Senior Life, 1200 Centre Street, Boston, MA, USA
| | - Thomas J Hagedorn
- Institute for Aging Research at Hebrew Senior Life, 1200 Centre Street, Boston, MA, USA
| | - Alyssa B Dufour
- Institute for Aging Research at Hebrew Senior Life, 1200 Centre Street, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | - Virginia A Casey
- Institute for Aging Research at Hebrew Senior Life, 1200 Centre Street, Boston, MA, USA
| | - Marian T Hannan
- Institute for Aging Research at Hebrew Senior Life, 1200 Centre Street, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Deschamps K, Roosen P, Bruyninckx H, Desloovere K, Deleu PA, Matricali GA, Peeraer L, Staes F. Pattern description and reliability parameters of six force-time related indices measured with plantar pressure measurements. Gait Posture 2013; 38:824-9. [PMID: 23665063 DOI: 10.1016/j.gaitpost.2013.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 04/04/2013] [Accepted: 04/07/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Functional interpretation of plantar pressure measurements is commonly done through the use of ratios and indices which are preceded by the strategic combination of a subsampling method and selection of physical quantities. However, errors which may arise throughout the determination of these temporal indices/ratio calculations (T-IRC) have not been quantified. The purpose of the current study was therefore to estimate the reliability of T-IRC following semi-automatic total mapping (SATM). METHODS Using a repeated-measures design, two experienced therapists performed three subsampling sessions on three left and right pedobarographic footprints of ten healthy participants. Following the subsampling, six T-IRC were calculated: Rearfoot-Forefoot_fti, Rearfoot-Midfoot_fti, Forefoot medial/lateral_fti, First ray_fti, Metatarsal 1-Metatarsal 5_fti, Foot medial-lateral_fti. FINDINGS Patterns of the T-IRC were found to be consistent and in good agreement with corresponding knowledge from the literature. The inter-session errors of both therapists were similar in pattern and magnitude. The lowest peak inter-therapist error was found in the First ray_fti (6.5 a.u.) whereas the highest peak inter-therapist error was observed in the Forefoot medial/lateral_fti (27.0 a.u.) The magnitude of the inter-session and inter-therapist error varied over time, precluding the calculation of a simple numerical value for the error. The difference between both error parameters of all T-IRC was negligible which underscores the repeatability of the SATM protocol. CONCLUSION The current study reports consistent patterns for six T-IRC and similar inter-session and inter-therapist error. The proposed SATM protocol and the T-IRC may therefore serve as basis for functional interpretation of footprint data.
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Affiliation(s)
- Kevin Deschamps
- Department of Rehabilitation Sciences - Musculoskeletal Rehabilitation Research Group, KULeuven, Belgium; Division of Musculoskeletal Disorders, Multidisciplinary Diabetic Foot Clinic, University Hospitals Leuven, KULeuven, Belgium; Laboratory for Clinical Motion Analysis, University Hospital Pellenberg, KULeuven, Belgium; Haute Ecole Léonard De Vinci, Institut D'Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Bruxelles, Belgium.
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Schuh R, Salzberger F, Wanivenhaus AH, Funovics PT, Windhager R, Trnka HJ. Kinematic changes in patients with double arthrodesis of the hindfoot for realignment of planovalgus deformity. J Orthop Res 2013. [PMID: 23192937 DOI: 10.1002/jor.22269] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Double fusion (i.e., fusion of the subtalar and talonavicular joint) represents a modification of triple arthrodesis preserving integrity of the calcaneocuboidal joint. Our aims were (1) to evaluate dynamic plantar pressure distribution in patients undergoing double arthrodesis, (2) to obtain a comparison of kinematic changes to healthy feet, (3) to evaluate the influence of radiographic alignment, and (4) to assess functional outcome. Sixteen feet (14 patients) treated by double fusion due to fixed planovalgus deformity were included. Dynamic plantar pressure distribution was assessed using a capacitive pressure platform. Results were compared with a demographically matched control group. Clinical assessment included the American Orthopaedic Foot and Ankle Society (AOFAS) score and radiographic assessment included measurement of talometatarsal, calcaneal pitch, and talocalcaneal (TC) angle on lateral radiographs. Significant differences in plantar pressure distribution were found for maximum force of the hindfoot, midfoot, and big toe region: While the hindfoot and hallux represented decreased load in the double arthrodesis patients, load increased in the midfoot region compared with healthy controls. The lateral talus-first metatarsal-angle increased from -16.3° to -8.2°, and the TC angle decreased from 41.3° to 35.8° (p < 0.05). The pre- and post-operative AOFAS score increased from 37 points (SD, 16.3) to 70 points (SD, 16.7). These results revealed that double arthrodesis represents a reliable method for correction of planovalgus deformity. Compared with healthy feet, force transmission of the midfoot is increased whereas push-off force decreases.
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Affiliation(s)
- Reinhard Schuh
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Sadra S, Fleischer A, Klein E, Grewal GS, Knight J, Weil LS, Weil L, Najafi B. Hallux valgus surgery may produce early improvements in balance control: results of a cross-sectional pilot study. J Am Podiatr Med Assoc 2013; 103:489-97. [PMID: 24297985 PMCID: PMC4815263 DOI: 10.7547/1030489] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hallux valgus (HV) is associated with poorer performance during gait and balance tasks and is an independent risk factor for falls in older adults. We sought to assess whether corrective HV surgery improves gait and balance. METHODS Using a cross-sectional study design, gait and static balance data were obtained from 40 adults: 19 patients with HV only (preoperative group), 10 patients who recently underwent successful HV surgery (postoperative group), and 11 control participants. Assessments were made in the clinic using body-worn sensors. RESULTS Patients in the preoperative group generally demonstrated poorer static balance control compared with the other two groups. Despite similar age and body mass index, postoperative patients exhibited 29% and 63% less center of mass sway than preoperative patients during double-and single-support balance assessments, respectively (analysis of variance P =.17 and P =.14, respectively [both eyes open condition]). Overall, gait performance was similar among the groups, except for speed during gait initiation, where lower speeds were encountered in the postoperative group compared with the preoperative group (Scheffe P = .049). CONCLUSIONS This study provides supportive evidence regarding the benefits of corrective lower-extremity surgery on certain aspects of balance control. Patients seem to demonstrate early improvements in static balance after corrective HV surgery, whereas gait improvements may require a longer recovery time. Further research using a longitudinal study design and a larger sample size capable of assessing the long-term effects of HV surgical correction on balance and gait is probably warranted.
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Affiliation(s)
- Saba Sadra
- Center for Lower Extremity Ambulatory Research, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Adam Fleischer
- Center for Lower Extremity Ambulatory Research, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL.,Weil Foot and Ankle Institute, Des Plaines, IL
| | - Erin Klein
- Weil Foot and Ankle Institute, Des Plaines, IL
| | - Gurtej S. Grewal
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery and Interdisciplinary Consortium on Advanced Motion Performance, Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ
| | | | | | - Lowell Weil
- Weil Foot and Ankle Institute, Des Plaines, IL
| | - Bijan Najafi
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery and Interdisciplinary Consortium on Advanced Motion Performance, Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ
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Canseco K, Long J, Smedberg T, Tarima S, Marks RM, Harris GF. Multisegmental foot and ankle motion analysis after hallux valgus surgery. Foot Ankle Int 2012; 33:141-7. [PMID: 22381346 PMCID: PMC4612516 DOI: 10.3113/fai.2012.0141] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Gait changes in patients with hallux valgus, including altered kinematic and temporal-spatial parameters, have been documented in the literature. Although operative treatment can yield favorable clinical and radiographic results, restoration of normal gait in this population remains unclear. Segmental kinematic changes within the foot and ankle during ambulation after operative correction of hallux valgus have not been reported. The aim of this study was to analyze changes in multisegmental foot and ankle kinematics in patients who underwent operative correction of hallux valgus. METHODS A 15-camera Vicon Motion Analysis System was used to evaluate 24 feet in 19 patients with hallux valgus preoperatively and postoperatively. The Milwaukee Foot Model was used to characterize segmental kinematics and temporal-spatial parameters (TSPs). Preoperative and postoperative kinematics and TSPs were compared using paired nonparametric methods; comparisons with normative data were performed using unpaired nonparametric methods. Outcomes were evaluated using the SF-36 assessment tool. RESULTS Preoperatively, patients with hallux valgus showed significantly altered temporal-spatial and kinematic parameters. Postoperatively, kinematic analysis demonstrated restoration of hallux position to normal. Hallux valgus angles and intermetatarsal angles were significantly improved, and outcomes showed a significant increase in performance of physical activities. Temporal-spatial parameters and kinematics in the more proximal segments were not significantly changed postoperatively. CONCLUSION Postoperative results demonstrated significant improvement in foot geometry and hallux kinematics in the coronal and transverse planes. However, the analysis did not identify restoration of proximal kinematics. CLINICAL RELEVANCE Further investigation is necessary to explore possible causes/clinical relevance and appropriate treatment interventions for the persistently altered kinematics.
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