Quantitative motion analysis in patients with hallux rigidus before and after cheilectomy

The purpose of this study was to quantify changes in temporal‐spatial parameters and multisegmental foot/ankle kinematics in a group of patients with hallux rigidus following cheilectomy. Three‐dimensional motion analysis was conducted using a 15‐camera Vicon Motion Analysis System on a population of 19 patients who underwent cheilectomy for hallux rigidus. Data were analyzed using the four‐segment Milwaukee Foot Model. Preoperative and postoperative tests were compared using paired parametric methods. Results showed significant improvements in walking speed, cadence, stride length, and stance/swing ratio from preoperative to postoperative state. Altered hallux and forefoot positions preoperatively showed shifts towards normal after cheilectomy. Although clinical improvements in pain and passive range of motion were statistically significant, similar improvements in range of motion were not demonstrated during ambulatory testing. The results of this study provide insight into ambulatory improvements following cheilectomy, and suggest further study of the rehabilitation process to improve the recovery of functional range of motion. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:128–134, 2009     

Post-surgical hallux varus. A case report

Sometimes a hallux varus occurs as a consequence of the treatment for a hallux valgus, determined by an alteration of the balance between the muscolo-ligamentous structure which crosses the first metatarso-phalangeal joint. This complication is poorly tolerated by patients. Various operations have been proposed to correct the varus, which includes the bone and the soft tissue. A clinical case has been presented which uses a split extensor hallucis longus transfer, distally sectioned and made to pass under the deep transverse intermetatarsal ligament, used as a pulley, and through a tunnel made in the bone at the proximal-lateral base of the proximal phalanx, and then tensioned and sutured to its medial side.     

Common disorders of the adult foot and ankle

Intricate bony and soft tissue anatomy associated with complex biomechanics can provide a significant challenge when considering the pathologies affecting the adult foot and ankle. The aim of this article is to introduce some of the clinical features and treatments for more common foot and ankle conditions.     

第一跖骨近端斜楔形截骨联合软组织手术治疗重度拇外翻

目的:探讨第一跖骨近端斜楔形截骨联合软组织手术治疗重度拇外翻的临床疗效。方法:2008年7月～2010年7月对21例重度拇外翻患者采用第一跖骨近端斜楔形截骨,同时对外侧关节囊松解、内侧关节囊紧缩、拇内收肌腱部分切断治疗。测量患足负重X线,采用美国足踝外科协会Maryl and的评分方法对患足进行手术前后评定。结果:本组患者21例,术后随访6～24个月,无截骨不愈合及延迟愈合现象。23足无疼痛,1足偶有轻微疼痛。术后Mar yl and评分:90～100分19足,80～89分4足,70～79分1足,优良率95%。结论:第一跖骨近端斜楔形截骨联合软组织手术治疗重度拇外翻效果可靠,可以推广。     

联合趾截骨手术在外翻矫形中的价值

目的探讨趾截骨手术（Akin截骨术）在外翻畸形矫形中的价值。方法我院2010年5月至2011年4月联合使用Akin截骨术治疗外翻患者32例49足。在本组患者中,术前均拍摄患足负重正位X线片,测量外翻角、跖间角、远侧关节固定角,依据跖间角分别采用Chevron截骨术（Austin手术）,跖楔关节融合手术（Lapidus手术）或第一跖骨基底斜楔形截骨（Juvara手术）。术后及随访测量外翻角、跖间角、远侧关节固定角改变。采用AOFAS评分对患足进行功能评价。结果所有患者平均随访12个月。外翻角由术前（39.7±7.5）°纠正为（16.1±7.6）°,P〈0.05,平均纠正（25.9±9.5）°;跖间角由术前（15.4±3.9）°纠正为（7.6±2.5）°,P〈0.05,平均纠正（7.1±3.0）°;远侧关节固定角由术前（6.3±2.7）°纠正为（-5.3±4.0）°,P〈0.05,平均纠正（11.4±4.0）°;AOFAS得分由术前平均43.5分提高至85.6分,P〈0.05。结论 Akin截骨术是外翻矫形程序中的一种辅助手术,可以改善疗效、降低复发率且操作简便、安全。     

The Modified McBride Procedure: Clinical, Radiological, and Pedobarographic Evaluations

Nineteen patients (27 feet) with symptomatic hallux valgus who underwent modified McBride procedure were studied prospectively. The outcome measures included preoperative and postoperative American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal scoring, weight-bearing radiographs, and pedobarography using the EMED-SF*6 System. The average patient age was 49.7 years, and all patients were women. The average follow-up was 7 months. Results showed an average improvement in rating scale score from 53 to 87/100, in the hallux valgus angle from 32 degrees to 15 degrees, and in the first intermetatarsal angle from 15 degrees to 10 degrees. Pedobarographic analysis showed a statistically significant increase in the contact area of the hallux by 17.5% (P<.001), with a reduction of peak pressures of the hallux by 29% from 67.5+/-29.5 N/cm2 to 48+/-34 N/cm2 (P<.001; confidence interval, 9.887, 29.233) and the total foot by 8% from 89+/-26 N/cm2 to 82+/-25 N/cm2 (P<.05; CI, 0.727, 14.900). The overall satisfaction rate was 96%. We conclude that the modified McBride procedure has a role in patients with passively correctable hallux valgus and a supple metatarsocuneiform joint.     

"跖袖"的解剖学特点及临床意义

目的:探讨跖袖的解剖学特点及临床意义。方法:对20只足的跖袖的构成特点进行应用解剖学观测及力学分析。结果:跖袖的构成复杂,其中收肌、展肌是维持前足横弓及籽骨系统动力平衡的关键因素,跖袖的动力平衡失调,特别是展肌与收肌通过籽骨系统导致的平衡失调是外翻形成的核心机制,在外翻畸形的发生中有着特殊的临床意义。结论:展肌与收肌移位吻合矫正外翻的新术式恢复了跖袖的正常解剖关系,重建前足横弓,恢复了前足的生理解剖结构及生物力学功能。