| 1BackgroundHallux valgus deformity is a common disease of foot surgery, and the main clinical manifestations are malformation, pain and callus. We found that the pain of the inner side of the first metatarsal, the pain under the first metatarsal head or the other metatarsal head is caused by the deformity of hallux valgus in the long-term clinical work. The the pain of the inner side of the first metatarsal usually caused by the capsulitis of the first metatarsal, but the pain under the first metatarsal head caused by the abnormal pressure under the first metatarsal head. The pain under the other metatarsal head caused by the head of second, third, fourth metatarsal weight bearing increased. In hallux valgus, besides varus, uplifting and pronation of the first metatarsal and the out-shifting of the sesamoids, the stress-relaxation of the interosseous metatarsal ligment and the stress and overstrain of the great toe abduct muscle can lead to abnormal weight bearing of the first metatarsal through the sesamoid. Due to the decreased weight bearing of the first metatarsal, the increased weight bearing of the other metatarsal (2/3/4) appears. And then the head of other metatarsal slide down, which could cause transverse arch down, finally, it leads to the pain and callus under the head of other metatarsal. Also it is reported that the abnormal of the first ray is the main reason of the other pathological changes, such as the balance of the first ray is destroyed, the effect of the plantar fascia working on the first ray is weakened. when standing, the proximal phalanx of the first toe is unable to be pulled by the Plantar fascia, which leads to less instability and more upward movement of the first metatarsal. finally, it causes the collapse of anterior section of the longitudinal arch of foot. In addition, according to traditional Chinese medicine, the wind, cold, dampness, heat combined with pathogens such as resistance meridians closed which resulting in physical functioning of Qi and Blood, resulting in pain as the main performance of disease is liver and kidney is deficient meridian grinds to more natural decay less poor Qi and Blood combined with prolonged standing on foot strain caused by chronic plantar strain on the muscles and other soft tissue. So it is found that there are the stress-relaxation of soft tissue in the plantar of the patient with hallux valgus, including tendons, ligaments, sole muscles of foot and so on.The stress-relaxation gives rise to buffer action of foot decreased. It shows that the arch of foot became more collapse under weight-bearing than non weigh-bearing. Therefore, we find that the stress-relaxation of soft tissue maybe one of the reason casued the pain under the metatarsal.X-ray measurement is one of the most important methods for diagnosing and evaluating hallux valgus. It is reported that the inter-metatarsal angle between the first and second metatarsals(IM1-2), the inter-metatarsal angle between the first and third metatarsals (IM1-3), the inter-metatarsal angle between the first and fourth metatarsals (IM1-4), the inter-metatarsal angle between the first and fifth metatarsals(IM1-5) and the distance between the first and fifth metatarsals is likely increased when patients’ foot with hallux valgus under non weight-bearing turn to weight-bearing, which measued from anteroposteror aspect X-ray film. Similarly, the anterior angle of the medial longitudinal arch (AAOTMLA) is also likely increased, but the top angle of the medial longitudinal arch (TAOTMLA) is likely decreased which measued from lateral aspect X-ray film. It is similar to the result from the study on analysis the X-ray measurement indexes under weight-bearing and non weight-bearing of hallux valgus done by Zhang jianzhong. Not only the changes of the indexes is the same, but also the IM1-2is increased with the its deformit increased.It suggests that deformed changes of hallux valgus can be revealled by analysis the X-ray measurement indexes under weight-bearing and non weight-bearing.However, there are no further study on the correlation between the degree of the collapse of the arch of foot caused by hallux valgus deformity and the pain under the head of other metatarsal, the deformities of hallux valgus, the tenderness, callus and the age of patients from the perspective of analyzing the X-ray measurement indexes. So we think it’s necessary to make further study on these problems and analysis the factor causing the pain under the head of other metatarsal of the patient with hallux valgus to guide clinical applications. 2ObjectivesThe objective of research is to observe the exiting and appearance of the pain, the tenderness, callus under the head of other metatarsal (2/3/4) of hallux valgus, then to analyse the changes in the radiographic appearance during weight-bearing and non weigh-bearing in hallux valgus and to evaluate the collapse of the arch of foot with hallux valgus, to analyse the correlation between the collapse of the arch of foot with hallux valgus and the pain under the metatarsal. To expect to fand early the understanding of the factors causing pain and callus under the head of other metatarsal of hallux valgus and to provide new ideas of preventing and treating pain of hallux valgus. Moreover, provide theoretical support to that the collapse of the arch of foot is regarded as an important part of efficacy evaluation and that pain the head of other metatarsal (2/3/4) should be early intervened to improve the efficiency of treating hallux valgus.3MethodsFrom May to December in2012,194patients (383feet), including188women (374feet) and6men (9feet), who were treated for hallux valgus in Wangjing Hospital were collected. The age is from18to78years, and the average age is53years. This study used prospective clinical observation to observe the exiting and appearance of the pain, the tenderness, callus under the head of other metatarsal (2/3/4) of hallux valgus, the changes in the radiographic appearance during weight-bearing and non weigh-bearing in hallux valgus, including HVA, IM1-2, IM1-5, TAOTMLA, AAOTMLA, finally, The correlation between the changes of IM1-2, IM1-5, TAOTMLA, AAOTMLA and the degree of the deformity, the pain under the metatarsal were analysed.4Results4.1In the194patients (383feet), the degree of hallux valgus deformity of82feet are slight,185moderate and116serious. There are296feet with the pain under the metatarsal (2/3/4), accounting for77.26%of all383feet collected and there is no pain under the metatarsal (2/3/4) in other87feet. In all feet, the pain index:painless87feet, slight pain123feet, moderate pain114feet and serious pain59feet. Pressure test is positive in193feet accounting for50.39%of all383feet and is negative in the other190feet. There are183feet with the callus under the head of metatarsal (2/3/4), accounting for47.78%of all383feet. The age distribution of the194patients is that24patients’age is from18to39,96patients’ age is from40to59,74patients’ age is from60to78.4.2Through t-test, the result of comparison of HVA, IM1-2, IM1-5, TAOTMLA and AAOTMLA between weight-bearing and non weight-bearing was all P<0.05. IM1-2, IM1-5and TA is increased when patients’ foot with hallux valgus under non weight-bearing turn to weight-bearing, but HVA and AAOTMLA is decreased when patients’ foot with hallux valgus under non weight-bearing turn to weight-bearing.4.3Through Pearson correlation test, in all feet, there is statistical significance in the correlation between the degree of hallux valgus deformity and the different of IM1-2(P<0.05,r=0.212) and IM1-5(P<0.01, r=0.241).4.4Through Pearson correlation test, in the feet with serious degree of hallux valgus deformity, there is statistical significance in the correlation between the degree of hallux valgus and the different of IM1-2(P<0.01, r=0.350), IM1-5(P<0.01, r=0.339) and TAOTMLA (P<0.05, r=0.199).4.5Through Pearson correlation test, in the feet with slight and moderate degree of hallux valgus deformity, there is statistical significance in the correlation between the degree of hallux valgus and the different of IM1-5(P<0.05, r=0.136.4.6Through Pearson correlation test, in all feet, there is statistical significance in the correlation between the pain index of the pain under the metatarsal and the different of IM1-5(P<0.01, r=0.143) and AAOTMLA (P<0.05, r=0.101).4.7Through Pearson correlation test, in the feet with slight degree of hallux valgus deformity, there is statistical significance in the correlation between the pain index of the pain under the metatarsal and the different of IM1-5(P<0.01, r=0.29).4.8Through Pearson correlation test, in the feet with slight and moderate degree of hallux valgus deformity, there is statistical significance in the correlation between the pain index of the pain under the metatarsal and the different of IM1-5(P<0.01, r=0.172).4.9Through Pearson correlation test, by age segmentation, the age between40and59of patients with hallux valgus deformity, there is statistical significance in the correlation between the age of patiens and the different of IM1-5(P<0.01, r=0.364) and AAOTMLA (P<0.05, r=-0.165).4.10Through t-test, the result of comparison of the different of IM1-2, IM1-5between the feet with tenderness and the feet without tenderness was all P<0.05, but the result of comparison of the different of TAOTMLA, AAOTMLA between the feet with tenderness and the feet without tenderness was all P>0.05.4.11Through t-test, the result of comparison of the different of IM1-2, IM1-5between the feet with the callus and the feet without the callus was all P<0.05, but the result of comparison of the different of TAOTMLA, AAOTMLA between the feet with the callus and the feet without the callus was all P>0.05.5Conclusions5.1In a certain degree, the changes of IM1-5under weight-bearing and non weight-bearing increased with the degree of the pain, the tenderness, the callus under the metatarsal and the degree of the hallux valgus deformity become serious;5.2Among patients with hallux valgus, middle-aged woman is high-risk group with the pain under metatarsal and other clinical symptoms;5.3The changes of IM1-5under weight-bearing and non weight-bearing is good at forecasting the degree of the collapse of the arch of foot with hallux valgus and giving advise to protect the pain under the metatarsal early. |
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