Study On Risk Factors Related To Bone Setting Manipulation And Minimally Invasive Treatment Of Metatarsalgia After Hallux Valgus Surgery

1.BackgroundHallux valgus is a common and frequently-occurring disease in foot and ankle clinics.According to epidemiological statistics,the incidence of metatarsalgia after hallux valgus surgery is about 5%to 33%.Most patients are often unable to walk for a long time due to pain,which seriously affects their daily life and finally has to undergo surgery.These diseases are mostly caused by genetic factors,and can also be caused by the influence of wearing inappropriate shoes.They mainly occur in women aged 16 to 70,and the ratio of males to females is more than 1:20,which is symmetrical.Metatarsalgia is prone to occur after hallux valgus surgery,which is an important reason for postoperative readmission of patients with hallux valgus,causing new troubles to patients[3].Once metastatic metatarsalgia occurs,both conservative treatment and surgical treatment will increase the economic burden on patients and society.Custom professional orthopaedic insoles[3]are expensive and require regular adjustment and replacement.Surgery is more expensive.Therefore,the key to dealing with metatarsalgia after hallux valgus surgery is prevention.Research and prevention of metatarsalgia after hallux valgus surgery has become an urgent clinical problem to be solved.There are many types of hallux valgus surgery,but nothing more than changing the position and length of the first metatarsal and the first phalanx to restore the normal biomechanical balance of the forefoot,so as to achieve the purpose of correcting hallux valgus deformity.At present,there are few reports on metastatic metatarsalgia after hallux valgus surgery,which is limited to the analysis of an independent pathogenic factor and lacks a systematic multivariate analysis.At the same time,there is no quantitative standard for some of the more recognized risk factors.Clinically,it is necessary to strengthen the understanding of the etiology and pathogenesis of metatarsalgia after hallux valgus surgery,and to prevent and effectively treat metastatic metatarsalgia.In this paper,by reviewing and analyzing domestic and foreign literature,the possible risk factors of metatarsalgia after hallux valgus surgery were systematically analyzed and studied,and the main risk factors were identified.Therefore,purposeful interventions are made in advance in the operation and rehabilitation process to reduce the occurrence of metatarsalgia after hallux valgus surgery.2.ObjectiveThe possible risk factors were screened out by reviewing and analyzing relevant domestic and foreign literatures and combining clinical experience.The patients who met the criteria were included,and they were divided into the metatarsalgia group and the non-metatarsalgia group according to the diagnostic criteria of metatarsalgia before surgery,and logistic regression analysis was performed to preliminarily screen out the relevant risk factors.After operation,the patients were divided into pain group and normal group according to the presence or absence of metatarsalgia.Logistic regression analysis was performed again,and the related risk factors were finally obtained.A more systematic analysis was conducted to study the related risk factors of metastatic metatarsalgia after hallux valgus surgery,and to identify the main risk factors.It is of great significance to further understand the etiology and pathogenesis of metatarsalgia after hallux valgus surgery,and to prevent and effectively treat metatarsalgia.3.MethodA total of 94 patients(156 feet)who met the inclusion criteria and were admitted to the Second Department of Osteoarthrosis,Wangjing Hospital,China Academy of Chinese Medical Sciences from December 2019 to December 2021 were included in this study.All patients received bone-setting manipulation and minimally invasive treatment for bunion.All subjects were operated on by the same physician.Passed the review by the Ethics Committee of Wangjing Hospital of China Academy of Chinese Medical Sciences,agreed to participate in the study and signed the informed consent.The subjects were followed up 6 weeks,3 months and 6 months after surgery.Basic information,imaging observation indexes and plantar gait mechanics data were collected before and after operation.Firstly,according to the diagnostic criteria of metatarsal algia,156 patients with bunion before foot surgery were divided into pain group and normal group according to whether they were complicated with metatarsal algia.Univariate and multivariate regression analysis was conducted for the included risk factors,and the risk factors of metatarsal algia after bunion were initially screened.The patients with metastatic metataralgia were identified at the 6-month follow-up,and the risk factors in the preliminary screening were used to conduct regression analysis for the pain group and the normal group,respectively,to further eliminate the confounding factors of metastatic metataralgia after bunion.Finally,156 patients after foot bunion valgus were divided into two groups according to whether they had metastatic metalgia.Patients with postoperative metalgia were included in the pain group,while those without metalgia were included in the normal group.Univariate analysis was performed for the first two screening risk factors,and multivariate Logistic regression analysis was performed for variables with P<0.25 to finally determine the risk factors related to bone-setting manipulation and minimally invasive treatment of metastatic plantaralgia after bunion valgus.The quantitative relationship between closely related risk factors for metastatic plantaralgia was obtained through linear regression analysis.4.ResultsA total of 127 patients were collected,33 cases were shed,and 94 cases were included.According to the diagnostic criteria of plantaralgia,156 feet were divided into 2 groups before operation,including 104 feet in normal group and 52 feet in pain group.After Logistic regression,9 risk factors including pain VAS score,range of motion of the first metatarsophalangeal joint,dynamic maximum impulse under the metatarsal head,dynamic maximum pressure under the metatarsal head,hallis valgus Angle,Angle between the first and second metatarsal bones,length of the first and second metatarsal bones,sagittal range of motion of the first metatarsal wedge joint and length of the first metatarsal bones were identified Element.Metastatic metalgia occurred in 15 feet of 104 feet in the normal group and in 6 feet of 52 feet in the pain group.Logistic regression was carried out to further analyze the risk factors of the two groups based on the 9 risk factors initially screened before surgery,and the confounder VAS was removed.Eight risk factors including motion of the first metatarsophalangeal joint,dynamic maximum impulse under metatarsal head,dynamic maximum pressure under metatarsal head,bunion Angle,Angle between the first and second metatarsal bones,length of the first and second metatarsal phase,sagittal range of motion of the first metatarsal wedge joint and length of the first metatarsal phase were obtained.After 156 feet,21 feet showed metataralgia and 135 feet did not.Multivariate logistic regression analysis showed that the hallux valgus Angle,the length of the first and second metatarsal phase,the sagittal range of motion of the first metatarsal wedge joint,and the maximum dynamic impulse under the second metatarsal head were the risk factors for metastatic metatalgia after hallux valgus surgery,and the motion of the first metatarsal toe joint was the protective factor(P<0.05).Logistic regression equation was established:Logit(P)=-9.889+0.029×β1-0.127×β2+0.303×β3+0.137×β4+0.804×β5,where β1=hallux valva Angle,β2=range of motion of the first metatarsophalangeal joint,β3=range of motion of the sagittal plane of the first plantar wedge joint,β4=length of the first and second plantar bones,β5=maximum dynamic impulse under the second metatarsal head.5.ConclusionIn this study,the multivariate regression analysis was carried out on the related factors of metatarsalgia after hallux valgus surgery,and it was concluded that bone setting manipulation and minimally invasive treatment of metatarsalgia after hallux valgus surgery were associated with hallux valgus angle,1 st,2nd The relative length of the metatarsal,the range of motion of the first metatarsophalangeal joint,the sagittal range of motion of the first metatarsophalangeal joint and the dynamic maximum impulse under the second metatarsal head are closely related.The range of motion of the first metatarsophalangeal joint is a protective factor,and the other four is a risk factor.