| [Objective]Hallux valgus is a common skeletal-muscular deformity of the lower limbs, which is characterised by hallux abduct, bunion, pain and the first metatarsal adduct. Although it have been studied for many years, but there are argument among researchers about the pathogenesis and effective treatment method. Based on our clinical experience, 137 patients were followed up to determine the effective of the operation procedure of base osteotomy of the first metatarsal; To study the roentgenographic change in hallux valgus foot and the clinical value of the measurement parameters; To study the muscular disabilities in hallux valgus foot; To establish a finite element model of normal foot and analysis the joints force changes in the first ray between normal and posterior tibial tendon dysfunction foot. All the results will be used to improve the treatment methods of adolescent hallux valgus and to modify the operative procedure of hallux valgus.[Materials and Methods]1. Form Jan 1994 to Dce 2003, 204 patients 137 hallux valgus feet were operative and followed up in our department, 157 patients 98 feet with completely data. The roentgenographic measure parameters: the first cuneiform-metatarsal angle, hallux valgus angle, distal articular set angle, proximal articular set angle, I-II inter-metatarsal angle, I-V inter-metatarsal angle. All patients were questionair the American Orthopaedic Foot and Ankle Society Clinical Rating Scale (AOFAS) by letter or phone. The operative procedure were choiced: 1) bunion excision + fascial flap sutured tightly; 2) bunion excision + amputation of the hallux adduct muscle tendon; 3) bunion excision + amputation hallux adduct muscle tendon + base osteotomy of the first metatarsal; 4) bunion + amputation hallux adduct muscle tendon + base osteotomy of the first metatarsal + osteotomy of the proximal shaft of the second metatarsal. The difference results among difference methods were analysised.2. From Jan 2002 to Dec 2003, 24 patients 24 hallux vlgus feet were followed up, 27 volunteers 27 normal feet were examined as controlled group. All the subjectswere taken roentgenograph examine include weight- bearing anterior posterior, weight-bearing lateral, weight-bearing calcaneus axial. 12 measuring parameters were recorded: hallux valgus angle, metatarsal adduct angle, first cuneiform-metatarsal angle, I-II inter-metatarsal angle, I-V inter-metatarsal angle, II-V inter-metatarsal angle, distal articular set angle, proximal articular set angle, calcaneus inclination angle, calcaneus -navicular metatarsal angle, talus-first metatarsal angle, calcaneus articular facet-tibial axial angle. The differences between hallux valgus foot and normal foot were analysised.3. From Jan 2002 to Dec 2004, 18 patients 18hallux valgus feet and 18 volunteers 18 feet were examined with Dantec Keypoint four paths myoelectricitic evokedpotential apparatus, stimulus intensity: 18mA, scanner speed: 5mS/D, sensitivity: 5Mv/D, square wave: frequency bandwidth: 2ms, room temperature: 20°C~25°C. The EMG of fibular longus muscle, fibular brevis muscle, anterior tibial muscle, posterior tibial muscle, the difference of Lat and Amp were analysised between hallux valgus and normal foot.4. A volunteer is one normal male, 30 years old, nor any foot deformity neither foot operative/injury history. The right foot was scaned with spinal CT(GE), slice thickness was 1.2mm, scan interval is lmm, from the hindfoot to the most distal point to the phalangeal. In the Metlab software work station, the boundary of the bone, tendon and skin were discerned and the matrix data were collect. A finite element model of the foot was established in the Surface 10.0 software workstation. The model included the distal part of the tibial, the distal part of the fibula, calcaneus, talus, navicular, cuboid, cuneiform (3), metatarsal (5), sesamoid (2), phalangeal (14), posterior tibial tendon, hallux longus extensor tendon, hallux longus extensor tendon, hallux abduct muscle, plantar fascia, spring ligament, bifurcate ligament, talusnavicular dorsal ligament, talusnavicular plantar ligament, navicularcuneiform dorsal ligament, navicularcuneiform plantar ligament. In the ANASIS software workstation, the force among the joints of the first ray was analysised, especially in the PTTD condition, the change of the first ray stability, the relationship between the force of the first metatarsalphalangeal joint and the first cuneiformmetatarsal joint.[Result]1. 10 patients 16 hallux valgus feet were performed with operative procedure of "simple bunion excision + fascial flap sutured tightly", all of the patient were female, age 31-64 (average 49.30); 26 patients 43 hallux valgus feet were performed withoperative procedure of "bunion excision + amputation of the hallux adduct muscle tendon", age 20-75 (average 49.23), 3 patients 5 feet were male, age 20-37 (average 30.33), 36 patient 55 feet were female, age 31-75 (averege 50.81);26 patients 43 feet were performed with operative procedure of "bunion excision + amputation hallux adduct muscle tendon + base osteotomy of the first metatarsal", age 27-62 (average 56.10), 33 patients 6 feet were male, age 62-65 (average 63.67), 23 patient 37 feet were female, age 27-62 (average 48.17);9 patients 13 hallux valgus feet were performed with operative procedure of "bunion + amputation hallux adduct muscle tendon + base osteotomy of the first metatarsal + osteotomy of the proximal shaft of the second metatarsal", age49~69 (average 40.40), 1 patients 1 feet was male, 8 patient 12 feet were female. Other operative procedure include: Keller, Austin, Chevron, sesamoid osteotomy etal. Hallux valgus recurrence^, delayed union of the first metatarsal base osteotomy: 1, nonunion . The hallux valgus angle and the AOFAS was improved. There is significant difference among the 4 groups postoperatively compared to preoperatively. There are significant difference between the first and forth group in the HVA, FCMA, I-II IMA, I-V IMA and AOFAS.2. There is significant difference between hallux valgus and normal foot in the hallux valgus angle, I-II inter-metatarsal angle, I-V inter-metatarsal angle, distal articular set angle, proximal articular set angle, calcaneus inclination angle, calnaceus-navicular-metatarsal angle and talus-first metatarsal angle. There is not difference between hallux valgus and normal foot about the metatarsal adduct angle, II-V inter-metatarsal angle, calcaneus articular facet-tibial axial angle. Hallux valgus accompany with the first metatarsal abductus, the primary deformity is abnormal articular angel of the first cuneiform-metatarsal joint. Some hallux valgus patients may accompany with flat foot deformity. But it is unclear with is the cause and effect and some hallux valgus patients with flat foot do not complain symptom about flat foot.3. There is difference in the Amp and Lat of fibular longus tendon between normal and hallux valgus foot but not significant. There is significant difference in the Amp and Lat of posterior tibial tendon between normal and hallux valgus foot. The difference in Amp of the anterior tibial tendon is not significant and there is not difference in the Amp and Lat of the fibular brevis tendon , the Lat of the anterior tibial tendon between the normal and hallux valgus foot.4 A finite element model of foot was constructed with 63,956 tetrahedron...
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