| Objective: Dynamic foot pressure was analyzed before and after two kinds of hallux valgus correction surgery through the application of plantar pressure test system,the specific change combined with clinical evaluation and imaging measurement of the affected foot was noted to compare their efficacy to reduce the surgical options for affecting the prognosis of patients,improve the therapeutic effect,reduce and avoid the incidence of related complications,save medical cost and improve the quality of life of patients.Materials and Methods: Subject: Patients who were treated for moderate to severe hallux valgus were randomized into Scarf osteotomy(30 patients)and Ludloff osteotomy(30 patients)from Oct.2015 to Oct.2016 were chosen as subject group and followed up,all patients are female and were corrected by unilateral operation.The patient’s age,height,weight and other related information were recorded and without significant difference.The hallux valgus angle(HVA),1-2 metatarsal angle(IMA),distal metatarsal articular surface angle(DMAA),the first metatarsal length(ML),tibial sesamoid position(TSP)were measured on standardized weight bearing radiographs in two groups before and after surgery as radiological assessment,complications and American Orthopedic Foot and Ankle Society(AOFAS)scores were recorded as Clinical assessment.The control: The dynamic foot pressure of 30 healthy matched adult women was analyzed by MPS-system(Loran Engineering Sr L,Italy)as the same as the subject group before operation and 12 months later.The plantar aspect of the foot was divided into ten regions automatically:hallux(T1),toes 2 – 5(T2 – 5),first to fifth metatarsals(M1,M2,M3,M4,and M5),midfoot(MF),medial heel(MH),and lateral heel(LH).The changes of peek pressure(PF,k Pa)and maximum force(MF,N)and contact area(CA,cm2)were compared between the two groups before and after the operation was evaluated as a method of biomechanical evaluation.we evaluated and compared the efficacy of two surgical procedure for moderate to severe hallux valgus from the clinical,imaging and biomechanical results.Results:(1)Radiographic Results:Preoperatively,the HVA,IMA,DMAA,TSP,ML of Scarf osteotomies and Ludloff osteotomies were 35.48 °±7.65°,37.00° ±8.21°;15.72°± 4.82°,16.34°± 5.25°;11.73°±5.35°,11.21 °±5.42°;2.5±0.8,2.4±1.0;(63.24±3.13)mm,(62.76±3.09)mm respectively,and with no significant difference(P>0.05).Postoperatively those date were 14.83°±3.14°,13.92°±3.78°;8.61°±2.13°,7.58°±2.88°;6.32°±2.18°,7.49°±2.35°;0.7 ± 0.4,1.1 ± 0.5;(61.82±2.73)mm,(60.05±3.15)mm respectively and showed obvious improvement(P<0.05).The tibial seasmoid position,DMAA and first metatarsal length shortening postoperatively were significantly better in the scarf osteotomies compared with Ludloff osteotomies(P < 0.05).(2)Clinical Outcome : Complications : There were 2 postoperative complications in Scarf osteotomies,1 case of transfer metatarsalgia and recurrence of hallux valgus respectively and 5 cases in group Ludloff,1 case of malunion and internal fixation loosening and recurrence of hallux valgus respectively,2 cases of transfer metatarsalgia.AOFAS score:Preoperatively,the total and pain,function,alignment subcategories of the AOFAS score of Scarf osteotomies were 55.2 ±14.7,22.3 ± 5.5,32.3 ± 6.2,1.6 ± 3.1and 57.3 ±15.1,23.1 ± 6.3,32.5 ± 5.4,1.7 ± 3.2 in Ludloff osteotomies.Postoperatively,those date were 90.7 ±8.7,38.1 ± 3.5,38.9 ± 3.9,13.7 ± 1.6 and 83.2 ±6.3,34.7 ± 4.3,35.2 ± 3.6,14.3 ± 2.0 in each groups.Each score of two groups showed obvious improvement and with statistical difference(P<0.05).But there is no obvious difference of the total and subcategories of the AOFAS score between two groups(P > 0.05).Postoperatively,the alignment subcategories of the AOFAS score of Ludloff osteotomies was inferior to that of the Scarf osteotomies,and the difference was statistically significant(P < 0.05).(3)Biomechanical results:The changes of distribution of foot pressure in the subject group was mainly in the area of the hallux(T1)and the medial and middle forefoot(M1,M2,M3).Compared with the normal foot,the first metatarsal(T1,M1)load parameters(PP,MF)were reduced.And the foot pressure load of central forefoot(M2,M3)was obviously increased and the peak pressure(PP)increased most obviously,while the foot pressure load parameters of the lateral forefoot(M4,M5)had no obvious changes(P > 0.05),but there was an increasing trend.Compared with the normal foot,the hallux function in hallux valgus changes most obviously,and the T1 area pressure load parameter and the contact area all reduced obviously(P < 0.05).There was no significant changes in the parameters of the midfoot and hindfoot(P > 0.05),indicating that the main changes in the hallux valgus deformity were located in the forefoot and the hallux.And the way of pressure load transfer is significantly reduced in the first ray with the tendency load transfer to the lateral,and the second and third metatarsal head bear the main load and latal forefoot had increasing trend.In the experimental group,the distribution changes of the plantar pressure was mainly in the area of the hallux(T1)and the medial and middle part of the forefoot(M1,M2,M3),and there were no significant changes in the lateral forefoot and the midfoot and hindfoot.The preoperative load transferred from the first ray to the lateral forefoot were all recovered effectively after operation in two groups.Compared with the preoperative groups,the date had significant changes(P < 0.05).Compared with the normal control group,the abnormal plantar pressure distribution was restored(P > 0.05).The distribution of foot pressure after operation was compared between the two groups.There was no significant difference in the parameters of the other regions except the first metatarsal head(M1)contact area is smaller in Ludloff group than that the Scarf group(P < 0.05),and the parameters in Scarf group were closer to that of the normal control group.Conclusion:(1)For moderate to severe hallux valgus,both Scarf osteotomy and Ludloff osteotomy have good clinical effects,which can obviously correct the deformity,relieve pain and improve the function of the patients.However,the Scarf osteotomy group was superior to the Ludloff osteotomy group for the recovery of the dislocation of the sesamoids,the shortening of the first metatarsal,the improvement of the pain,the AOFAS score,the postoperative transfer metatarsalgia and the incidence of complications.(2)In normal walking condition,the peak pressure was highest under the second metatarsal head(M2),followed by the third metatarsal head(M3),the heel region and the first metatarsal head(M1).Peak pressure in forefoot areas showed decreased progressively from medial to lateral except for the first metatarsal,and the midfoot and the lateral toes was the smallest,while the medial and lateral heel pressure was similar.The highest MF values were found under the MH(MH is similar as LH),M2 zone is highest in forefoot and then M3,M1,M4,M5,showed decreased progressively from medial to lateral except for M1 and the distribution law were as same as the peak pressure parameters.The hindfoot(MH + LH)contact area is the largest,followed by midfoot(MF),M1 zone is highest in forefoot。(3)The load parameters of hallux valgus(PP/MF)show the biggest changes is the forefoot and hallux,lateral toes and midfoot and hindfoot had no obvious changes.In particular,the PP and MF of the second,third metatarsal head were significantly increased(P < 0.05),the first metatarsal head and the hallux were significantly decreased(P < 0.05),and the PP and MF in the fourth,fifth metatarsal head area were also increased,but were not statistically significant(P > 0.05).The contact area(CA)on the hallux and first metatarsal head were all decreased.When the hallux valgus deformity occurs,the load capacity of the first ray is significantly weakened and transferred to the central and lateral forefoot.(4)Both Scarf osteotomy and Ludloff osteotomy can significantly improve the plantar pressure distribution of the hallux valgus,and reverse the trend of plantar pressure load transferred from medial to lateral.However,the capability of weight bearing recovery of Ludloff osteotomy is less than Scarf osteotomy.(5)Based on the analysis of two operative methods,including clinical function,imaging and plantar pressure,Scarf osteotomy is better than Ludloff osteotomy for moderate to severe hallux valgus deformity. |
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