Abstract
BackgroundPostoperative transfer metatarsalgia is a common complication after hallux valgus surgeries. Shortening of the first metatarsal is traditionally thought to be the primary cause of it. However, we speculate the abnormal loading pattern during gait is the real reason. This study is to determine specific differences in the loading patterns between reconstructive hallux valgus (HV) feet with and without postoperative transfer metatarsalgia, so as to find risky loading characteristics of this complication.MethodsThirty feet with postoperative transfer metatarsalgia were recruited as pain group, while another 30 postoperative feet without pain as controls. All participants were asked to walk barefoot at self-selected speed through a plantar force measuring plate (Rs-Scan Inc.) for three times. Certain plantar load variables were recorded or calculated, and their differences between two groups were compared.ResultsFor pain group, the maximum plantar force and force time integral of the first metatarsal decrease significantly; the force time integral of the central rays (second plus third metatarsal) does not significantly differ with that in the controls, but their cumulative load percentage to the whole foot is higher. In pain group, the time point when central rays reached their peak force during the push-off is significantly later than that in controls. And the regional instant load percentage at this moment presented significantly higher for central rays, while significantly lower for the first metatarsal and the hallux compared to the controls.ConclusionsFor hallux valgus feet with postoperative metatarsalgia, the load function of the first metatarsal is obviously impaired. But for central rays, indicative difference is not reflected in either peak or cumulative load during the gait cycle, but in the instant load distribution when central rays reach their peak load. So we can conclude that whether the remaining regions can adequately share certain load during walking, especially around the time metatarsalgia often occurs, plays an unnegligible role. So surgeons should pay more attention to reconstruct a foot where load can be evenly distributed.
Highlights
Postoperative transfer metatarsalgia is a common complication after hallux valgus surgeries
There is no significant difference between the two groups in age, body weight, gender, postoperative hallux valgus angle (HVA), or the first intermetatarsal angle (IMA) (Table 1)
For feet with postoperative transfer metatarsalgia, mean peak force during the gait cycle was highest on The second and third metatarsals (M2+3) region, followed by The forth and fifth metatarsals (M4+5), The first metatarsal (M1), T1, and The second to fifth toes (T2–5), while for the controls, the rank was almost the same except the reverse between M1 and M4+5
Summary
Postoperative transfer metatarsalgia is a common complication after hallux valgus surgeries. This study is to determine specific differences in the loading patterns between reconstructive hallux valgus (HV) feet with and without postoperative transfer metatarsalgia, so as to find risky loading characteristics of this complication. Corrective surgery for hallux valgus (HV) deformities is one of the most common procedures in foot and ankle department. High unsatisfied rate is always related to postoperative complications, among which transfer metatarsalgia may be more prevalent than previously thought and sometimes unpredictable. Debate has emerged these years about whether and how much shortening of the first metatarsal could be allowed during HV correction, and different studies indicate different or even controversial conclusions [4,5,6,7,8]
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