Abstract
Metatarsal pain is a common pathological outcome in patients with a hallux valgus (HV) deformity. However, the relationship between the degree of HV deformity and metatarsal pain has not been systematically examined. The purpose of the present study was to investigate the correlation between metatarsal pain and the degree of HV deformity. Between October 2017 and September 2018, 512 HV patients (944 feet) participated in an evaluation of their HV angle (HVA) using X-ray images. The participants were divided into four groups corresponding to their HVA (<15°, 15° to 20°, 21° to 40°, or >40°). Load rate, impulse, contact duration, and contact area were measured and recorded as dynamic gait parameters using the RsScan system. Data were evaluated using SPSS statistical software. The visual analog scale (VAS) was used to assess metatarsal pain. For the four HV deformity groups, the peak value of impulse and contact duration was concentrated on the second and third metatarsals (Meta2 and Meta3) (P < 0.05); contact area was also shown on metatarsals 1, 2, and 5 (P < 0.05). Metatarsal pain on Meta2 had the highest VAS score (VAS: 6.57), followed by Meta3 (Mean VAS: 5.72). In the HV > 40° group, the load location on Meta2 was transferred to Meta1. The percent of pain attributed to Meta2 and Meta3 was also increased in this group. These findings illustrated that metatarsal pain was primarily located on Meta2 and Meta3 in the different degrees of HV deformity. This information can provide the location to target for pain relief and help guide further rehabilitation.
Highlights
Hallux valgus (HV) is a common condition in females and consists of complex malposition of the first metatarsal (Meta) and lateral deviation of the great toe [1]. e prevalence rate of 12–33% is much high because of constrictive or high heel shoes popular among women [2]
With increasing severity in the degree of HV deformity, the phalanx slowly drifts into a valgus position and the metatarsal head escapes from the sesamoid platform [6]. e medial articular cartilage on the first metatarsal head loses the normal contact relation with the proximal phalanx and is no longer subjected to the normal pressure [6, 7]
It was shown that the contact time had the tendency of increase between Meta2–3 and the plantar foot in the gait of HV patients [25, 26]. erefore, these results indicate that pain on Meta2 and Meta3 is nearly universal, regardless of HV patient severity. is provides information to determine whether operation or physical therapy would best benefit the further treatment of a patient with HV
Summary
Hallux valgus (HV) is a common condition in females and consists of complex malposition of the first metatarsal (Meta) and lateral deviation of the great toe [1]. e prevalence rate of 12–33% is much high because of constrictive or high heel shoes popular among women [2]. Compression of the skin and subcutaneous tissues between the footwear and foot exacerbates the bunion [2] and forms a protrusion tuberosity on the medial first metatarsal head [3]. As a result, this condition seriously affects the gait and foot health of HV patient [3]. Forefoot pain in HV patients has been reported by previous studies [4, 5]. Contacting the ground with the forefoot for a long period of time will induce medial pain in the first metatarsophalangeal joint [4]. Toe spacer pads [8], rehabilitation
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