Regular Shoes Research Articles

Immediate effect of orthopedic shoe and functional foot orthosis on center of pressure displacement and gait parameters in juvenile flexible flat foot

Flat foot in children is a common deformity in which the medial longitudinal arch is reduced or eliminated. The objective of this article was to compare flat foot and healthy children on the displacement of the center of pressure and walking parameters in children with two common orthoses (functional foot orthosis and medical shoe). Comparative study. This study included 30 children with flat foot and 20 healthy children as a control group. The step length and width, walking velocity, symmetry, and center of pressure (CoP) displacements were recorded and compared for three conditions: functional foot orthosis and regular shoe, a medical shoe and barefoot. The results from the CoP displacements showed that the regular shoe with functional foot orthosis caused a significant decrease in the level of displacement of the CoP in flat foot children. The findings indicated a significant improvement in symmetry of steps and walking speed with the functional foot orthosis in comparison to the medical shoe in flat foot children. The CoP displacement was decreased and the percentage of gait symmetry and walking speed were increased by the use of regular shoes with a functional foot orthosis in comparison to the medical shoes. An orthopaedic shoe can be expensive, and in particular heavy with most children reluctant to wear it. This study focussed on the CoP displacement and selected gait parameters with an orthopaedic shoe and functional foot orthosis, and showed that a combined prescription of a functional foot orthosis and with regular shoes may be a useful alternative for children with moderate flat foot.

Early Weightbearing Using Achilles Suture Bridge Technique for Insertional Achilles Tendinosis: A Review of 43 Patients

Posterior heel pain caused by insertional Achilles tendinosis can necessitate surgical intervention when recalcitrant to conservative care. Surgical treatment can necessitate near complete detachment of the Achilles tendon to fully eradicate the offending pathologic features and, consequently, result in long periods of non-weightbearing. A suture bridge technique using bone anchors is available for reattachment of the Achilles tendon. This provides restoration of the Achilles footprint on the calcaneus, including not only contact, but also actual pressure between the tendon and bone. We performed a review of 43 patients who underwent surgical treatment of insertional Achilles tendinosis with reattachment of the Achilles tendon using the suture bridge technique. The mean age was 53 (range 29 to 87) years. The mean follow-up period was 24 (range 13 to 52) months. The mean postoperative American Orthopaedic Foot and Ankle Society score was 90 (range 65 to 100). The mean preoperative visual analog scale pain score was 6.8 (range 2 to 10) and the mean postoperative visual analog scale pain score was 1.3 (range 0 to 6). The mean interval to weightbearing was 10 (range 0 to 28) days. No postoperative ruptures occurred. Of the 43 patients, 42 (97.6%) successfully performed the single heel rise test at the final postoperative visit. Concomitant procedures were performed in 35 patients, including 33 (77%) requiring open gastrocnemius recession and 2 (5%) requiring flexor hallucis longus tendon transfer. A total of 42 patients (97.6%) returned to regular shoe gear, and 42 (97.6%) returned to their activities of daily living, including running for 20 athletic patients (100%). Complications included postoperative wound dehiscense requiring surgical debridement in 2 patients (5%) and soft tissue infection requiring antibiotics and surgical debridement in 1 (2%) patient. Our findings support using the Achilles tendon suture bridge for reattachment of the Achilles tendon in the surgical treatment of insertional Achilles tendinosis.

The Impact of Footwear and Walking Distance on Gait Stability in Diabetic Patients with Peripheral Neuropathy

We explored gait differences in patients with diabetes and peripheral neuropathy (DPN) and aged-matched controls over short and long walking distances. The potential benefit of footwear for improving gait in patients with DPN was also explored. Twelve patients with DPN and eight controls walked at their habitual speed over short (7 m) and long (20 m) distances under two conditions: barefoot and regular shoes. A validated system of body-worn sensors was used to extract spatiotemporal gait parameters. Neuropathy severity was quantified using vibratory perception threshold measured at the great toe. Gait deterioration in the DPN group was observed during all of the walking trials. However, the difference between patients with DPN and participants in the control group achieved statistical significance only during long walking distance trials. Shod and barefoot double support times were longer in the DPN group during long walking distances (>20%, P = .03). Gait unsteadiness, defined as coefficient of variation of gait velocity, was also significantly higher in the DPN group when barefoot walking over long distances (83%, P = .008). Furthermore, there was a high correlation between neuropathy severity and gait unsteadiness best demonstrated during the barefoot walking/long walking distance condition (r = 0.77, P < .001). The addition of footwear improved gait steadiness in the DPN group by 46% (P = .02). All differences were independent of age, sex, and body mass index (P > .05). This study suggests that gait alteration in patients with DPN is most pronounced while walking barefoot over longer distances and that footwear may improve gait steadiness in patients with DPN.

Effects of toning shoes on lower extremity gait biomechanics

BackgroundThe Reebok Easy Tone shoe concept was developed to induce instability during walking and standing with the primary purpose of increasing muscle activity of the lower extremity muscles. To the authors' knowledge, no scientific work has been published, which analyzed neuromuscular and biomechanical effects when walking and standing with Reebok Easy Tone shoes. Therefore, the purpose of this study was to investigate the immediate effects of using such footwear on gait biomechanics for the lower extremity in healthy participants. MethodsFive healthy female and seven healthy male participants volunteered to participate in this study. During quiet standing, centre of pressure excursion was determined. 3D gait analyses were performed with simultaneously collecting surface electromyography data of the leg muscles when walking with regular shoes and with Reebok Easy Tone shoes. FindingsCentre of pressure excursion did not show any significant differences. For walking, only slight differences were found in kinematics and kinetics. When walking with Reebok Easy Tone shoes, the first vertical peak of the ground reaction force was significantly increased as well as the maximum plantarflexion moment during initial contact and loading response. Mean muscle activation for vastus medialis and lateralis showed an increase during the second half of stance, but failed to reach significance. InterpretationResults of this study did not show any increased instability during standing and only a slight increase of vastii activity during stance. Thus, the marketing claims that “toning shoes” could serve as a sort of training devices for lower limb muscles during walking, cannot be supported.

Running in a minimalist and lightweight shoe is not the same as running barefoot: a biomechanical study

AimThe purpose of this study was to determine the changes in running mechanics that occur when highly trained runners run barefoot and in a minimalist shoe, and specifically if running...

Evaluation of lower limb electromyographic activity when using unstable shoes for the first time

Unstable shoes, which have recently become popular, claim to provide additional physiological and biomechanical advantages to people who wear them. Alterations in postural stability have been shown when using the shoe after training. However, the immediate effect on muscle activity when walking in unstable shoes for the first time has not been investigated. To evaluate muscle activity and temporal parameters of gait when wearing Masai Barefoot Technology shoes(®) for the first time compared to the subject's own regular trainer shoes. A pilot repeated-measures quasi control trial. Electromyographic measurements of lower leg muscles (soleus, medial gastrocnemius, lateral gastrocnemius, tibialis anterior, peroneus longus, rectus femoris, biceps femoris and gluteus medius) were measured in 15 healthy participants using Masai Barefoot Technology shoes and trainer shoes over a 10-m walkway. Muscle activity of the third and sixth steps was used to study the difference in behaviour of the muscles under the two shoe conditions. Temporal parameters were captured with footswitches to highlight heel strike, heel lift and toe off. Paired samples t-test was completed to compare mean muscle activity for Masai Barefoot Technology and trainer shoes. Indicated that the use of Masai Barefoot Technology shoes increased the intensity of the magnitude of muscle activity. While this increase in the activity was not significant across the subjects, there were inter-individual differences in muscle activity. This variance between the participants demonstrates that some subjects do alter muscle behaviour while wearing such shoes. A more rigorous and specific assessment is required when advising patients to purchase the Masai Barefoot Technology shoe. Not all subjects respond positively to using unstable shoes, and the point in time when muscle behaviour can change is variable. Use of Masai Barefoot Technology shoe in patient management should be monitored closely as the individual muscle changes and the point in time when changes occur vary between subjects, and evaluation of how a subject responds is not yet clear.

Treatment Results of Late-relapsing Idiopathic Clubfoot Previously Treated With the Ponseti Method

Idiopathic clubfoot has a stubborn tendency for relapse, with most relapses happening within the first few years. However, a few patients relapse later, adding to the complexity of management. This study investigates the treatment results of relapsing clubfoot deformity after age 4. Thirty-nine patients (60 feet) met the inclusion criteria. Age at initial treatment, previous treatment, number of casts and tenotomies, length of bracewear, and relapse presentation were recorded. Treatment of late relapse followed 1 of the 5 courses: (1) observation only (4 feet); (2) bracing (26 feet); (3) casting followed by bracing (7 feet); (4) casting followed by tibialis anterior tendon transfer (TATT) with or without open tendo Achilles lengthening (TAL) (8 feet); or (5) primary TATT±TAL (15 feet). Of the 37 feet treated initially with observation, bracing, or casting, 33 went on to have TATT (89%). Multiple other concurrent procedures were performed according to the specific deformities. These included plantar fasciotomy (6 feet), extensor hallicus longus recession (5 feet), limited posterior release 5 feet, and others (3 feet). Five feet underwent revision surgery after TATT, 2 of which ended in triple arthrodeses. Average age at final follow-up was 23.3 years (range, 8.5 to 50.6 y). Ninety percent of patients wore regular shoes, 41% had pain with activities, but only 18% were limited in function by their feet. Average ankle dorsiflexion was 6 degrees (range, -15 to 25 degrees). Mild residual deformities were noted in 55% of feet. This challenging group of patients with apparently persistent deforming biology achieves acceptable results with individualized evaluation and treatment of their foot deformities. Therapeutic level IV.

Effect of a rocker non-heeled shoe on EMG and ground reaction forces during gait without previous training

Unstable shoes have been designed to promote “natural instability” and during walking they should simulate barefoot gait, enhancing muscle activity and, thus, attributing an advantage over regular tennis shoes. Recent studies showed that, after special training on the appropriate walking pattern, the use of the Masai Barefoot Technology (MBT) shoe increases muscle activation during walking. Our study presents a comparison of muscle activity as well as horizontal and vertical forces during gait with the MBT, a standard tennis shoe and barefoot walking of healthy individuals without previous training. These variables were compared in 25 female subjects and gait conditions were compared using ANOVA repeated measures (effect size:0.25). Walking with the MBT shoe in this non-instructed condition produced higher vertical forces (first vertical peak and weight acceptance rate) than walking with a standard shoe or walking barefoot, which suggests an increase in the loads received by the musculoskeletal system, especially at heel strike. Walking with the MBT shoe did not increase muscle activity when compared to walking with the standard shoe. The barefoot condition was more effective than the MBT shoe at enhancing muscle activation. Therefore, in healthy individuals, no advantage was found in using the MBT over a standard tennis shoe without a special training period. Further studies using the MBT without any instruction over a longer period are needed to evaluate if the higher loads observed in the present study would return to their baseline values after a period of adaptation, and if the muscle activity would increase over time.

Chondroblastoma in a Metatarsal Treated with Autogenous Fibular Graft: A Case Report

Chondroblastoma is a relatively rare tumor that mimics giant cell tumor and displays a predilection for long bones. In the present report, we describe the case of a benign chondroblastoma localized to the second metatarsal in a 20-year-old male who presented with a 2-year history of painless left foot swelling. Treatment of the tumor involved excision of the second metatarsal with use of an autologous structural fibular bone graft to stabilize the metatarsus and second toe. After 27 months of follow-up, the patient was ambulating well in regular shoes, with no clinical or radiographic evidence of tumor recurrence.

Modified track shoes and their effect on the EMG activity of calf muscles

Although track and field spike shoes are crafted for runners, these shoes are not designed for regular walking. With such shoes, runners may eventually encounter serious chronic injuries such as plantar fasciitis, shin splints, achilles tendinitis, chondromalacia, and iliotibial band syndrome. To address this problem, a modified spike shoe was tested and compared to a regular spike shoe. The modification consists of adding a removable heel to the shoe sole in order to reduce the flexion of the foot and properly level the foot for walking. Nine healthy participants performed walking drills at 2 and 3 mph, using the original and the modified shoes. Electromyography (EMG) measurements were used to evaluate muscle activities. Participants also rated their discomfort on a 0-10 scale. Results show that the use of modified shoes resulted in a reduction of 22% and 24.25% EMG activity for the tibialis and gastrocnemius muscles, respectively. Comfort ratings increased by an average of 2.7, 2.6, 3.9, and 4.2 points at the knees, calves, ankles, and feet, respectively.

Surgical Technique: Medial Column Arthrodesis in Rigid Spastic Planovalgus Feet

Treatment of spastic planovalgus feet is challenging, especially in patients with severe and rigid deformities. The available techniques do provide some correction but not at the site of the deformity and sometimes the correction is lost over time. We describe a new surgical approach at the site of the deformity. Indications for the surgery included adolescents or young adults with severe and rigid planovalgus deformities of the feet resulting from cerebral palsy. Through a medial approach, arthrodesis of the talonavicular, navicular-medial cuneiform, and medial cuneiform first metatarsal joints was internally fixed using a single-molded plate over the plantar surface of the foot, recreating the longitudinal arch. We retrospectively reviewed 21 patients (35 feet) with spastic cerebral palsy in whom the new technique was indicated for severe and rigid deformity, gait dysfunction, and pain (mean age, 190 months; range, 96-345 months). The mean age of the patients was 16 years (range, 8-29 years). We analyzed the patients clinically and radiographically. The minimum followup was 2.5 years (mean, 58 months; range, 2.5-7.5 years). At last followup, 34 of the 35 feet (97%) had radiographic improvement of the deformity with no difficulties wearing shoes; one patient had persistent pain despite bone union. Union was achieved initially in eight patients (17 feet) and in another eight (10 feet) after revision surgery, of 27 of the 35 feet. The radiographic calcaneal inclination angle improved an average of 13°. The lateral talocalcaneal angle decreased from a mean of 43° to 26° after surgery. Four patients (five feet) had revision surgery for pseudoarthrosis, and another four patients (five feet) had revision surgery for other problems. Based on our preliminary observations, we believe stabilization of the medial column is a reasonable option for treating selected patients with severe and rigid planovalgus feet by providing a stable and pain-free foot, recreating the anatomy, and allowing the use of braces or regular shoes. Further studies with longer followup periods will be required to confirm these initial results and to verify if these findings persist over time. Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Longitudinal Tears of Peroneus Longus and Brevis Tendons: A Gouty Infiltration

The natural history of recurrent uric acid deposition includes joint destruction, as well as tendon weakening and rupture. Simultaneous rupture of the peroneus longus and brevis tendons secondary to tophaceous gout is very rare. In the present report, we describe the case of a 37-year-old man who had a history of recurrent ankle pain and 4 previous episodes of acute gout localized to his ipsilateral first metatarsophalangeal joint. The physical examination revealed the ankle pain to actually be localized to the peroneal tendons immediately distal to the fibular malleolar groove. Magnetic resonance imaging showed longitudinal tears in the peroneus longus and brevis. Surgical exploration and repair of the ruptured tendons revealed the presence of monosodium urate deposition within the substance of the tendons at the rupture sites. The tendons were debrided and repaired using longus to brevis tenodesis. The postoperative course was unremarkable and entailed referral to a rheumatologist for metabolic management. After more than a 1-year period of follow-up, the patient was ambulating without difficulties wearing regular shoe gear.

Skecher Shape-ups Do Not Increase the Metabolic Cost of Walking

BACKGROUND: Skecher Shape-Ups (SSU) are advertised as an enhancer of the effect of physical activity (i.e., metabolic cost) and therefore increase the efficiency of time spent ambulating. PURPOSE: To determine if wearing SSU increases the metabolic cost of walking. Furthermore, we sought to determine if weight differences between shod conditions accounted for any metabolic changes. METHODS: Twenty-eight subjects (17 females, 11 males; age = 22.8 ± 6.6 y; mass = 72.4 ± 20.2 kg; height = 170.0 ± 6.7 cm; % fat = 23.0 ± 11.7 %) walked on a treadmill (0% grade) at a self-selected speed plus 10% (76.1 ± 11.8 m·min-1) in each of the following lab-provided shoes: SSU, walking regular shoe (W), and walking in regular shoe plus the difference between SSU and W shoe mass (WM). There was about 2-5 minutes rest between randomized conditions for subjects to change shoes and/or have weight added to the shoe. Accumulated breath-by-breath VO2 was measured for 10 minutes during each condition (ORCA Cardiopulmonary System, Santa Barbara, CA). VO2 mode was determined from 10 minutes of data for each condition and a repeated-measures ANOVA was used to compareVO2 mode among shod conditions (p < 0.05). RESULTS: There was no significant difference in VO2 among walking shoe conditions (9.9 ± 3.1, 9.8 ± 3.4, & 10.2 ± 3.0 mlO2·kg-1·min-1 for SSU, W, & WM, respectively; p = 0.068). CONCLUSION: SSU and WM did not increase the metabolic cost of exercise (VO2) for healthy, young subjects walking slightly faster than a preferred speed. It seems that there is no additional caloric benefit of wearing SSU beyond the typical walking shoe.

Minimal Invasive Percutaneous Bipolar Radiofrequency for Plantar Fasciotomy: A Retrospective Study

The purpose of this study was to present the results of a relatively new, minimally invasive surgical technique for the treatment of chronic plantar fasciitis in 14 patients, 2 of whom underwent the treatment bilaterally one foot at time on separate occasions. This was a retrospective, multicenter, nonrandomized study. All of the patients had failed conservative therapy and had symptoms for at least 6 months. The mean follow-up duration was 15.25 months (range, 6–33 months). The postoperative mean American Orthopaedic Foot & Ankle Society hindfoot score was 82.06 (range, 56–100). None of the patients developed complex regional pain syndrome, and all but 2 (14.29% of patients, 12.5% of feet) of the patients were able to return to regular shoe gear by 2–4 weeks postoperative, and only 1 (7.14% of patients, 6.25% of feet) patient was considered a treatment failure. Based on our experience with minimally invasive percutaneous bipolar radiofrequency plantar fasciotomy, we believe the technique to be a relatively easy intervention that is effective and requires less healing time in comparison with traditional open surgical procedures.

The Reconstruction of Foot Soft Tissue Defects by Tangential Debulking of the Latissimus Dorsi Flap

Reconstruction of foot soft tissue is challenging particularly in the presence of a large defect involving both dorsal and plantar surfaces. In large defects, use of a latissimus dorsi muscle (LDM) flap is the preferred coverage method, yet LDM flaps are bulky. Despite undergoing multiple debulking procedures, patients whose feet are repaired with LDM flaps must wear oversized custom-made shoes. We developed an approach to allow patients to wear regular shoes. In six patients, we used a debulking procedure that was based on tangential trimming of the flap to the level of thickness required for normal foot contour. All patients underwent debulking 3 months after initial LDM flap coverage. The mean duration of follow-up care was 21 months (range, 8 to 32 months). All flaps survived a secondary debulking procedure. One patient developed an ulcer at the weight-bearing area of a sole. All six patients were able to wear regular shoes without difficulty.

A Proof-of-Concept Study for Measuring Gait Speed, Steadiness, and Dynamic Balance Under Various Footwear Conditions Outside of the Gait Laboratory

This pilot study examined the effect of custom and prefabricated foot orthoses on self-selected walking speed, walking speed variability, and dynamic balance in the mediolateral direction. The gait of four healthy participants was analyzed with a body-worn sensor system across a distance of at least 30 m outside of the gait laboratory. Participants walked at their habitual speed in four conditions: barefoot, regular shoes, prefabricated foot orthoses, and custom foot orthoses. In the custom foot orthoses condition, gait speed was improved on average 13.5% over the barefoot condition and 9.8% over the regular shoe condition. The mediolateral range of motion of center of mass was reduced 55% and 56% compared with the shoes alone and prefabricated foot orthoses conditions, respectively. This may suggest better gait efficiency and lower energy cost with custom foot orthoses. This tendency remained after normalizing center of mass by gait speed, suggesting that irrespective of gait speed, custom foot orthoses improve center of mass motion in the mediolateral direction compared with other footwear conditions. Gait intercycle variability, measured by intercycle coefficient of variation of gait speed, was decreased on average by 25% and 19% compared with the barefoot and shoes-alone conditions, respectively. The decrease in gait unsteadiness after wearing custom foot orthoses may suggest improved proprioception from the increased contact area of custom foot orthoses versus the barefoot condition. These findings may open new avenues for objective assessment of the impact of prescribed footwear on dynamic balance and spatiotemporal parameters of gait and assess gait adaptation after use of custom foot orthoses.

Immediate Ambulation after a First Metatarsophalangeal Joint Fusion using a Locking Plate: Technique and case reports

Purpose: Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a predictable procedure to relieve pain and dysfunction of the first MTPJ. Many fixation techniques have been described. The authors present two cases in which a locking plate was successfully used for first MTPJ fusion. The patients began immediate weight-bearing post-operatively without a delay in union, hardware failure, or malalignment. Methods: A retrospective chart and radiographic review of a 53 year-old male and a 59 year-old female was performed. Serial radiograph was taken to assess fusion at the arthrodesis site. Procedures: Cartilage was resected from the head of the first metatarsal and base of the proximal phalanx preserving the curvature of the joint. The joint was placed in the desired position and interfragmental compression was obtained using a cannulated 4.0-millimeter partially threaded screw from proximal medial to distal lateral with all threads crossed the fusion site. A locking plate was then placed on the dorsal aspect of the joint and secured with locking screws proximal and distal. Results: The patients began ambulating immediately post-operatively with a post-operative shoe. Both patients had successful fusion by 8 weeks with good alignment and intact fixation. Patients returned to regular shoe gear once trabeculation was noted. Conclusion: These 2 case reports suggest excellent results and immediate ambulation with compression screws and locking plates. This clinical report shows promise in regards to early ambulation using locking plate fixation technique and further studies are encouraged.

10-metre Shuttle Run Test

The 10-metre shuttle run test is an adapted version of the 20-metre shuttle run test to accommodate children with cerebral palsy (CP) classified at Level I or Level II on the Gross Motor Function Classification System (GMFCS) (Verschuren et al 2006). Separate protocols were designed for each level (SRT-1 and SRT-2). The course is 10 metres long; the end is marked with 2 cones and measuring tape. Subjects should wear regular sports clothing and shoes, and orthoses, if applicable. Each child should also wear a heart rate monitor. Children walk or run between the 2 markers at a set incremental speed. These runs are synchronised with a pre-recorded CD, which plays beeps at set intervals. As the test proceeds, the interval between each successive beep reduces, forcing the child to increase speed over the course of the test, until it is impossible to keep in sync with the recording. There are 2 protocols available for the shuttle run test. The Level I shuttle run test (SRT-I) is for children classified at GMFCS Level 1 (ie, able to walk indoors and outdoors without restrictions). The SRT-I starts at 5 km/h.

The management of Charcot joint disease affecting the ankle and foot by arthrodesis controlled by an Ilizarov frame

Charcot osteoarthropathy of the foot is a chronic and progressive disease of bone and joint associated with a risk of amputation. The main problems encountered in this process are osteopenia, fragmentation of the bones of the foot and ankle, joint subluxation or even dislocation, ulceration of the skin and the development of deep sepsis. We report our experience of a series of 20 patients with Charcot osteoarthropathy of the foot and ankle treated with an Ilizarov external fixator. The mean age of the group was 30 years (21 to 50). Diabetes mellitus was the underlying cause in 18 patients. Five had chronic ulcers involving the foot and ankle. Each patient had an open lengthening of the tendo Achillis with excision of all necrotic and loose bone from the ankle, subtalar and midtarsal joints when needed. The resulting defect was packed with corticocancellous bone graft harvested from the iliac crest and an Ilizarov external fixator was applied. Arthrodesis was achieved after a mean of 18 weeks (15 to 20), with healing of the skin ulcers. Pin track infection was not uncommon, but no frame had to be removed before the arthrodesis was sound. Every patient was able to resume wearing regular shoes after a mean of 26.5 weeks (20 to 45).

No Midterm Benefit from Low Intensity Pulsed Ultrasound after Chevron Osteotomy for Hallux Valgus

Chevron osteotomy is a widely accepted method for correction of symptomatic hallux valgus deformity. Full weight bearing in regular shoes is not recommended before 6 weeks after surgery. Low intensity pulsed ultrasound is known to stimulate bone formation leading to more stable callus and faster bony fusion. We performed a randomized, placebo-controlled, double-blinded study on 44 participants (52 feet) who underwent chevron osteotomy to evaluate the influence of daily transcutaneous low intensity pulsed ultrasound (LIPUS) treatment at the site of osteotomy. Follow-up at 6 weeks and 1 year included plain dorsoplantar radiographs, hallux-metatarsophalangeal-interphalangeal scale and a questionnaire on patient satisfaction. There was no statistical difference in any pre- or postoperative clinical features, patient satisfaction or radiographic measurements (hallux valgus angle, intermetatarsal angle, sesamoid index and metatarsal index) except for the first distal metatarsal articular angle (DMAA). The DMAA showed statistically significant ( p = 0.046) relapse in the placebo group upon comparison of intraoperative radiographs after correction and fixation (5.2 degrees) and at the 6-week follow-up (10.6 degrees). Despite potential impact of LIPUS on bone formation, we found no evidence of an influence on outcome 6 weeks and 1 year after chevron osteotomy for correction of hallux valgus deformity. (E-mail: max_zacherl@hotmail.com)