OUTCOME OF HALLUX VALGUS CORRECTION: A PROSPECTIVE CLINICAL AND RADIOGRAPHIC STUDY WITH FOOT PRESSURE MEASUREMENT

Abstract

Introduction: Hallux valgus is a common presentation at the elective orthopaedic clinics. Patients complain of pain and deformity of the big toe. Treatment is aimed at improving the cosmesis and alleviating pain in the fore foot.

This study assesses the pre and post-operative pedal pressures during stance phase of dynamic gait cycle to identify objective biomechanical factors which influence the final outcome.

Materials and Methods: This is a prospective study, approved by the local research and ethics committee, in which 17 feet were assessed with moderate to severe hallux valgus. Distal-L and Scarf osteotomies were performed for moderate and severe deformities, respectively.

Pedobarography was performed before and 8 months after surgery, on an average. Sole was divided into eight segments i.e. heel, midfoot, lateral forefoot, central forefoot, medial forefoot, II–V toes, hallux and total sole area. Variables compared were contact area, peak pressure, mean pressure and contact time. Manchester-Oxford foot questionnaire (MOXFQ) was used to assess the clinical disability. The inter-metatarsal and metatarso-phalengeal angles were measured radiographically. Both clinical and radiological assessments were performed pre and post-operatively.

Results: 11 had distal-L and 6 had Scarf osteotomies. There were significant improvements in all the three domains of the subjective MOXFQ questionnaire i.e. walking/standing (p 0.013), pain (p 0.001) and social limitation (p 0.002).

The inter-metatarsal angle reduced from 15 to 7 (p 0.001) and the metatarso-phalengeal angle reduced from 32 to 9 (p 0.001).

There was significant reduction in heel contact area (p 0.002), the medial forefoot (p 0.030) and II – V toes (p 0.048) contact time.

Conclusion: Both distal-L and Scarf osteotomies resulted in significant improvements in clinical and radiographic outcome. Although there was reduction in heel contact area and medial forefoot contact time, there were no significant changes in pedal pressures at 8 months postoperatively.