No abstract

Mild hallux valgus (HV), which can lead to alteration of the plantar pressure pattern with an overpressure under the hallux, can be repaired percutaneously. Our goals were to determine whether the percutaneous distal soft tissue release (DSTR)-Akin procedure restores the loading pattern and to evaluate which are the determinants of the measures of post-operative outcome. Seventynine percutaneous DSTR-Akin procedures were performed in the same number of patients. The plantar pressure patterns were evaluated using the BioFoot/IBV 1 in-shoe system and compared with measurements from 98 controls. The clinical and radiological outcome parameters measured were the pre-and post-operative AOFAS scores, and the first intermetatarsal, hallux abductus, and first metatarsal-hallux declination angles (FIMA, HAA, FMHDA) in weight-bearing radiographs. The mean follow-up was 28.1 (range 24-33) months. The plantar pressure analysis showed a significant decrease (328-152 kPa, p ¼ 0.001) in the mean pressure under the hallux. Significant improvements occurred in the AOFAS scores, and angular deviations were reduced. The post-operative HAA correlated with the mean pressure under the 1st toe (r 2 ¼ 0.132, p < 0.001). The DSTR-Akin percutaneous technique in mild HV restores physiological patterns of pressure on the hallux and achieves significant correction of radiographic angles and commensurate improvement in clinical status. ß

Hallux valgus (HV) is a common, complex, and progressive deformity of the first ray, leading to biomechanical changes. The purpose of this study is to describe the midterm outcomes of the percutaneous distal soft tissue release-Akin procedure for mild hallux valgus on plantar pressures distribution, clinical outcome, and radiographic parameters. Twenty-six patients (30 feet) who had undergone this procedure were evaluated prospectively. The BioFoot in-shoe system was used for an objective functional evaluation of dynamic plantar pressures in the heel, midfoot, first through fifth metatarsal heads, hallux, and lesser toes. The clinical outcome measurements included preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score. The radiological parameters measured were hallux abductus angle (HAA) and first intermetatarsal angle in weight-bearing radiographs. The average follow-up was 12.1 months. There were improvements in the AOFAS rating scale score from 68.7 to 88.1, in HAA from 25.4 degrees to 11.4 degrees, and in the first intermetatarsal angle from 12.0 degrees to 9.2 degrees. The pedobarographic analysis showed a statistically significant decrease (P < .001) in the maximum peak pressure (from 1037 to 498 kPa) and mean pressure (from 487 to 159 kPa) under the hallux. The percutaneous distal soft tissue release-Akin procedure improved the patients' clinical status and reduced the plantar pressures beneath the hallux. This improvement could be attributable to the removal of the medial eminence, which avoids pain around the first metatarsophalangeal joint, and to the Akin procedure, which provides a more physiological postoperative position of the hallux.