Hallux Valgus Plantar Pressure Distribution before and after a Distal Metatarsal Osteotomy

Abstract

Background: Hallux valgus (HV) morphological alterations impact forefoot kinetics. Surgery aims to restore both the morphology and function. Plantar pressure (PP) distribution systems represent an innovative additional tool to evaluate the hallux functional outcome after surgery in order to assess the hallux dorsiflexion, coupled with plantar flexion of the first ray. However, the literature reports limited evidence regarding the rebalancing of the plantar pressure distribution following surgery. The purpose of the present study was to examine the PP distribution in HV patients before and after a distal metatarsal osteotomy using a novel anatomically based protocol for in-shoe plantar load analysis during gait. Methods: A consecutive series of 18 patients with mild-to-moderate symptomatic HV who underwent a distal metatarsal osteotomy (S.E.R.I. technique) were prospectively evaluated using clinical scores (AOFAS and NRS), radiographic parameters (hallux valgus angle, intermetatarsal angle), and PP measurements via W-INSHOE© (Medicapteurs, Balma, France). Data were collected preoperatively and 12 months after surgery. Results: At 12 months follow-up, 3 patients were lost to follow-up, leaving 15 patients (24 HV) for examination. Both clinical and radiographical outcomes showed significant improvements from the pre- to postoperative periods. The PP distribution pattern revealed a significant increase in the peak pressure under the first metatarsal head associated with a significant increase in the peak pressure under the central metatarsals area between the pre- and postoperative periods. Conclusions: PP measurement systems hold promise as an additional clinical tool, yet current findings remain inconclusive. Further long-term follow-up studies that incorporate additional parameters are warranted.

Minimally Invasive Chevron Akin (MICA) Osteotomy Corrects Radiographic Parameters but Not Central Metatarsal Loading in Moderate to Severe Hallux Valgus without Metatarsalgia

“…Pedographic changes after different distal metatarsal osteotomy techniques, but not MICA, in HV patients have been reported in the literature [11][12][13][14][15][16][17] (Table 7). Although good radiographic and clinical outcomes were consistently reported [11][12][13][14][15][16][17], the pedographic results varied, indicating increased [11][12][13][14][15], unchanged [16,17], or decreased [17] plantar loading on central metatarsals.…”

“…Pedographic changes after different distal metatarsal osteotomy techniques, but not MICA, in HV patients have been reported in the literature [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ] ( Table 7 ). Although good radiographic and clinical outcomes were consistently reported [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ], the pedographic results varied, indicating increased [ 11 , 12 , 13 , 14 , 15 ], unchanged [ 16 , 17 ], or decreased [ 17 ] plantar loading on central metatarsals. Cancilleri et al [ 17 ] reported the only series of reduced central metatarsal loading following a distal metatarsal osteotomy for HV.…”

“…The consensus on pedographs related to HV feet is limited. Various studies have reported conflicting findings on the pedographs of HV-affected feet [ 8 , 9 , 10 ] as well as the pedographic changes after HV correction [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. While the only consensus when comparing the pedographs of HV-affected feet to healthy feet may be the increased central metatarsal loads [ 8 , 9 , 10 ], the pedographic outcomes after HV correction by different techniques are diverse and inconclusive for each foot region [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

“…The discrepancy in results may be due to the variations in patient groups across studies [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ], as HV encompasses a broad spectrum of severity and related comorbidities [ 1 ]. Metatarsalgia is a symptom that is often related to HV [ 1 ].…”

“…Metatarsalgia is a symptom that is often related to HV [ 1 ]. Although previous studies have suggested that the pedographs differ between HV patients with and without metatarsalgia [ 18 ], most of the related pedographic studies did not clarify their patient inclusion regarding metatarsalgia [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”