Hallux Valgus Plantar Pressure Distribution Before and After Surgery

Abstract

Hallux valgus is a common foot deformity that may cause pain and functional limitation, and often requires surgical correction. Clinical and radiographic parameters are typically used to assess postoperative outcomes. Plantar pressure distribution systems represent an innovative additional tool to evaluate hallux functional outcome after surgery. A systematic review of the current literature was performed to assess evaluation systems used for plantar pressure analysis and differences before and after hallux valgus surgery, and a possible relationship between different surgical techniques and clinical and radiographic results. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for this review. Initial search results yielded 40 studies. Two additional studies were found through cross-reference. Twenty-five studies were screened. A total of 10 articles were included in the review process. Two main plantar pressure analysis systems were identified. Hallux function restoration based on plantar pressure measurement did not always occur. No relevant relationships between plantar pressure distribution data and different surgical techniques were established. All patients achieved satisfactory clinical and radiographic outcomes, regardless of surgical techniques used; however, no clear relationships were observed between clinical and radiographic results and the change in foot plantar pressure patterns. The current literature on this topic showed several methodologic limitations. Therefore, it is not possible to provide sufficiently supported evidence-based data regarding plantar pressure distribution rebalance after surgery using current plantar pressure analysis systems. Further investigations are needed to fill these gaps in evidence.

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

“…Although several studies were conducted on the plantar pressure distribution in relation to HV surgery, poor evidence regarding the rebalancing of plantar pressure distribution after surgery is reported by the current literature [ 36 ].…”

“…However, the increased peak pressure under the central metatarsal area, regardless of the good clinical and radiographic results, remains challenging to interpret. A recent review [ 36 ] showed no clear relationships between clinical and radiographic results and changes in foot plantar pressure patterns. It can be hypothesized that plantar pressure measurement is a more sensitive method for assessing surgical efficacy, potentially predicting any recurrence and residual pain in the long term, or it could be a method influenced by the follow-up time, whereby the expectation is a progressive reduction in the pressure distribution under the central metatarsal area.…”

“…Therefore, while the loss of three patients at follow-up may pose a challenge in interpreting the results of a study with a small sample size, there are circumstances in which this loss may not be statistically significant, as in the present case, when the results were preliminary or the lost patients did not exhibit unique characteristics compared with the other participants. Although the mean follow-up duration was limited to 12 months, this time frame was deemed adequate by previous studies to achieve a stable rebalancing of plantar pressure following surgery [ 36 ]. A major limitation at present is the lack of standardization of these tools, particularly with regard to data extraction and the subsequent comparison between scientific studies.…”