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Prospective gait analysis in patients with first metatarsophalangeal joint arthrodesis for hallux rigidus. Foot Ankle Int. 2007 Feb;28(2):162-5
Brodsky JW, Baum BS, Pollo FE, Mehta H
Quote:
BACKGROUND: Arthrodesis of the first metatarsophalangeal (MTP) joint is a common procedure with a proven long-term success rate. However, there is limited scientific information on its functional results. There is little data in the literature about changes in gait parameters after first MTP joint arthrodesis. The purpose of this study was to objectively evaluate the effects of first MTP joint arthrodesis on gait.
METHODS: Twenty-three patients with symptomatic hallux rigidus refractory to nonoperative treatment were treated with first MTP joint arthrodesis. A prospective gait analysis study was performed on all patients at an average of 8.6 days before surgery and then again at least 1 year postoperatively. Preoperative and postoperative data from the patients were compared to determine differences in clinically relevant temporal-spatial, kinematic, and kinetic parameters of gait.
RESULTS: There were three statistically significant changes in gait: increases in maximal ankle push-off power and single-limb support time on the involved extremity, and a decrease in step width.
CONCLUSIONS: First MTP joint arthrodesis produces objective improvement in propulsive power, weightbearing function of the foot, and stability during gait.
Re: Gait changes following surgery for hallux rigidus
Quantitative characterization of gait kinematics in patients with hallux rigidus using the milwaukee foot model.
Canseco K, Long J, Marks R, Khazzam M, Harris G. J Orthop Res. 2007 Oct 30; [Epub ahead of print]
Quote:
The purpose of this study was to provide a quantitative analysis of the changes that occur in the foot and ankle during the gait of patients with hallux rigidus. Using a 15-camera Vicon Motion Analysis System, gait analysis was conducted on a population of 22 patients with hallux rigidus and compared to that of 25 healthy ambulators. Weight-bearing radiographs were measured to index marker positions to underlying bony anatomy. The Milwaukee Foot Model was used to perform three-dimensional analysis of dynamic foot and ankle motion, and temporal-spatial parameters were also calculated. Values were compared to controls using unpaired parametric methods (Student t-test, p < 0.002). The hallux rigidus population showed significant alterations in gait patterns as compared to controls in various planes in all segments (hallux, forefoot, hindfoot, and tibia) of the foot and ankle, particularly in the range of motion of the hallux and the forefoot. Prolonged stance phase was also observed. As reports regarding the quantitative study of the multisegment foot and ankle are limited, this study was useful in providing characterization of gait patterns in patients with hallux rigidus.
There is limited objective scientific information on the functional
effects of cheilectomy. The purpose of this study was to test the
hypothesis that cheilectomy for hallux rigidus improves gait by
increasing ankle push-off power.
Methods: Seventeen patients with
symptomatic Stage 1 or Stage 2 hallux rigidus were studied. Pre- and
postoperative first metatarsophalangeal (MTP) range of motion and AOFAS
hallux scores were recorded. A gait analysis was performed within 4
weeks prior to surgery and repeated at a minimum of 1 year after
surgery. Gait analysis was done using a three-dimensional motion
capture system and a force platform embedded in a 10-m walkway. Gait
velocity sagittal plane ankle range of motion and peak sagittal plane
ankle push-off power were analyzed.
Results: Following cheilectomy,
significant increases were noted for first MTP range of motion and
AOFAS hallux score. First MTP motion improved an average of 16.7
degrees, from means of 33.9 degrees preoperatively to 50.6 degrees
postoperatively (p < 0.001). AOFAS hallux score increased from 62 to 81
(p < 0.007). As demonstrated through gait anaylsis, a significant
increase in postoperative peak sagittal plane ankle push-off power from
1.71 ± 0.92 W/kg to 2.05 ± 0.75 W/kg (p < 0.04).
Conclusion: In
addition to clinically increased range of motion and improved AOFAS
Hallux score, first MTP joint cheilectomy produced objective
improvement in gait, as measured by increased peak sagittal-plane ankle
push-off power.
Background: The correlation between angle of fusion of the first metatarsophalangeal (1MTTP) joint and pressures under metatarsal heads and hallux has not been well characterized. The main purpose was to investigate the correlation between fusion dorsiflexion angle of the 1MTTP joint and plantar pressures under the first metatarsal head and hallux during gait.
Methods: Patients who underwent arthrodesis of the 1MTTP joint from 2005 to 2010 were seen for a follow-up examination. Of 27 patients, 15 (22 feet) with a mean follow-up of 26.2 months were evaluated in the study. Main outcomes included the fusion clinical and radiological dorsiflexion angles and the mean and maximum dynamic plantar pressures under all 5 metatarsal heads and under the hallux. Plantar pressures were measured through an in-shoe system while patients walked normally along a corridor.
Results: The dorsiflexion angle was positively correlated with mean dynamic plantar pressures under the first metatarsal head: P = .02 (r = 0.5) for clinical angle, and P = .01 (r = 0.58) for radiological angle. Patients with 15 degrees or more of clinical dorsiflexion angle demonstrated higher mean dynamic plantar pressure under the first metatarsal head (P = .05) and higher maximum dynamic plantar pressure under the second metatarsal head (P = .04) compared with patients with less than 15 degrees. In contrast, the latter patients demonstrated higher mean dynamic plantar pressure beneath the hallux (P = .04). Patients with 30 degrees or more of radiological dorsiflexion angle demonstrated significantly higher mean dynamic plantar pressure under the first metatarsal head (P = .04) compared with patients with less than 30 degrees.
Conclusion: Higher dorsiflexion angles correlate with higher plantar pressures under the first metatarsal head. Lower dorsiflexion angles increase plantar pressures beneath the hallux during gait.
Clinical Relevance: Significant increase in plantar pressure under the first metatarsal head may be avoided by performing the arthrodesis of the 1MTTP joint below 30° and 15° for the radiological and clinical dorsiflexion angles, respectively.
Gait changes following surgery for hallux rigidus
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