| Objective:Through comparing the values of hallux valgusangle,intermetatarsal angle, activity of plantar wedge joint, and AOFAS score,between adolescent hallux valgus, adult hallux valgus and adolescent withnormal toe, to find the pathological characteristics of adolescent hallux valgus.According the rationale, We apply distal metatarsal osteotomy, osteotomy ofmetatarsal base, and arthrodesis of the plantar wedge to treat adolescent halluxvalgus patients with different pathological characteristics, observing thecurative effect in postoperative, to find the individualized and effectivetreatment of adolescent hallux valgus.MethodFrom June2005-June2010,60cases of adolescent hallux valgus (111feet) were treated.130cases of adolescent hallux valgus (57feet),30cases of adult halluxvalgus (56feet),30cases of adolescents with normal toe (60feet) wereselected randomly.Each foot take lateral and entopic radiograph, Surving thehallux valgus angle and intermetatarsal angle with graphometer, measuring theactivity of plantar wedge joint, acquire the AOFAS score according to TheAmerican Orthopaedic Foot and Ankle Society (AOFAS) score. Analysis ofvariance on all the values With SPSS13.230cases of adolescent patients were seleceted which the intermetatarsalangle is greater than15degrees, dividing them into two group randomly,group a15patients27feet, group b15patients28feet. Measuring the halluxvalgus angle, intermetatarsal. angle with graphometer, measuring the activityof plantar wedge joint and the AOFAS scores in preoperative. If there is nodifference between the two groups. Group a underwent metatarsal osteotomy,group b underwent metatarsal osteotomy and osteotomy of metatarsal base. Measuring the hallux valgus angle, the activity of plantar wedge joint,theAOFAS scores in postoperative follow-up.330cases of adolescent patients were seleceted whose activity of plantarwedge joint is abnomal, dividing them into two group randomly, group C15patients30feet, group D15patients26feet. Measuring the activity of plantarwedge joint., intermetatarsal. angle,the AOFAS scores in preoperative. Ifthere is no difference between the two groups.Group C underwent metatarsalosteotomy, group D underwent metatarsal osteotomy and arthrodesis of theplantar wedge. Measuring the hallux valgus angle, the activity of plantarwedge joint and the AOFAS scores in follow-up.Independent-samoles T test on all the values With SPSS13.Result1Angle of adolescent hallux valgus is39.39±1.16degrees,intermetatarsal angle is14.14±0.36degrees, activity of plantar wedge joint is21±0.36mm, AOFAS score is88.44±0.46; Angle of adult hallux valgus is35.43±0.99degrees, intermetatarsal angle is12.50±0.33degrees, activity ofplantar wedge joint is18.63±0.49mm, AOFAS score of70.41±0.90, Angleof adolescent with normal toe is5.73±0.33, intermetatarsal angle is3.8±0.22, metatarsal wedge joint activity is11.78±0.46mm, AOFAS score of100±0.2Preoperative:In group a, hallux valgus angle is39±1.5degrees,intermetatarsal angle is15.92±0.21degrees, activity of plantar wedge joint is22±0.28mm, AOFAS score is86.19±1.44degrees. In group b, hallux valgusangle is40.2±2.18degrees, intermetatarsal angle is15.89±0.44degrees,activity of plantar wedge joint is21.93±0.32mm, AOFAS score is87.89±1.12.Postoperative: In group a, hallux valgus angle is15±0.46degrees,intermetatarsal angle is15.92±0.21degrees, AOFAS score is86.19±1.44, Ingroup b hallux valgus angle is11.54±0.51degrees, intermetatarsal angle is9.75±0.59degrees, AOFAS score is96.96±0.95.3Preoperative: In group C hallux valgus angle is41.07±1.11degrees, intermetatarsal angle is15.13±0.42degrees, activity of plantar wedge joint is21.93±0.32mm, AOFAS score is85.8±1.2. In group D, hallux valgus angleis40.42±2.15degrees; intermetatarsal angle is15.50±0.51degrees, activityof plantar wedge joint is22±0.28mm, AOFAS score is87.11±1.1Postoperative: In group C hallux valgus angle is16.47±0.45degrees,intermetatarsal angle is15.13±0.42, AOFAS score is89.6±1.17, In group Dhallux valgus angle is12.46±0.51degrees, intermetatarsal angle is8.30±0.52degrees, AOFAS score is94.62±1.18.Having a statistical analysis on the hallux valgus, intemetatasal angle,activity of plantar wedge joint,the AOFAS score during all the groups.4.1The result of T test between adolescent hallux valgus, adult halluxvalgus,adolescent with normal toe: There is a significant difference betweenthe three groups in the hallux valgus angle, F is440.02, P <0.05, the pairwisecomparisons of three groups have a difference; There is a difference betweenthe three groups in the intemetatasal angle, F is342.22, P <0.05, the pairwisecomparisons of three groups have a difference; There is a difference betweenthe three groups in activity of plantar wedge joint F is116.397, P <0.05, thepairwise comparisons of three groups have adifference; There is a differencebetween the three groups in the AOFAS score F is685.53, P <0.05, thepairwise comparisons of three groups have a difference.4.2.1The result of T test between group a and group b in preoperative:There is no significant difference between group a and group b in halluxvalgus angle, t is-0.455, P=0.651; There is no significant difference betweengroup a and group b in intermetatarsal angle,t is0.067, p=0.947; There is nosignificant difference between group a and group b in activity of plantarwedge joint, t is0.168, P=0.867; There is no significant difference betweengroup a and group b in the AOFAS score t is-0.940, P=0.352.4.2.2The statistic result of T test between group a and group b inpostoperative: In hallux valgus angle group a is higher than group b, t is5.02,P <0.05; In intermetatarsal angle group a is higher than group b, t is9.56, P<0.05; In the AOFAS score group b is higher than group a,t is-6.296,P <0.05. 4.3.1The result of T test between group Cand group D in preoperative:In hallux valgus angle There is no significant difference between group C andgroup D, t is0.276, P=0.783; There is no significant difference betweengroup C and group D in intermetatarsal angle, t is-0.56, p=0.579; There isno significant difference between group C and group D in activity of plantarwedge joint, t is-0.156, P=0.876; There is no significant difference betweengroup C and group D in the AOFAS score t is0.781, P=0.438.4.3.2The result of T test between group a and group b in postoperative:In hallux valgus angle group a is higher than group b, t is5.88, P <0.05; Inintermetatarsal angle group a is higher than group b, t is10.32, P <0.05; In theAOFAS score group b is higher than group a,t is-3.00P <0.05.Conclusion1There is a statistic difference during adolescent hallux valgus, adulthallux valgus and adolescents with normal toe on the hallux valgus angle,intermetatarsal angle, activity of plantar wedge joint and the AOFAS score, theadolescent hallux valgus is higher than adult hallux valgus and adolescentswith normal toe in all of the index, but it is lower than adolescents withnormal toe in the AOFAS score.2There is a significant difference between group a and group b in theadolescent hallux valgus whose intermetatasal angle is greater than15degrees,in postoperative. The hallux valgus angle and intermetatasal angle ingroup b is lower than group a.but group b is higher than group a in theAOFAS score. Osteotomy of metatarsal base is proper for these patients.3There is a significant difference between group C and group D in theadolescent hallux valgus whose activity of plantar wedge joint is abnomal. Thehallux valgus angle and intermetatasal angle in group D is lower than group C,but group D is higher than group C in the AOFAS score. Arthrodesis of theplantar wedge is proper for these patients. |
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