Correlative Analysis On Pain And Pressure Under The Second Metatarsal Head With The Weight-bearing X-ray Indexes Of Hallux Valgus

1BackgroundHallux valgus deformity is a common disease, frequently occurring disease in the foot. Hallux valgus deformity is closely related with the wear of high heels, so the number of female patients is on the rise, but the occurrence of the disease also has an obvious genetic tendency. The main symptoms are toe lateral tilt, the first metatarsus varus hallux metatarsophalangeal joint, medial and plantar pain, and this pain become worsening when you are walking. Its common complications include the Hallux bursitis, the painful callus under the metatarsal head (especially in the second metatarsal head), mallet toes. The disease can be complicated by plantar toe arthritis, stiff thumb, and the first and second plantar toe joint dislocation. The main pathology of hallux valgus includes extrophy and pronation of great toe. Thumb long stretch, flexor tendon have changed in the biological mechanics because of extrophy and pronation of great toe, playing the role of the bowstring in the gait of the great toe propulsion so as to make the first metatarsal head entropion and increase the angle between1,2metatarsal. Pronation of the first metatarsal, relative out-shifting of the sesamoids and as well the pull of the first medial metatarsophalangeal joint capsule broke the balance of thumb adductor and thumb abductor muscle, following the front horizontal arch collapse lead to the pain and callus under the second and third metatarsal head. It is reported that, the laxity of the first tarsometatarsal joint can lead to the uplifting and pronation of the first metatarsal also make the pressure center of front plantar outward migration and the pain and callus under the second and third metatarsal head.The second metatarsal head is more likely to be affected in the procedure of outward migration of the front plantar pressure center because of the idiosyncrasy of the second metatarsal Physiological anatomy:①the majority of people’s the second metatarsal is longer than the other four;②inlaying in wedge bone between1and3, the second metatarsal is more stable than other four, this make itself more susceptible to greater stress in the gait and lead to the pain under the second metatarsal head. X-ray measurement is one of the most important basis for the diagnosis and evaluation of the hallux valgus deformity. X-ray measurement indexes under non-weight bearing are not able to reflect the stable of the foot that soft tissue play on. When the soft tissue of foot strain, non weight-bearing at X ray film seem to be normal, but it can be discovered increase of the inter-metatarsal angle between the first and second metatarsals(IMA1-2) and the inter-metatarsal angle between the first and fifth metatarsals(IMAl-5) which indicate the reduce of front feet cross bow, increase of the top angle of the medial longitudinal arch (TAOTMLA) and the decrease of the anterior angle of the medial longitudinal arch (AAOTMLA) which indicate the reduce of Medial longitudinal arch in X ray film under the weight-bearing. The change of the angle in the foot X-ray film reflects the extent of the foot soft tissue strain.However, there are no further studies on the correlation between the pressure, pain and callus under the second metatarsal head and the change of foot X-ray caused deformity of hallux valgus. We think it is necessary to make further study on these problems and it can help to provide quantitative indicators in Preoperative scheme evaluation and prevention and treatment of metatarsalgia of Hallux Valgus.2ObjectivesWe try to observe the pain and callus under the second metatarsal head in Hallux valgus, to measure and compare the difference of weight bearing a X-ray film and plantar pressure indicators under the second metatarsal head, and further to find how the change of weight bearing a X ray film influence Plantar pressure indicators under the second metatarsal head, which can provide Quantitative data for evaluate Evaluation, prevention, diagnosis and treatment of Hallux valgus deformity.3MethodsRetrospective analysis medical records about the Hallux valgus patients from January2012to June2013in Wangjing hospital. Observe the pain and callus under the second metatarsal head in Hallux valgus. Compare the differences between the indicators of X-ray film and the plantar pressure indicators, analysis the correlations between the indicators of X-ray film and the plantar pressure indicators, discuss the risk factor influence the Hallux valgus severity and pain under the second metatarsal head in Hallux valgus.4Results4.1Statistical descriptionsAll the254patients(477feet), both feet of hallux valgus accounted for223cases, single hallux valgus foot accounted for31cases include15left feet and16right feet. The degree of hallux valgus deformity of148feet is slight,198moderate and131serious.182feet merged the second plantar bone pain, accounting for38.16%,250feet merged callus under second metatarsal head, accounting for52.41%, and there are172feet merged pain and callus under the second metatarsal head simultaneous, accounting for36.06%.4.2Comparative analysis the degree of Hallux valgus deformityThrough analysis of variance, all the normal distribution and variance of quantitative data including the Inter-metatarsal angle between the first and second metatarsals (IMA1-2), the Inter-metatarsal angle between the first and fifth metatarsals (IMA1-5), top angle of the medial longitudinal arch (TAOTMLA), the second metatarsal relative length than the first (SMRL) are statistical significance in the different degree of hallux valgus deformity (P<0.05), but the SMRL is not (P>0.05). Through rank sum test, there are statistical significance in different degree of hallux valgus deformity of anterior angle of the medial longitudinal arch (AAOTMLA), touch the ground time percentage under the second metatarsal head (TPUM)(P<0.05), but the weight, peak pressure under the second metatarsal head(PPUM), impulse under the second metatarsal head(IUM) are not (P>0.05).4.3Analysis the correlations on HAVA between the indicators of X-ray film and the plantar pressure indicatorsThrough Spearman rank correlation test, there are statistical significance in correlation between HAVA and IMA1-2, IMA1-5, TAOTMLA, AAOTMLA(P<0.05, r=0.647、0.553、0.127、-0.165), but the age, weight, SMRL, PPUM, IUM are not(P>0.05).4.4Analysis the pain under the second metatarsal of477feet hallux valgus4.4.1Divided the patients into two groups according to the second plantar bone pain, through t test, there are not statistical significance in IMA1-2, IMA1-5, TAOTMLA between two groups, but SMRL are statistical significance (P<0.05). Through rank sum test, there are statistical significance in HAVA, TPUM, IUM in two groups (P<005), but weight, AAOTMLA, PPUM are not (P>0.05).4.4.2Set the pain under the second metatarsal head as dependent, through single factor Logistic regression analysis, there are statistical significance in HAVA (ORj=1.033), SMRL(ORj=1.066), TPUM(ORj=1.068); Through multi-factorial Logistic regression analysis, there are statistical significance in HAVA (ORj=1.031), SMRL(ORj=1.074), TPUM(ORj=1.062).4.5Compare two age groups4.5.1All the patients are break into different groups by ages. The Youth group and the Middle-aged group, through t teat, there are statistical significance in TAOTMLA, SMRL (P<0.05), but the differences of IMA1-2and IMA1-5are not (P>0.05). Through rank sum test, there are statistical significance in HAVA, weight, AAOTMLA and TPUM (P<0.05), but the differences of PPUM and IUM are not in two age groups (P>0.05).4.5.2Through the chi-square test, the degree of Hallux valgus are statistical significance in two-age group (χ2=4.798, P<0.05). The pain under the second metatarsal head are statistical significance in two-age group (χ2=4.798, P<0.05). The callus under the second metatarsal head are not statistical significance in two-age group (χ2=1.349, P>0.05).4.6Analysis the callus under the second metatarsal of477feet hallux valgus4.6.1Divided the patients into two groups according to the second plantar bone callus, through t test, there are not statistical significance in IMA1-2, IMA1-5, TAOTMLA, SMRL between two group (P>0.05);4.6.2Through rank sum test, there are statistical significance in HAVA, TPUM, IUM PPUM in two groups (P<0.05), but the differences weight and AAOTMLA are not (P>0.05).4.6.3Set the callus under the second as dependent, through single factor Logistic regression analysis, there are statistical significance in HAVA (ORj=1.031), PPUM (ORj=1.019), IUM (ORj=1.006), TPUM (OR=1.037). Through multi-factorial Logistic regression analysis, there are statistical significance in HAVA (ORj=1.031).4.7Compare the pain and callus under the second metatarsalDivided the patients into four groups according to the second plantar bone pain and callus, through rank sum test, there are statistical significance in HAVA, TPUM, IUM, PPUM in four group(P<0.05).5Conclusions5.1The degree of hallux valgus deformity aggravates with the increase of age. The more severe the hallux valgus deformity is, the flatter the foot arch collapse will be and this degree of collapse can also be reflected by weight-bearing X-ray measurements.5.2Foot arch collapse in hallux valgus leads to the increase of the TPUM and the pain under the second metatarsal. The increasing of HAVA may be one of the main reasons that lead to occurrence of painful callus under the second metatarsal head.