Based On "Raise Up The Lower"Principle,Clinical Anaysis Of The Efficacy To Metatarsalgia Treated By Distal Metatarsal Bone Osteotomy Elevation Surgery

1 ObjectiveBased on "With the higher flat,Raise up the lower" principle,clinical analysis of the efficacy to metatarsalgia without obvious metatarsop-halangeal joint dislocation treated by distal metatarsal osteotomy elevation surgeryValidation and evaluation scientific and practicability of the standard of classification about metatarsalgia.2 MethodTask Force 20 based on 6 years of experience in the treatment of more than one thousand cases of metatarsalgia,metatarsalgia proposed indexing standards based on"With the higher flat,Raise up the lower"design principle proposed treatment plan, on which the "1 degree "metatarsalgia patients to take distal metatarsal bone osteotomy elevation surgery.Selection of cases:From March 2014 to March 2016,62 feet of 43 patients (Included 49 cases of 70 feet,8 feet off six cases,patients were lost to follow-induced shedding)of metatarsalgia without obvious metatarsophalangeal joint dislocation were treated by distal metatarsal bone osteotomy elevation surgery.Among them,3 males and 4 feet,58 feet and 40 females, a total of 76 metatarsal bones;46 second metatarsal, the third metatarsal 27, the fourth metatarsal 3.Patients’ages range from 52 to 71 years,an average age 62.1.Postoperative follow-up time were 12 to 24 months, the average of follow-up time were 14 months.To measure a series of data..including the size of callosum, tenderness index,ACFAS and VAS were used to assessment clinical outcomebefore and after surgery for evaluation.Footscan analyzer using plantar pressure measurement and recording normal gait cycle corresponding metatarsal head under maximum pressure to bear.before and after the change of the maximum pressure and impulse. All patients were observed by shooting a X-ray before and after surgery,and Observe the relevant indicators.Inform patients before surgery details.and signed informed consent were included in line with the conditions,no surgical contraindications before inclusion in this study.3 ResultsAfter the distal metatarsal bone osteotomy elevation surgery,the disappearance and significantly reduce the rate of callosum is 90.8%.The preoperative VAS score (5.42±1.22) and postoperative VAS score (1.64±1.54);Tenderness index before surgery was(2.21±1.39) points after the (1.19±0.93)points;ACFAS score before surgery was(54.98±17.18) points,postoperative was (89.21±18.11) points;The differences were statistically significant (P<0.05).The maximum pressure of the pain area was decreased from (139.66±90.26)N to(79.52±52.29)N;The former maximum pressure under the responsibility of the metatarsal head surgery was (132.06±45.21)N,surgery is (110.20±41.13)N; maximum pressure before surgery was (18.48±7.55)N/cm2, after the (14.28±8.19)N/cm2;The maximum impulse before surgery was (60.77±28.69)Ns,surgery was (23.10±15.89)Ns;The clea ranee of differences were statistically significant before and after surgery (P<0.05).4 Conclusion4.1 Based on "With the higher flat, Raise up the lower"distal metatarsal bones osteotomy elevation surgery for treatment of elevated design principle presented no significant dislocation metatarsalgia,can significantly improve the forefoot pain,if mild metatarsophalangeal joint dislocation dislocation can be alleviated to some extent the situation,less complications,clinical curative effect.4.2 The methods of classification of metatarsalgia has certain scientific and practical,and has clinical guiding significance.