| Objective:Discussion relevant factors and pathogenesis about hallux valgus metatarsal pain,providing a higher reliability theoretical basis for hallux valgus patients.Method:Select patients that from Foot and Ankle Surgery of the Third affiliated hospital of Beijing university of Chinese medicine between the April 2013-2014 in April,met the inclusion criteria,with hallux valgus joint line Warlock,80 cases of 153 feet,75 female,144 feet,5 males and 9 feet;located 10 cases of normal control group,20 feet.Hallux valgus patients shooting foot weight-bearing anteroposterior and lateral film when preoperative and postoperative 3 months.Measurements include hallux valgus angle(HAV),the first and second metatarsal Kakuma(IMA),metatarsal extended length(MPD)and forefoot width.Using the American Orthopaedic Foot Surgery Society toe metatarsophalangeal joint assessment criteria(AOFAS)clinical assessment.All study subjects were divided into before the surgery group,postoperative pain persists metatarsal group,postoperative pain does not exist metatarsal and normal group,and each group of data were compared.Meanwhile hallux valgus patients still metatarsal pain before surgery and postoperative follow-up clinic in March,using Foot scan dynamic plantar pressure system testing,regional peak pressures before and after surgery foot 1 to 5 under the metatarsal head(PP)and the proportion of each share under pressure time integral(PTI)and forefoot 1 to 5 under the metatarsal head metatarsal stress in normal walking comparative analysis of changes in the state.Result:1.the overall clinical efficacy:after 3 months follow-up and evaluation of the efficacy of the overall symptom improvement rate statistics:cured 120 feet,effective 20 foot,13 foot valid,invalid 0 feet,the cure rate was 78.4%,markedly effective rate of 13.1%,there efficiency of 9.1%;2,patients with postoperative pain exists metatarsal compared with patients without preoperative presence metatarsal pain:HAV average of 33.15°±2.32 °reduced to 14.08 ± 1.78,IMA average of 13.11°±2.19°down to 9.68°±2.12°,the average foot width reduced from 82.88mm ± 6.42mm 76.36mm ± 7.17mm,the first and second metatarsal by the relative prominence of the reduced-1.54mm ± 1.23mm-2.08mm ± 0.46mm,the difference between the groups has statistics significance(P<0.05).Exist in patients with postoperative pain metatarsal metatarsal presence of pain compared to patients before surgery,HAV average of 37.32 °± 9.43± down to 16.21°±6.74°,IMA average of 14.21°±4.24°down to 13.12 ° ± 3.67 °,foot wide average of 85.78 ° ± 8.45 ° reduced to 75.36° ± 5.64°,the first and second metatarsal relative prominence of the average of-2.87mm ? 1.66mm reduced to-3.18°±0.46 °,each set of data was statistically significant(P<0.05).The presence of relatively lower postoperative pain metatarsal head pain group and the group does not exist under the metatarsal head after surgery,HAV,IMA difference was not statistically significant(P>0.05).Foot width,the first and second metatarsal difference between the relative prominence was statistically significant(p<0.05);after each set of data with normal feet were statistically significant differences(p<0.05).2.Hallux valgus forefoot lateral foot under pressure significantly increased inside pressure decreases,the relocation of the center of pressure occurs.Hallux valgus peak pressure and pressure time integral of the maximum value in the second or third metatarsal head,the third metatarsal head is the largest regional forefoot pressure,followed by the second metatarsal head.Compared with normal foot,hallux valgus third metatarsal head area significantly increased pressure,peak pressure of the second,fourth and fifth metatarsal head region also has an increasing trend,but the peak pressure of the first metatarsal head region has reduced trend.Hallux valgus pressure time integral in the third,fourth and fifth metatarsal head region was significantly greater than the normal foot.,Second,third and fourth metatarsal heads under pressure and peak pressure is reduced compared with the preoperative time points after osteotomy,and the first,the next five metatarsal head pressures greater than before surgery.Peak pressure change of the first metatarsal head three statistically significant,fourth,fifth metatarsal was not statistically significant;first three,five changes in pressure time integral metatarsal head was statistically significant,no significant changes in the fourth metatarsal significance.And forefoot to stress the second and third metatarsal heads max.Conclusion:1.Hallux valgus angle and metatarsal angle bigger,wider forefoot,a relatively long second metatarsal head is more likely to occur under the metatarsal head pain2.Metatarsal pain associated with hallux valgus surgery,alleviate symptoms related to the correction of hallux valgus angle closer to each normal range,the more obvious symptoms metatarsal pain relief3.For hallux valgus with plantar metatarsal pain,intractable pain has formed the corpus callosum,and the sinking of patients metatarsal head,hallux valgus osteotomy line at the same time,the proposal minor metatarsal osteotomy line... |
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