Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the first ray during the stance phase.
BACKGROUND
Operative treatment of people with hallux valgus can yield favorable clinical and radiographic results. However, plantar pressure analysis has demonstrated that physiologic gait patterns are not restored after hallux valgus surgery.


OBJECTIVE
The purpose of this study was to illustrate the changes of plantar pressure distribution during the stance phase of gait in patients who underwent hallux valgus surgery and received a multimodal rehabilitation program.


METHODS
This was a prospective descriptive study.


METHODS
Thirty patients who underwent Austin (n=20) and scarf (n=10) osteotomy for correction of mild to moderate hallux valgus deformity were included in this study. Four weeks postoperatively they received a multimodal rehabilitation program once per week for 4 to 6 weeks. Plantar pressure analysis was performed preoperatively and 4 weeks, 8 weeks, and 6 months postoperatively. In addition, range of motion of the first metatarsophalangeal joint was measured, and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot questionnaire was administered preoperatively and at 6 months after surgery.


RESULTS
The mean AOFAS score significantly increased from 60.7 points (SD=11.9) preoperatively to 94.5 points (SD=4.5) 6 months after surgery. First metatarsophalangeal joint range of motion increased at 6 months postoperatively, with a significant increase in isolated dorsiflexion. In the first metatarsal head region, maximum force increased from 117.8 N to 126.4 N and the force-time integral increased from 37.9 N.s to 55.6 N.s between the preoperative and 6-month assessments. In the great toe region, maximum force increased from 66.1 N to 87.2 N and the force-time integral increased from 18.7 N.s to 24.2 N.s between the preoperative and 6-month assessments.


CONCLUSIONS
A limitation of the study was the absence of a control group due to the descriptive nature of the study.


CONCLUSIONS
The results suggest that postoperative physical therapy and gait training may lead to improved function and weight bearing of the first ray after hallux valgus surgery.
Schuh
Reinhard
R
Gait Analysis Laboratory, Foot and Ankle Center Vienna, Alserstrasse 43/8D, 1080 Vienna, Austria. reini.schuh@gmx.at
Hofstaetter
Stefan G
SG
Adams
Samuel B
SB
Pichler
Florian
F
Kristen
Karl-Heinz
KH
Trnka
Hans-Joerg
HJ
D000328:Adult; D000368:Aged; D001317:Austria; D005260:Female; D005684:Gait / Q000502:physiology*; D006215:Hallux Valgus / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000502:physiology; D008875:Middle Aged; D010027:Osteotomy / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D026761:Physical Therapy Specialty / Q000379:methods; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D055070:Resistance Training; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology*; D055815:Young Adult