title: Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the first ray during the stance phase.
abstract: 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.
authors.affiliation: Gait Analysis Laboratory, Foot and Ankle Center Vienna, Alserstrasse 43/8D, 1080 Vienna, Austria. reini.schuh@gmx.at
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schuh
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Hofstaetter
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Adams
authors.forename: Florian
authors.initials: F
authors.lastname: Pichler
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kristen
authors.forename: Hans-Joerg
authors.initials: HJ
authors.lastname: Trnka
mesh_terms: 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