title: Plantar loading after chevron osteotomy combined with postoperative physical therapy.
abstract: BACKGROUND
  Recent pedobarographic studies have demonstrated decreased loading of the great toe region and the first metatarsal head at a short- and intermediate-term followup. The purpose of the present study was to determine if a postoperative rehabilitation program helped to improve weightbearing of the first ray after chevron osteotomy for correction of hallux valgus deformity.
  
  
  METHODS
  Twenty-nine patients with a mean age of 58 years with mild to moderate hallux valgus deformity who underwent a chevron osteotomy were included. Postoperatively, the patients received a multimodal rehabilitation program including mobilization, manual therapy, strengthening exercises and gait training. Preoperative and one year postoperative plantar pressure distribution parameters including maximum force, contact area and force-time integral were evaluated. Additionally the AOFAS score, ROM of the first MTP joint and plain radiographs were assessed. The results were compared using Student's t-test and level of significance was set at p < 0.05.
  
  
  RESULTS
  In the great toe, the mean maximum force increased from 72.2 N preoperatively to 106.8 N 1 year after surgery. The mean contact area increased from 7.6 cm(2) preoperatively to 8.9 cm(2) 1 year after surgery and the mean force-time integral increased from 20.8 N(*)sec to 30.5 N(*)sec. All changes were statistically significant (p < 0.05). For the first metatarsal head region, the mean maximum force increased from 122.5 N preoperatively to 144.7 N one year after surgery and the mean force-time integral increased from 42.3 N(*)sec preoperatively to 52.6 N(*)sec 1 year postoperatively (p = 0.068 and p = 0.055, respectively). The mean AOFAS score increased from 61 points preoperatively to 94 points at final followup (p < 0.001). The average hallux valgus angle decreased from 31 degrees to 9 degrees and the average first intermetatarsal angle decreased from 14 degrees to 6 degrees (p < 0.001 for both).
  
  
  CONCLUSIONS
  Our results suggest that postoperative physical therapy and gait training with a Chevron osteotomy may help to improve weightbearing of the great toe and first ray. Therefore, we believe there is a restoration of more physiological gait patterns in patients who receive this postoperative regimen.
authors.affiliation: Innsbruck Medical University, Department of Orthopaedic Surgery, Anichstrasse 35, Innsbruck, 6020, Austria. reinhard.schuh@uki.at
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schuh
authors.forename: Samuel
authors.initials: S
authors.lastname: Adams
authors.forename: Stefan Gerhard
authors.initials: SG
authors.lastname: Hofstaetter
authors.forename: Martin
authors.initials: M
authors.lastname: Krismer
authors.forename: Hans-Joerg
authors.initials: HJ
authors.lastname: Trnka
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005545:Forefoot, Human / Q000502:physiology*; D005684:Gait; D006214:Hallux / Q000502:physiology*; D006215:Hallux Valgus / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D011312:Pressure; D011446:Prospective Studies; D016474:Weight-Bearing / Q000502:physiology*