title: Joint Manipulation Under Anesthesia for Arthrofibrosis After Hallux Valgus Surgery.
abstract: Arthrofibrosis is a known complication of hallux valgus surgery. Joint manipulation under anesthesia has been studied for adhesive capsulitis of the shoulder; however, a paucity of published data exists on the use of this modality in the foot and ankle. The purpose of the present study was to investigate the outcomes of first metatarsophalangeal joint manipulation for arthrofibrosis that occurred as a complication of bunion surgery. The study population consisted of patients attending a single foot and ankle specialty clinic who were evaluated for arthrofibrosis after bunion surgery. Patients who underwent joint manipulation under anesthesia were asked to complete a research visit in which a clinical examination was performed and the presence and severity of joint pain were assessed. A total of 38 patients (34 females, 4 males, 53 feet), with a mean age of 55.7 ± 11.8 (range 30 to 83) years, agreed to participate. The mean follow-up period was 6.5 ± 3.4 (range 1 to 17) years. The visual analog scale scores improved significantly from baseline to the final follow-up visit (baseline 6.5 ± 1.5, range 2 to 10; final follow-up visit 2.3 ± 1.5, range 0 to 6; p < .001). Furthermore, joint motion had increased significantly (p < .001) for both dorsiflexion and plantarflexion at the final follow-up examination. The final range of motion (dorsiflexion, r = -0.431, p = .002; plantarflexion, r = -0.494, p < .001) correlated highly with patient self-reported pain in the first metatarsophalangeal joint. Our findings suggest that joint manipulation could be a useful modality for increasing first metatarsophalangeal joint mobility and alleviating pain in patients who experience arthrofibrosis after surgical correction of hallux valgus.
authors.affiliation: Associate, South Chicago Foot and Ankle, Chicago, IL. Electronic address: cathie.feuerstein@gmail.com.
authors.forename: Catherine
authors.initials: C
authors.lastname: Feuerstein
authors.affiliation: President and Fellowship Director, Weil Foot and Ankle Institute, Des Plaines, IL.
authors.forename: Lowell
authors.initials: L
authors.lastname: Weil
authors.affiliation: Director, Weil Foot and Ankle Institute, Des Plaines, IL.
authors.forename: Lowell Scott
authors.initials: LS
authors.lastname: Weil
authors.affiliation: Associate, Weil Foot and Ankle Institute, Des Plaines, IL.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Klein
authors.affiliation: Associate, Silverstone Podiatry, New York, NY.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Argerakis
authors.affiliation: Director of Research, Weil Foot and Ankle Institute, Des Plaines, IL.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Fleischer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006215:Hallux Valgus / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*
keywords: bunion deformity; complication; first metatarsophalangeal joint; great toe; stiffness