SLR - January 2013 - Huynh
Reference: Smith S, Coleman S, Bacon S, Polo F, Brodsky J, Improved Ankle Push-Off Power Following Cheilectomy for Hallux Rigidus: A Prospective Gait Analysis Study. Foot and Ankle International, Volume 33, No. 6 June 2012, DOI: 10.3113/FAI.2012.0457
Scientific Literature Review
Reviewed by: H. Aden Huynh, DPM
Residency Program: DVA Central Alabama, Montgomery, AL
Podiatric Relevance:
The motion of the first metatarsalphalangeal joint (MTPJ) is an integral part of gait. During gait, the hallux is in a fixed position so there must be a sufficient amount of motion at this joint to allow the body to pass over the hallux. Degenerative arthridities at the MTPJ cause pain at the joint, synovial inflammation, swelling, and decreased ROM secondary to osteophytosis and joint incongruity and may ultimately affect ADLs. There are multiple conservative and surgical procedures described to treat this condition. The authors of this study focus on the cheilectomy to determine if it improves gait by improving ankle push-off power for stage 1 and stage 2 hallux rigidus (HR).
Methods:
A prospective study was conducted on 17 patients (9 M, 8 F) with stage 1 and 2 HR who failed at least six months of conservative treatment and were treated with a cheilectomy. The mean age was 47.4 years (range, 37-64 years). The average weight was 84.1±19.9kg and BMI was 27.3±4.6. Average follow-up was 1.8 ±0.9 years. All patients underwent a cheilectomy consisting of resection of the dorsal prominences, and spurs to the level of the dorsal cortex of the metatarsal shaft and osteophytes were resected from the base of the proximal phalanx. Preoperatively and postoperatively, patients were assessed by first MTPJ ROM, AOFAS hallux scores, gait analysis using a five-camera, three dimensional capture system at least four weeks prior to surgery and one year after surgery, gait velocity sagittal plane ankle ROM and peak sagittal plane ankle push-off power. Postoperatively, patients were placed in a soft dressing and rigid soled postoperative shoe. Patients were allowed to bear weight and perform passive and active range of motion exercises three times per day after the incision site was healed.
Results:
Following a cheilectomy, an increase in first MTPJ and AOFAS hallux scores were noted with preoperative values being 33.9 degrees and 62 points and postoperatively increasing to 50.6 degrees and 81 points, respectively. Peak sagittal plane ankle push power increased from 1.71±0.92 W/kg preoperatively to 2.05±0.75 W/kg postoperatively. No significant changes were noted with velocity and sagittal plane ankle ROM.
Conclusions:
The authors of this study provided results demonstrating there is an improvement in gait, first MTPJ ROM and sagittal plane ankle push-off power following a cheilectomy procedure. Additional long term studies involving other first MPTJ procedures that treat hallux rigidus should be performed and used for comparison to determine if other procedures may be used in lieu of the cheilectomy and still offer similar results.