Shoe and Insole Modification for Hallux Valgus and Its Associated Foot Deformities

OBJECTIVE: To evaluate outcomes of treatment of hallux valgus and its associated foot deformities with shoe and insole modification. METHOD: We present the short-term follow-up of 32 symptomatic hallux valgus deformities in 20 patients. The patients were all female and 32 to 77 years in age at the time of modification of shoe and insole. Twenty patients were evaluated on an average of 4 weeks following their shoe and insole modification. Hallux valgus angles and first-second intermetatarsal angle were evaluated as well as the range of motion of the first metatarsophalangeal joint and patient's satisfaction. Outcome was measured using changes in visual analogue scale (VAS) on twenty occasions during 4 weeks. RESULTS: Hallux valgus was commonly associated with the lesser (2nd~5th) toe deformity (21 cases, 65.5%), pes planus (12 cases, 37.5%), Achilles tightness (12 cases, 37.5%) and great toe pronation (10 cases, 31.5%). The result obtained was highly significant (p<0.002), suggesting that the shoe and insole modification were as effective in reducing the level of pain due to hallux valgus and its associated foot deformities. CONCLUSION: The shoe and insole modification can be an effective treatment of reducing pain of hallux valgus and its associated deformities.

Conduction Study of Dorsomedial Cutaneous Nerve to the Great Toe

OBJECTIVE: The dorsomedial cutaneous nerve (DMCN) to the great toe is a branch of the medial dorsal cutaneous nerve, which originates from the superficial peroneal nerve. The objective of this study is to standardize the electrodiagnostic technique, and to investigate the usefulness of dorsomedial cutaneous nerve (DMCN) conduction study in patients with peripheral neuropathy. METHOD: Sixty two legs in 31 normal adults and 56 legs in 28 patients with the clinical signs and symptoms as well as electrodiagnostic evidences of peripheral neuropathy were evaluated with the DMCN conduction study. The stimulating electrode was placed over the lateral 1/3 between medial and lateral malleoli and the active electrode was placed over 12 mm medial and 10 mm proximal to the extensor hallucis longus tendon over the 1st metatarsophalangeal joint. RESULTS: The mean values of DMCN conduction study in normal adults were 2.95+/-0.47 msec for onset latency, 3.58+/-0.43 msec for peak latency, 6.67+/-2.87microvolt in amplitude, and 12.96+/-1.17 cm for distance from active electrode to stimulation point. There were statistically significant differences between normal and patients groups in all parameters except the distance. CONCLUSION: A method for DMCN conduction study was introduced which could be used as a valuable technique for the early evaluation of peripheral neuropathy.