ABSTRACT
Traditional rebalancing techniques, such as capsulotomies and capsulorrhaphies, are commonly performed during complex hammertoe and lesser metatarsal osteotomy procedures involving metatarsophalangeal joint (MTPJ) contractures; however, floating toes, digital instability, and malalignment are concerns. We critically analyzed the outcomes after anatomic reconstruction of the plantar plate and collateral ligaments compared with those after traditional rebalancing techniques. A case-control study was conducted of 54 patients who had undergone surgical correction of lesser MTPJ imbalances due to complex hammertoe deformities (power 80%, type I error = 0.05). Cases were defined as consecutive patients treated with anatomic plantar plate and collateral ligament reconstruction. Controls had undergone traditional lesser MTPJ rebalancing and were matched to cases by age, gender, follow-up duration (minimum 12 months), and concomitant procedures of the same lesser ray. Multivariate logistic regression demonstrated that patients treated with anatomic reconstruction had greater digital stability (negative dorsal drawer and negative paper pull-out test findings) at final follow-up examination compared with the controls. American College of Foot and Ankle Surgeons (ACFAS) forefoot module scores were greater in the anatomic group in all domains (p ≤ .05). Controls had greater postoperative radiographic MTPJ angles than the cases, with no differences detected between the 2 groups in visual analog scale scores or proximal interphalangeal joint angles. The importance of restoration of the plantar plate and collateral ligament integrity as a digital stabilizer is generally accepted but has not been well studied. We found that anatomic reconstruction yielded greater digital stability, greater ACFAS Forefoot module scores, and better radiographic MTPJ alignment than controls. Additional studies are warranted to assess the long-term viability of anatomic lesser MTPJ reconstruction.
Subject(s)
Conservative Treatment/methods , Hammer Toe Syndrome/surgery , Metatarsophalangeal Joint/surgery , Osteotomy/methods , Plantar Plate/surgery , Plastic Surgery Procedures/methods , Adult , Aged , Case-Control Studies , Female , Hammer Toe Syndrome/diagnostic imaging , Hammer Toe Syndrome/rehabilitation , Humans , Joint Instability/prevention & control , Linear Models , Logistic Models , Male , Metatarsophalangeal Joint/diagnostic imaging , Metatarsophalangeal Joint/physiopathology , Middle Aged , Multivariate Analysis , Plantar Plate/physiopathology , Postoperative Care/methods , Prognosis , Radiography/methods , Recovery of Function , Risk Assessment , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Adult , Humans , Hammer Toe Syndrome/rehabilitation , Hammer Toe Syndrome/therapy , Hammer Toe Syndrome , Ferula , Immobilization/methods , Finger Phalanges/injuries , Finger Phalanges , Radiculopathy/complications , Radiculopathy/rehabilitation , RadiculopathyABSTRACT
BACKGROUND: Chronic foot conditions have been reported to be a significant cause of impairment and disability to individuals affected. However, studies to date have particularly focussed on patient satisfaction with outcomes following surgery. OBJECTIVES: The aim of this study is to examine the impact of three common foot conditions on the levels of impairment and quality of life prior to surgery. Three conditions include Hallux Valgus (HV), Hallux Rigidus (HR) and Hammer Toe (HT). METHODS: This was a pilot cross-sectional observational study of people who were radiologically and clinically diagnosed with one of the three common foot pathologies: HV, HR and HT. Age and gender matched controls were also recruited. Self-reported quality of life was measured. RESULTS: The SF-36 scores did not differ significantly between the groups. There was a significant difference in self reported impairment between the groups on the Global Foot and Ankle Scale indicating that the 'bilateral foot group' perceived themselves to be significantly more impaired than their counterparts in the control group. CONCLUSION: Patient quality of life is now recognised as one of the most important outcomes of surgery. These findings serve to highlight the level of impairment and quality of life of individuals prior to surgery.
Subject(s)
Disability Evaluation , Foot Deformities/psychology , Quality of Life , Adult , Aged , Aged, 80 and over , Arthrometry, Articular , Chronic Disease , Cross-Sectional Studies , Female , Follow-Up Studies , Foot Deformities/diagnosis , Foot Deformities/rehabilitation , Hallux Rigidus/diagnosis , Hallux Rigidus/psychology , Hallux Rigidus/rehabilitation , Hallux Valgus/diagnosis , Hallux Valgus/psychology , Hallux Valgus/rehabilitation , Hammer Toe Syndrome/diagnosis , Hammer Toe Syndrome/psychology , Hammer Toe Syndrome/rehabilitation , Humans , Male , Middle Aged , Pilot Projects , Prognosis , Retrospective Studies , Severity of Illness Index , Surveys and Questionnaires , Young AdultABSTRACT
OBJECTIVE: The aim of this study was to analyze the prevalence of claw toes and its correlation to other lower limb disorders as well as the global functional recovery in a population of hemiplegic patients 1year post-stroke. PATIENTS AND METHODS: This prospective study included 39 stroke patients hospitalized in the Physical Medicine and Rehabilitation (PM&R) department of a hospital between September2000 and September2001. The evaluation looked for incidence of claw toes during the first year post-stroke and whether there was a potential link to triceps surae spasticity, motor impairment of the leg and patients' functional abilities (Barthel Index, postural assessment scale for stroke patients [PASS], functional ambulation classification [FAC]). RESULTS: We conducted a total of 64 evaluations (one to four by patient). In 18 out of 39 (46%) patients, we found an occurrence of claw toes. In 15 out of 18 (83%) patients, who regained average functional capacities, its onset took place before the end of the third month post-stroke (Barthel: 30-70, PASS: 15-33, FAC: 3-4) and it was significantly linked to equinus and/or varus foot (p<0.0001). CONCLUSION: The occurrence of claw toes in hemiplegic patients is common and happens early on post-stroke. Equinus and/or varus foot and average functional capacities were associated to claw toes. Despite the few studies devoted to this condition in stroke patients, this condition must be diagnosed early and taken into account to improve the patient's rehabilitation care.
Subject(s)
Hammer Toe Syndrome/etiology , Hemiplegia/etiology , Stroke/complications , Aged , Early Diagnosis , Female , Follow-Up Studies , Gait Disorders, Neurologic/etiology , Hammer Toe Syndrome/epidemiology , Hammer Toe Syndrome/rehabilitation , Hemiplegia/rehabilitation , Humans , Incidence , Male , Middle Aged , Muscle Spasticity , Prevalence , Prospective Studies , Severity of Illness IndexABSTRACT
Inserts are orthopedic aids in the treatment of foot disorders that result from changes of the static or dynamic situation. Provision of appropriate orthopedic devices can relieve the pain caused by forefoot deformities either in lieu of surgical intervention or in rare cases also following surgical treatment to improve the symptoms of residual pain.Available materials provide support, padding, and cushioning. Inserts are custom-made to measure and/or based on a plaster impression. Determining the indication, prescribing the inlay, and checking the orthosis are the tasks of the physician. One treatment option for relieving the pain of forefoot deformities consists in conservative therapy with an insert combining features of padding and support as well as adjusting a ready-made shoe. The shoe and inlay should constitute a functional unit since often the optimal effect is only achieved with a combination of insert and orthopedic adjustment of the ready-made shoe.
