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Gait changes following cheilectomy for hallux rigidus

Discussion in 'Foot Surgery' started by NewsBot, Mar 20, 2008.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Dynamic kinematic and plantar pressure changes following c: a mid-term followup.
    Nawoczenski DA, Ketz J, Baumhauer JF.
    Foot Ankle Int. 2008 Mar;29(3):265-72.
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. Dieter Fellner

    Dieter Fellner Well-Known Member

    OK - so someone had to 'study' this, I su'ppose. Seems kind of obvious ? The bony projection is the consequence of abnormal joint function, at least in most cases. Its' removal would have little effect to improve joint mechanics... but now we can at last point to the evidence thanks to three-dimensional in vivo first MTP joint kinematics and loading characteristics following cheilectomy.

    (assuming it can withstand the rigour of study critique)

    Kind of lightens my heart - I have made the same point for years but some argue a simple cheilectomy can be as effective as an osteotomy.... :wacko:

    All the same: this kind of study ( sure it's valuable) has some of the hallmarks of another great study; £1 million was, allegedly, assigned to discover if Falkland penguins tumble when aircraft pass overhead. Great job. :bash:

    Penguins wobble but they don't fall down
    http://news.bbc.co.uk/1/hi/sci/tech/1149900.stm
     

    Attached Files:

  4. W J Liggins

    W J Liggins Well-Known Member

    Haven't read the full article, so I don't intend to offer a critique. I'm interested however that dorsiflexion at the MTPJ significantly increased whilst the hallux remained plantarflexed relative to the met head.

    I think that one problem with these studies is that the aetiology is not examined. Anecdotally, the vast majority of hallux limitus/rigidus I see seems to be associated with a long 1st met. Cheilectomy or no, this is clearly going to affect gait. This is why I frequently find a shortening osteotomy rewarding provided that the degeneration is not end stage, in which case arthrodesis seems appropriate - as discussed in a recent thread.

    However, this is a logitudinal study and is to be applauded for that reason.

    Cheers

    Bill
     
  5. Adrian Misseri

    Adrian Misseri Active Member

    G'day all,

    I think this article skims the fact that all surgery to the foot is going to alter foot mechanics, especially at the first MTPJ. My thesis was a systematic review and meta-analysis of the surgical procedures for hallux limitus/rigidus. Essentially, chilectomy, like all otehr arthroplasties, will demonstrate an increase in range of motion, and a better quality of life with a reduction in pain at the 1st MTPJ. One paper studdies did demonstrate a change in peak pressures and timing of pressure under the 1st MTPJ.

    I do agree with Bill, great to see someone having an attempt at some decnt surgical studies!

    -Adrian
     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Quantitative motion analysis in patients with hallux rigidus before and after cheilectomy.
    Canseco K, Long J, Marks R, Khazzam M, Harris G.
    J Orthop Res. 2008 Jul 16. [Epub ahead of print]
     
  7. drsarbes

    drsarbes Well-Known Member

    "Essentially, chilectomy, like all otehr arthroplasties, will demonstrate an increase in range of motion, and a better quality of life with a reduction in pain at the 1st MTPJ."

    Not sure I agree with this.
    IF there is increased pain due to a fractured osteophyte then a debridement (I personally don't like the term CHILECTOMY) will help.

    Does debridement of the 1st MTPJ give long standing results?
    Does debridement of an arthritic ankle, knee or hip give long term results?
    No.
    The patient will return for a more definitive procedure.

    STeve
     
  8. rosherville

    rosherville Active Member

    Steve et al,

    "Essentially, cheilectomy, like all other arthroplasties, will demonstrate an increase in range of motion, and a better quality of life with a reduction in pain at the 1st MTPJ."

    On balance I agree with this, of course, there will always be exceptions for a number of reasons.

    'Does debridement of the 1st MTPJ give long standing results?
    Does debridement of an arthritic ankle, knee or hip give long term results?
    No.
    The patient will return for a more definitive procedure.'

    On balance I disagree with this generalisation.
    I do not believe ankle, knee and hip are a fair comparison to an mpt.
    I think the difference is that in addition to the intrinsic biomechanical component of the etiology there is the shoe factor.
    I have several patients, reviewed after 15 years, who had varying degrees of cheilectomy and Valenti procedures, who are still pleased with the result and have not noticably regressed.

    I believe this is due to the fact that the patients tend to be of an age when they are wearing more accomodating shoes. If they continued wearing the more extreme style of shoes, limiting forefoot function, that they wore in the 15-30 year age period I am not so sure that the results would be so pleasing after another 15 years !

    Regards,
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Arthrodesis of the first metatarsophalangeal joint for hallux rigidus—Optimal position of fusion
    Morten Aas, , Tor Magne Johnsen, and Vilhjalmur Finsen
    The Foot; Volume 18, Issue 3, September 2008, Pages 131-135
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Valenti technique in the treatment of hallux rigidus.
    Harisboure A, Joveniaux P, Madi K, Dehoux E.
    Orthop Traumatol Surg Res. 2009 Apr 24. [Epub ahead of print]
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Functional Outcome of Cheilectomy for the Treatment of Hallux Rigidus.
    Wagenmann B, Schuh R, Trnka HJ.
    Z Orthop Unfall. 2010 Mar 8. [Epub ahead of print]
     
  12. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Risk Factors for Failure of Cheilectomy for Hallux Rigidus
    Austin Sanders, BA, Joseph Nguyen, MPH, Jonathan Deland, MD, ...
    Foot & Ankle Orthopaedics September 18, 2017
     
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