A comparison between over-the-toe plaster slab and off-loading forefoot shoes following hallux valgus correction

doi:10.3969/j.issn.2095-4344.2017.26.023

Abstract

Abstract:

BACKGROUND: Operative correction of hallux valgus is one of the most procedures in foot and ankle department, but postoperative plaster slab immobilization often brings great inconvenience and pain. Off-loading forefoot shoes can theoretically help them to do activities off bed early, and prevent loading on the forefoot during walking. But its advantages and disadvantages compared with plaster slab are still unknown.

OBJECTIVE: To compare the clinical effects of over-the-toe plaster slab and off-loading forefoot shoes after hallux valgus correction.

METHODS: Patients with hallux valgus undergoing distal Chevron osteotomy or Scarf osteotomy in the Huashan Hospital of Fudan University between May 2012 and October 2013 were retrospectively reviewed. Group A patients had a below-knee and over-the-toe plaster slab while Group B had an off-loading forefoot shoe applied after surgery. Radiological assessment was done at 6 weeks postoperatively. Immobilization was removed once bone union was indicated. Clinical scales and subjective satisfaction investigation were performed at final follow-up, and complications during follow-up were noted. All values between groups were analyzed statistically.

RESULTS AND CONCLUSION: Totally 125 patients (157 feet) were completely followed up, including 83 patients (95 feet) in Group A and 42 patients (62 feet) in Group B. There was no significant difference in demographics, pre-and-post operative radiological assessments, clinical scale, union time or general satisfaction rates between two groups. However, Group B patients had less chance to suffer metatarsophalangeal joint or inter-phalangeal joint stiffness, restricted ankle motion and supra-ankle pains of operated side in comparison with Group A (P < 0.05), and were more willing to accept the same treatment if they could choose again (P < 0.05). Compared with the plaster slab, the application of off-loading shoes not only maintains correction level, but also reduces such complications as stiffness or restricted motion of the joint, limb pains and so on, which makes patients more likely to accept, and should be given priority to in the rehabilitation following hallux valgus correction.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Key words: Hallux Valgus, External Fixators, Follow-Up Studies, Tissue Engineering

CLC Number:

R318

Geng Xiang, Huang Jia-zhang, Ma Xin, Wang Xu, Zhang Chao, Chen Li, Wang Chen.

A comparison between over-the-toe plaster slab and off-loading forefoot shoes following hallux valgus correction

[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(26): 4234-4239.

Figures/Tables 5

2.2 基线资料比较 2组患者的年龄、性别构成、术前拇外翻角、第一二跖骨间角及AOFAS评分、手术方式构成、术后住院天数的差异均无显著性意义(P > 0.05)，见表1。2.3 随访结果在术后6周时，2组患者矫正后的拇外翻角、第一二跖骨间角以及骨愈合时间差异并无显著性意义(见表2)。进一步经过12-30个月的随访，2组患者最终的AOFAS评分差异亦无显著性意义(见表3)。在评价整个治疗方式和效果时，穿着前足减压患者的满意率(98%)高于使用超趾石膏托的患者(95%)，但差异无显著性意义；而当被问到“如果遇到相同情况是否愿意再次接受这种治疗”的时候，使用石膏托固定的患者仅有82%表示愿意，而这一比例在穿着减压鞋的患者中高达95%，此差异有显著性意义(见表3)。 2.4 不良事件围手术期对照组、试验组患者分别有1足和2足出现伤口周围红肿，但均为浅表感染，口服抗生素后均顺利愈合；对照组患者去除超趾石膏托后有20足(21%)出现第一跖趾关节僵硬(定义为屈伸活动<30°[25])或趾间关节僵硬(定义为屈伸活动<10°[21])，56足(59%)出现踝关节活动受限(屈伸活动<30°[21])，石膏托固定期间有46足(48%)在手术侧踝关节以上出现疼痛；而相比之下，试验组患者在去除减压鞋后，发生上述不适者分别为4足(7%)、3足(5%)和13足(21%)，且此3例踝关节活动受限患者的踝关节X射线均有关节炎征象；通过χ2检验，证实穿着前足减压鞋发生跖趾关节或趾间关节僵硬、踝关节活动受限、手术侧踝关节以上关节或肢体疼痛的概率比使用短腿超趾石膏托固定低，差异有显著性意义(见表2)。出现远期并发症包括转移性跖痛和拇外翻复发(拇外翻角>20°[26])，其发生率在2组间差异无显著性意义(见表2)；所有患者均未出现骨延迟愈合或不愈合、拇内翻以及内固定松动等并发症。 "

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