Plantar loading after chevron osteotomy combined with postoperative physical therapy

Abstract

Background: Recent pedobarographic studies have demonstrated decreased loading of the great toe region and the first metatarsal head at a short- and intermediate-term followup. The purpose of the present study was to determine if a postoperative rehabilitation program helped to improve weightbearing of the first ray after chevron osteotomy for correction of hallux valgus deformity.

Materials and methods: Twenty-nine patients with a mean age of 58 years with mild to moderate hallux valgus deformity who underwent a chevron osteotomy were included. Postoperatively, the patients received a multimodal rehabilitation program including mobilization, manual therapy, strengthening exercises and gait training. Preoperative and one year postoperative plantar pressure distribution parameters including maximum force, contact area and force-time integral were evaluated. Additionally the AOFAS score, ROM of the first MTP joint and plain radiographs were assessed. The results were compared using Student's t-test and level of significance was set at p < 0.05.

Results: In the great toe, the mean maximum force increased from 72.2 N preoperatively to 106.8 N 1 year after surgery. The mean contact area increased from 7.6 cm(2) preoperatively to 8.9 cm(2) 1 year after surgery and the mean force-time integral increased from 20.8 N(*)sec to 30.5 N(*)sec. All changes were statistically significant (p < 0.05). For the first metatarsal head region, the mean maximum force increased from 122.5 N preoperatively to 144.7 N one year after surgery and the mean force-time integral increased from 42.3 N(*)sec preoperatively to 52.6 N(*)sec 1 year postoperatively (p = 0.068 and p = 0.055, respectively). The mean AOFAS score increased from 61 points preoperatively to 94 points at final followup (p < 0.001). The average hallux valgus angle decreased from 31 degrees to 9 degrees and the average first intermetatarsal angle decreased from 14 degrees to 6 degrees (p < 0.001 for both).

Conclusion: Our results suggest that postoperative physical therapy and gait training with a Chevron osteotomy may help to improve weightbearing of the great toe and first ray. Therefore, we believe there is a restoration of more physiological gait patterns in patients who receive this postoperative regimen.