Multisegmental foot and ankle motion analysis after hallux valgus surgery

Abstract

Background: Gait changes in patients with hallux valgus, including altered kinematic and temporal-spatial parameters, have been documented in the literature. Although operative treatment can yield favorable clinical and radiographic results, restoration of normal gait in this population remains unclear. Segmental kinematic changes within the foot and ankle during ambulation after operative correction of hallux valgus have not been reported. The aim of this study was to analyze changes in multisegmental foot and ankle kinematics in patients who underwent operative correction of hallux valgus.

Methods: A 15-camera Vicon Motion Analysis System was used to evaluate 24 feet in 19 patients with hallux valgus preoperatively and postoperatively. The Milwaukee Foot Model was used to characterize segmental kinematics and temporal-spatial parameters (TSPs). Preoperative and postoperative kinematics and TSPs were compared using paired nonparametric methods; comparisons with normative data were performed using unpaired nonparametric methods. Outcomes were evaluated using the SF-36 assessment tool.

Results: Preoperatively, patients with hallux valgus showed significantly altered temporal-spatial and kinematic parameters. Postoperatively, kinematic analysis demonstrated restoration of hallux position to normal. Hallux valgus angles and intermetatarsal angles were significantly improved, and outcomes showed a significant increase in performance of physical activities. Temporal-spatial parameters and kinematics in the more proximal segments were not significantly changed postoperatively.

Conclusion: Postoperative results demonstrated significant improvement in foot geometry and hallux kinematics in the coronal and transverse planes. However, the analysis did not identify restoration of proximal kinematics.

Clinical relevance: Further investigation is necessary to explore possible causes/clinical relevance and appropriate treatment interventions for the persistently altered kinematics.

Fig. 1

Upper: average hallux kinematics during complete gait cycle (HVpre versus HVpost versus Normals). Circles denote phases of gait cycle with significantly different minimum and maximum positions (HVpre versus HVpost). Lower: hallux ROM (average ± SD). Circles denote phases of gait cycle with significantly different ROMs (HVpre versus HVpost). Note: Hallux kinematics were calculated relative to forefoot.

Fig. 2

Upper: average forefoot kinematics during complete gait cycle (HVpre versus HVpost versus Normals). Circles denote phases of gait cycle with significantly different minimum and maximum positions (HVpre versus HVpost). Lower: forefoot ROM (average ± SD). Circles denote phases of gait cycle with significantly different ROMs (HVpre versus HVpost). Note: Forefoot kinematics were calculated relative to hindfoot.

Fig. 3

Upper: average hindfoot kinematics during complete gait cycle (HVpre versus HVpost versus Normals). Circles denote phases of gait cycle with significantly different minimum and maximum positions (HVpre versus HVpost). Lower: hindfoot ROM (average ± SD). Circles denote phases of gait cycle with significantly different ROMs (HVpre vs, HVpost). Note: Hindfoot kinematics were calculated relative to tibia.

Fig. 4

Upper: average tibia kinematics during complete gait cycle (HVpre versus HVpost versus Normals). Circles denote phases of gait cycle with significantly different minimum and maximum positions (HVpre versus HVpost). Lower: tibia ROM (average ± SD). Circles denote phases of gait cycle with significantly different ROMs (HVpre versus HVpost). Note: Tibia kinematics were calculated relative to laboratory global.