Funktionelles Outcome der Cheilektomie in der Behandlung des Hallux rigidus

Zusammenfassung

Fragestellung: Die Cheilektomie wird als Operationsverfahren bei Hallux rigidus angewandt und hat die Schmerzreduktion und Verbesserung der Funktion zum Ziel. Die Ergebnisse anhand klinisch funktioneller und pedobarografischer Parameter sowie die subjektive Beurteilung seitens der Patienten waren Inhalt dieser Untersuchung. Methode: In dieser retrospektiven Studie wurden 44 Patienten (52 Füße) nach Cheilektomie untersucht. Das Durchschnittsalter betrug 60,1 Jahre (range: 41–79), das durchschnittliche Follow-up 14,9 Monate (range: 6–40). Es wurden die subjektive Patientenzufriedenheit, der AOFAS-Score und der ROM des MTP 1 erhoben sowie dynamische Messungen der plantaren Druckverteilung durchgeführt. Ergebnisse: 27 Patienten waren mit dem Operationsergebnis sehr zufrieden, 10 Patienten zeigten sich zufrieden. Im untersuchten Kollektiv stieg der AOFAS-Score von insgesamt 35 Punkten präoperativ auf 88 Punkte postoperativ. Die Messdaten der Pedobarografie zeigten im Vergleich zu den nicht operierten Füßen keinen signifikanten Unterschied. Schlussfolgerung: Die Cheilektomie stellt ein geeignetes Operationsverfahren bei Hallux rigidus dar, mit dem eine hohe Patientenzufriedenheit und ein gutes funktionelles Ergebnis erzielt werden können. Die pedobarografischen Analysen zeigen, dass dem pathologisch veränderten Abrollverhalten über den lateralen Fußrand mittels Cheilektomie Abhilfe geschaffen werden kann und die Großzehe wieder aktiv im Gangzyklus Verwendung findet.

Abstract

Introduction: Cheilectomy is performed as treatment for hallux rigidus. Its aim is the relief of pain and improvement of function. Previous pedobarograhic studies have revealed that osteoarthritis of the first metatarsophalangeal joint leads to a lateralisation of peak forces during the stance phase of gait. This occurs since the big toe does not participate in push-off in a sufficient way. The results concerning functional outcome as well as subjective patient satisfaction were assessed in the present study. Plantar pressure distribution analysis was used in order to investigate functional outcome in a biomechanically objective way. Patients and Method: In this retrospective study 44 patients (52 feet) who underwent cheilectomy for the treatment of hallux rigidus were examined. There were 30 women and 14 men with a mean age of 60.1 years (range: 41–79). The average follow-up was 14.9 months (range: 6–40). The assessment included a four-stage subjective satisfaction rating scale, the American Orthopaedic Foot and Ankle Society (AOFAS) metatarsophalangeal-interphalangeal score and first metatarsophalangeal joint (MTP) range of motion (ROM) measurements. In addition, dynamic plantar pressure distribution measurements were performed using the EMED system (Novel GmbH, Munich). The parameters maximum force (N), peak pressure (kPa), contact area (cm²), contact time (msec) and impulse (N × sec) were calculated for the geometric regions of interest great toe, second toe, first metatarsal head, second metatarsal head and total object. Statistical analysis was performed using paired student's t-test and level of significance was set at alpha < 0.05. Results: 27 patients have been very satisfied with the operation, for 10 patients the result of the operation has been satisfactory. The mean AOFAS score increased statistically significant from 35 points presurgery to 88 points postsurgery. First MTP ROM increased from 18.1 ° before surgery to 49.1 ° at follow-up. Isolated dorsiflexion increased from 21.4 ° to 34.1 ° (p = 0.0009) and isolated plantar flexion was 15.8 ° presurgery and 16.9 ° at follow-up (p = 0.214). Plantar pressure analysis revealed no significant difference between the foot that was operated and the non-operated foot for any region of interest or pedobarographic parameter Conclusion: Cheilectomy represents a reliable technique for hallux rigidus that can achieve good results in patient satisfaction and functional outcome. Since the resection of osteophytes improves kinematics of the first MTP joint the technique of cheilectomy may help to restore physiological gait patterns. This is represented by the pedobarographic results of the present study. In fact, they revealed a plantar pressure distribution that is reconstructed to a satisfactory extent, showing that the big toe is reintegrated into a physiological gait pattern.

Schlüsselwörter

Hallux rigidus - Cheilektomie - Pedobarografie - retrospektive Studie - ROM

Key words

hallux rigidus - cheilectomy - pedobarography - retrospective study - ROM

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