Prognostic Performance of the Maximal Systolic Acceleration at the Hallux in Healing of Foot Ulcers: A Retrospective Cohort Study.

BACKGROUND: The accurate prediction of foot ulcer healing remains a major challenge in clinical practice. To date, no reliable bedside tests are available. The primary aim of this study was to determine the prognostic performance of the maximal systolic acceleration (ACCmax) to predict ulcer healing. Secondary objectives comprised the investigation of the prognostic accuracy in patients prone to medial arterial calcification and to assess the potential risk of amputation. METHODS: A single-center retrospective cohort study was conducted. Patients aged ≥18 years who presented with a new-onset ulcer (i.e. Fontaine IV and neuropathic ulcers) on the foot and underwent an ACCmax measurement at the hallux were included. Ulcer healing was defined as an intact skin with epithelialization after 3 or 12 months of follow-up. Prognostic performance was calculated by using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR). RESULTS: In total, 136 patients with 143 wounds were included. Almost half of the patients were diagnosed with diabetes mellitus (47%), and wound infection was present in 42% of cases. After 3 months of follow-up, an NPV of 97.9%, PLR of 3.25, and NLR of 0.19 were found when applying an ACCmax threshold of 0.5 m/s2. When looking at 12 months, these numbers were 85.6%, 2.72, and 0.50, respectively. Subgroup analysis for patients with diabetes mellitus and chronic kidney disease showed comparable results. The risk of amputation increased significantly when a measurement below 1.0 m/s2 was present (odd ratio 5.3, P = 0.010). CONCLUSIONS: ACCmax measurements at the hallux can have additional prognostic value in patients with foot ulcers. An ACCmax below 1.0 m/s2 is associated with nonhealing of an ulcer and a higher risk of amputation, while higher ACCmax values are associated with limb salvage. Therefore, ACCmax could be used for grading ischemia in a wound classification system.

Diagnosis and conservative management of great toe pathologies: a review.

Acute great toe (Hallux) pain is a common complaint encountered by the primary care physician. Pathological conditions can vary from acute trauma to acute exacerbation of underlying chronic conditions. Delay in treatment or misdiagnosis can lead to debilitating loss of function and long-lasting pain. This review endeavors to discuss the pertinent history, physical exam findings, radiographic evidence, conservative treatment options, and surgical management for the musculoskeletal causes of acute and acute on chronic great toe pain in the adult population. The acute pathologies discussed in this review are hallux fractures and dislocations, turf toe, sand toe, and sesamoid disorders. The chronic pathologies discussed include hallux rigidus, hallux valgus, and chronic sesamoiditis.

Early Failures of Polyvinyl Alcohol Hydrogel Implant for the Treatment of Hallux Rigidus.

BACKGROUND: The purpose of this study was to evaluate the clinical and radiological outcomes following a polyvinyl alcohol hydrogel implant in the treatment of hallux rigidus. METHODS: A retrospective cohort study investigating patients treated with a polyvinyl alcohol hydrogel implant for hallux rigidus was performed. Clinical outcomes were evaluated with the Foot and Ankle Outcomes Score (FAOS) and visual analog scale (VAS) score at the final follow-up. Plain radiographs were assessed postoperatively. Eleven patients (11 feet) with a mean follow-up of 20.9 months (range, 14-27 months) were included. The mean age was 60.3 years. RESULTS: All FAOS subscales showed pre- to postoperative improvements, but there was no statistical significance in all subscales. The mean VAS score showed improvement from 4.1 to 3.0 (P = .012). On postoperative plain radiographs, implant subsidence was observed 60% (6/10) at 4 weeks after surgery and 90% (9/10) at the final follow-up. Fifty percent (5/10) showed radiologic lucency around the implant. Forty percent (4/10) had erosion of the proximal phalanx of the great toe. Four patients (36%) reported no improvement following surgery at the final follow-up, which were considered as failures. Three patients required additional surgery related to the implants. An additional patient is waiting to revise the implant. CONCLUSION: Our current cohort study demonstrated a high failure rate with the polyvinyl alcohol hydrogel implant in patients with hallux rigidus. Significant radiologic subsidence with lysis around the implant, erosion of the proximal phalanx countersurface, and implant wear are harbingers for concern in the long term. LEVEL OF EVIDENCE: Level IV, case series.

Increased flexor hallucis longus tension decreases ankle dorsiflexion.

BACKGROUND: Restricted excursion of the flexor hallucis longus (FHL) is associated with several clinical problems. An FHL excursion measurement device (EMD) was used to objectively assess differences between patients with clinically normal or tight FHL tendons. METHODS: 188 patients (356 feet) were enrolled. The EMD measured maximum ankle dorsiflexion with the great toe in 15°, 30°, and 45° of dorsiflexion. All had clinical assessment of FHL tightness by their provider independently of the EMD measurement. RESULTS: Increased hallux DF always caused decreased ankle DF. Patients with clinically tight FHLs demonstrated decreased ankle DF compared to normal subjects at all hallux positions (p<0.01). The EMD measurement was not sensitive enough for detection of FHL tightness in individuals. A clinically tight FHL was seen in almost 50% of feet. CONCLUSIONS: Tension in the FHL can limit ankle DF. Clinical tightness of the FHL is likely more common than currently recognized.

Correlations between weight-bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot.

BACKGROUND: Measurements of plantar loading reveal foot-to-floor interaction during activity, but information on bone architecture cannot be derived. Recently, cone-beam computer tomography (CBCT) has given visual access to skeletal structures in weight-bearing. The combination of the two measures has the potential to improve clinical understanding and prevention of diabetic foot ulcers. This study explores the correlations between static 3D bone alignment and dynamic plantar loading. METHODS: Sixteen patients with diabetes were enrolled (group ALL): 15 type 1 with (N, 7) and without (D, 8) diabetic neuropathy, and 1 with latent autoimmune diabetes. CBCT foot scans were taken in single-leg upright posture. 3D bone models were obtained by image segmentation and aligned in a foot anatomical reference frame. Absolute inclination and relative orientation angles and heights of the bones were calculated. Pressure patterns were also acquired during barefoot level walking at self-selected speed, from which regional peak pressure and absolute and normalised pressure-time integral were worked out at hallux and at first, central and fifth metatarsals (LOAD variables) as averaged over five trials. Correlations with 3D alignments were searched also with arch index, contact time, age, BMI, years of disease and a neuropathy-related variable. RESULTS: Lateral and 3D angles showed the highest percentage of significant (p < 0.05) correlations with LOAD. These were weak-to-moderate in the ALL group, moderate-to-strong in N and D. LOAD under the central metatarsals showed moderate-to-strong correlation with plantarflexion of the 2nd and 3rd phalanxes in ALL and N. LOAD at the hallux increased with plantarflexion at the 3rd phalanx in ALL, at 1st phalanx in N and at 5th phalanx in D. Arch index correlated with 1st phalanx plantarflexion in ALL and D; contact time showed strong correlation with 2nd and 3rd metatarsals and with 4th phalanx dorsiflexion in D. CONCLUSION: These preliminary original measures reveal that alteration of plantar dynamic loading patterns can be accounted for peculiar structural changes of foot bones. Load under the central metatarsal heads were correlated more with inclination of the corresponding phalanxes than metatarsals. Further analyses shall detect to which extent variables play a role in the many group-specific correlations.

The coordination patterns of the foot segments in relation to lateral ankle sprain injury mechanism during unanticipated changes of direction.

Preventing lateral ankle sprain injuries (LAS) in females competing in court sports is a high priority, as an athlete's risk for re-injury and developing long term dysfunction increases significantly after sustaining an acute LAS. Stability to the ankle joint is passively provided by the joint congruity and ligaments, and actively by the muscles acting on the foot. The ankle joint is most stable when loaded and dorsiflexed. However, during unanticipated changes of direction, typical in court sports, the foot is often in a vulnerable unloaded, plantarflexed position. Stability of the forefoot and controlling rearfoot movement to avoid excessive ankle inversion and adduction thus becomes imperative. Information regarding the coupling relationship between the forefoot (hallux and metatarsal segments) and the rearfoot (calcaneus segment) during unanticipated changes of direction is lacking. The aim of this study was to supplement current LAS prophylactic knowledge by describing and quantifying hallux-calcaneus and metatarsal-calcaneus coupling. The coupling angles between sagittal plane hallux, tri-planar metatarsal and frontal- and transverse plane calcaneus movement, respectively, were calculated with a modified vector coding technique which used segmental velocities in a local, anatomical reference frame instead of segmental angles in a global reference frame. Coupling relationships revealed anti-phase movement between sagittal- metatarsal and frontal plane calcaneus movement throughout stance. During loading, sagittal- and frontal plane metatarsal acceleration/deceleration were coupled with frontal-transverse plane calcaneus acceleration/deceleration respectively. The remainder of the braking phase was characterized by calcaneus eversion deceleration. During propulsion, the hallux and metatarsal segments increased plantar flexion velocity in response to calcaneus inversion and adduction acceleration. As the forefoot was the only point of contact during stance, the coupling between segments were most likely neuromuscular. Strengthening intrinsic and extrinsic foot muscles may thus contribute to foot and ankle stability, adding to current prophylactic LAS strategies.

Turf Toe, Traumatic Hallux Valgus, and Hallux Rigidus -What Can I Do After an Metatarsophalangeal Fusion?

Turf toe injuries should be recognized and treated early to prevent long-term disability. The accurate clinical assessment and radiological evaluation of appropriate cases is important. Both conservative and surgical treatments play a major role in getting athletes back to their preinjury level. There are more recent reported case series and systemic reviews that encourage operative treatment as early as possible for grade III turf toe injury. If the patient presents late from a traumatic hallux injury with subsequent degenerative changes or has hallux rigidus from other etiologies, a first metatarsophalangeal arthrodesis should be considered to minimize pain and improve function.

Posterior Ankle Impingement and Flexor Hallucis Longus Pathology.

Posterior ankle pain is a common complaint, and the potential causative pathologic processes are diverse. The constellation of these numerous etiologies has been collectively referred to as posterior ankle impingement syndrome. The pain associated with posterior ankle impingement is caused by bony or soft tissue impingement of the posterior ankle while in terminal plantar flexion. This condition is most frequently encountered in athletes who participate in sports that involve forceful, or repetitive, ankle plantar flexion. This article discusses the associated pathology, diagnosis, conservative treatment, and surgical techniques associated with flexor hallucis longus and posterior ankle impingement syndrome.

"Electrifying dysmorphology": Potassium channelopathies causing dysmorphic syndromes.

Potassium channels are a heterogeneous group of membrane-bound proteins, whose functions support a diverse range of biological processes. Genetic disorders arising from mutations in potassium channels are classically recognized by symptoms arising from acute channel dysfunction, such as periodic paralysis, ataxia, seizures, or cardiac conduction abnormalities, often in a patient with otherwise normal examination findings. In this chapter, we review a distinct subgroup of rare potassium channelopathies whose presentations are instead suggestive of a developmental disorder, with features including intellectual disability, craniofacial dysmorphism or other physical anomalies. Known conditions within this subgroup are: Andersen-Tawil syndrome, Birk-Barel syndrome, Cantú syndrome, Keppen-Lubinsky syndrome, Temple-Baraitser syndrome, Zimmerman-Laband syndrome and a very similar disorder called Bauer-Tartaglia or FHEIG syndrome. Ion channelopathies are unlikely to be routinely considered in the differential diagnosis of children presenting with developmental concerns, and so detailed description and photographs of the clinical phenotype are provided to aid recognition. For several of these disorders, functional characterization of the genetic mutations responsible has led to identification of candidate therapies, including drugs already commonly used for other indications, which adds further impetus to their prompt recognition. Together, these cases illustrate the potential for mechanistic insights gained from genetic diagnosis to drive translational work toward targeted, disease-modifying therapies for rare disorders.

First metatarsophalangeal joint range of motion is associated with lower limb kinematics in individuals with first metatarsophalangeal joint osteoarthritis.

BACKGROUND: Osteoarthritis of the first metatarsophalangeal joint (1st MTP joint OA) is a common and disabling condition that results in pain and limited joint range of motion. There is inconsistent evidence regarding the relationship between clinical measurement of 1st MTP joint maximum dorsiflexion and dynamic function of the joint during level walking. Therefore, the aim of this study was to examine the association between passive non-weightbearing (NWB) 1st MTP joint maximum dorsiflexion and sagittal plane kinematics in individuals with radiographically confirmed 1st MTP joint OA. METHODS: Forty-eight individuals with radiographically confirmed 1st MTP joint OA (24 males and 24 females; mean age 57.8 years, standard deviation 10.5) underwent clinical measurement of passive NWB 1st MTP joint maximum dorsiflexion and gait analysis during level walking using a 10-camera infrared Vicon motion analysis system. Sagittal plane kinematics of the 1st MTP, ankle, knee, and hip joints were calculated. Associations between passive NWB 1st MTP joint maximum dorsiflexion and kinematic variables were explored using Pearson's r correlation coefficients. RESULTS: Passive NWB 1st MTP joint maximum dorsiflexion was significantly associated with maximum 1st MTPJ dorsiflexion (r = 0.486, p < 0.001), ankle joint maximum plantarflexion (r = 0.383, p = 0.007), and ankle joint excursion (r = 0.399, p = 0.005) during gait. There were no significant associations between passive NWB 1st MTP joint maximum dorsiflexion and sagittal plane kinematics of the knee or hip joints. CONCLUSIONS: These findings suggest that clinical measurement of 1st MTP joint maximum dorsiflexion provides useful insights into the dynamic function of the foot and ankle during the propulsive phase of gait in this population.

PAPPI: Personalized analysis of plantar pressure images using statistical modelling and parametric mapping.

Quantitative analyses of plantar pressure images typically occur at the group level and under the assumption that individuals within each group display homogeneous pressure patterns. When this assumption does not hold, a personalized analysis technique is required. Yet, existing personalized plantar pressure analysis techniques work at the image level, leading to results that can be unintuitive and difficult to interpret. To address these limitations, we introduce PAPPI: the Personalized Analysis of Plantar Pressure Images. PAPPI is built around the statistical modelling of the relationship between plantar pressures in healthy controls and their demographic characteristics. This statistical model then serves as the healthy baseline to which an individual's real plantar pressures are compared using statistical parametric mapping. As a proof-of-concept, we evaluated PAPPI on a cohort of 50 hallux valgus patients. PAPPI showed that plantar pressures from hallux valgus patients did not have a single, homogeneous pattern, but instead, 5 abnormal pressure patterns were observed in sections of this population. When comparing these patterns to foot pain scores (i.e. Foot Function Index, Manchester-Oxford Foot Questionnaire) and radiographic hallux angle measurements, we observed that patients with increased pressure under metatarsal 1 reported less foot pain than other patients in the cohort, while patients with abnormal pressures in the heel showed more severe hallux valgus angles and more foot pain. Also, incidences of pes planus were higher in our hallux valgus cohort compared to the modelled healthy controls. PAPPI helped to clarify recent discrepancies in group-level plantar pressure studies and showed its unique ability to produce quantitative, interpretable, and personalized analyses for plantar pressure images.

Knot of Henry Variation and the Effect on Plantar Flexion Strength.

BACKGROUND: The flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons are commonly used for tendon transfer in reconstructive foot and ankle procedures. Some patients experience great toe weakness and loss of push-off strength. The objective of this biomechanical study was to quantify plantarflexion force after FHL and FDL harvest and correlate it to variations in tendon crossover patterns at the knot of Henry to determine if specific patterns have an increased tendency toward forefoot weakness. METHODS: Simulated loads through the Achilles, FHL, and FDL were applied to cadaveric specimens while plantarflexion force was measured using a pressure mapping system. Force was recorded with the FDL and FHL unloaded to simulate tendon transfer. Afterward, specimens were dissected to classify the tendinous slips between the FHL and FDL based on a previously determined system. Functional and anatomical relationships between the classification type and loading patterns were analyzed. RESULTS: There were no statistical differences between the tendon crossover patterns in forefoot force reduction after FHL or FDL harvest. Average decrease in great toe and total forefoot pressure after FHL harvest was 31% and 22%, respectively. Average decrease in lesser toe and total forefoot push-off force after FDL harvest was 23% and 9%, respectively. CONCLUSION: This study quantified loss of plantarflexion force after simulated FHL and FDL harvest and correlated these losses to variations in anatomic crossover patterns at the knot of Henry. Variations at the knot of Henry do not contribute to differences in forefoot weakness. CLINICAL RELEVANCE: The decrease in forefoot pressure seen here would help explain the clinical scenario where a patient does note a loss of great toe strength after FHL transfer.

Cathodal tDCS on the motor area decreases the tactile threshold of the distal pulp of the hallux.

Transcranial direct current stimulation (tDCS) has been reported to modulate cortical excitability. Most studies on this topic addressed the modulation effects of tDCS on the upper extremities. Foot-sole tactile sensation is essential to gait, but little is known about the effect of tDCS on sensory function in the foot area. Here we administered tDCS to 10 healthy adults, and we observed that the modulation effects of cathodal tDCS on the left motor area led to a decrease in the tactile threshold of the left center of the distal pulp of the hallux. This effect was not observed in the sham condition. In addition, the subjects' vigilance levels were not changed between before and after the tDCS. These results suggest that sensation on the sole of the left foot could be modulated by cathodal tDCS on the left motor area.

Plantar forces mid-term after hemiarthroplasty with HemiCAP for hallux rigidus.

BACKGROUND: The aim of this study was to examine the biomechanical gait effects and range of motion following a proximal hemiarthroplasty with a HemiCap®. METHODS: Forty-one HemiCAP-operated participants with a mean follow-up time of 5 years had plantar force variables (PFVs) examined and compared with their non-operated foot and a control group. PFVs were compared to the MTPJ1 range of motion (ROM), and pain measured by Visual Analog Scale (VAS). RESULTS: The HemiCAP participants' operated feet had higher PFVs laterally on the foot and lower PFVs under the hallux. Dorsal ROM of the operated feet was a median 45° (range 10-75) by goniometer and 41.5 (range 16-80) by X-ray. An increase in ROM decreased the forces under the hallux. Most participants were pain-free. No correlation between pain and PFVs was found. CONCLUSIONS: Increased dorsiflexion decreased the maximum force under the hallux. A mid-term HemiCAP maintains some motion. The decreased PFVs under the hallux may reflect a patient reluctance to load the first ray, although no correlation between plantar forces and pain was found.

Great toe drop following knee ligament reconstruction: A case report.

Case Description: A 17-year-old male post anterior cruciate ligament reconstruction complained of the inability to extend his great toe immediately following surgery. Background: Neurological injuries following knee arthroscopy have been reported to occur between 0.6%-2.5%. The most commonly injured nerves are the saphenous and common fibular nerve (CFN). Great toe-drop secondary to isolated denervation of the extensor hallucis longus (EHL), has only been reported one time in the literature. This report describes a case of isolated denervation of the EHL following knee cruciate ligament reconstruction. A detailed description of the anatomy of the CFN is reviewed as well as how electroneuromyographic (EMG/NCS) testing can assist in the diagnosis, prognosis, and intervention of this type of injury. Outcomes: EHL paralysis did not functionally limit the patient from participating in a post-surgical rehabilitation regime. The patient successfully completed his ACL reconstruction rehabilitation and was released to return to sporting activities 9 months postsurgery. Twelve months post-surgery, the patient regained full great toe extension and strength. Discussion: It is important to note that physical therapists can identify the need for, refer, and in some instances perform EMG/NCS testing on patients with neuromuscular disorders. Isolated injury of the CFN branch that innervates the EHL is extremely rare. Understanding the anatomy of the CFN and its branches is critical for the physical therapist when performing an examination and interpreting the findings. It is also important to understand the potential causes and management approaches following this type of injury.

Constraints on variation of weight-shifting by foot during walking in adolescents with valgus alignment of hallux.

PURPOSE: Etiology of hallux valgus (HV) remains unclear and effective treatments and prophylaxis for this condition are lacking and conclusions of researches concerning HV are inconsistent. Recognition of the function-structure interrelation in foot at the early stage of valgus alignment of first metatarsophalangeus joint (1stMTPJ) would help explain the etiology of HV. METHODS: The frequency of weight-shifting patterns during walking and the body mass index (BMI) were assessed relative to goniometric measurements of the 1stMTPJ angle in adolescents. Weight-shifting patterns were identified with a plantar pressure analysis, performed with the Gaitline- Maxline Distance method. RESULTS: As the 1stMTPJ angle widened, the frequency distributions of identified weight-shifting patterns became increasingly lopsided, due to the favoring or disfavoring of one pattern at the expense of the other. The two sexes showed opposite trends in the weight-shifting patterns that were favored/disfavored, relative to participants with a 0º 1stMTPJ angle. The clear predominance of a central-shift pattern, at the expense of a medial-shift, occurred with the largest (20º) 1stMTPJ angle among girls. Additionally, the BMI distributions associated with 1stMTPJ angle characteristics showed opposite trends between the sexes. CONCLUSIONS: Valgus alignment of 1stMTPJ among adolescents were associated with limitations in weight-shifting freedom of the foot during walking, that could be involved in maintaining balance. An 1stMTPJ angle of 20º, where distinct limitations were observed, might serve as a criterion of HV pathology.

Double origin of the extensor hallucis longus muscle: a case report.

Most of the anatomic variations of the extensor hallucis longus (EHL) muscle are related to the tendon of insertion. We show a double origin of the EHL from the medial aspect of the fibula and the lateral aspect of the tibia. A 27-year-old male with a double closed fracture of tibia and fibula showed an involuntary extension of the big toe during foot plantar flexion after surgery. A tendon fibrosis by the fixation plates could be the cause of the foot functional alteration. Interestingly, the anatomic variation described could be related to the postsurgical foot dysfunction, since when the fibrotic tissue was removed the normal extension of big toe recovered. As illustrated in this case report, knowledge of anatomic variations is very useful, particularly in the context of foot surgery.

Efficacy, Outcomes, and Alignment Following Isolated Fibular Sesamoidectomy via a Plantar Approach.

BACKGROUND: The purpose of this study was to evaluate patients for intermediate-term pain relief, functional outcome, and changes in hallux alignment following isolated, complete fibular sesamoidectomy via a plantar approach for sesamoid-related pain recalcitrant to conservative treatment. METHODS: A retrospective query of a tertiary referral center administrative database was performed using the Current Procedural Terminology code 28135 for sesamoidectomy between 2005 and 2016. Patients who underwent an isolated fibular sesamoidectomy were identified and contacted to return for an office visit. The primary outcome measure was change in visual analog pain score at final follow-up. Secondary measures included satisfaction, hallux flexion strength, hallux alignment, pedobarographic assessment, and postoperative functional outcome scores. Patients who met the 2-year clinical or radiographic follow-up minimum were included. Ninety fibular sesamoidectomies were identified. Thirty-six sesamoidectomies met inclusion criteria (median 60-month follow-up). The average patient was 36 years old and underwent sesamoidectomy 1.1 years after initial diagnosis. RESULTS: Median visual analog scale scores improved 5 (6 to 1) points at final follow-up (P < .001). Final postoperative mean hallux valgus angle did not differ from preoperative values (10.5 degrees/8.5 degrees, P = .12); similarly, the intermetatarsal angle did not differ (8.0 degrees/7.9 degrees, P = .53). Eighty-eight percent of patients would have surgery again and 70% were "very satisfied" with their result. Hallux flexion strength (mean 14.7 pounds) did not differ relative to the contralateral foot (mean 16.1 pounds) (P = .23). Among the full 92 case cohort, 3 patients underwent 4 known reoperations. CONCLUSION: Fibular sesamoidectomy effectively provided pain relief (median 5-year follow-up) for patients with sesamoid pathology without affecting hallux alignment. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Reliability of peak foot pressure in patients with previous diabetic foot ulceration.

BACKGROUND: Previous reliability studies on peak plantar pressure measurements in patients with previous diabetic foot ulceration (DFU) did not stratify their analyses according to whether the foot had a previous ulcer. RESEARCH QUESTION: Does test-retest reliability of peak foot pressure measurements from the various foot regions differ between the ulcerated and non-ulcerated feet? METHODS: Data from 23 participants with peripheral neuropathy and healed plantar DFU were analysed in this test-retest reliability comparison study. Plantar pressure was evaluated on two sessions using Pedar®-X in-shoe system, with a mean of 7.2 days (SD = 1.6) between sessions. RESULTS: The intraclass correlation coefficient (ICC) and coefficient of variation (CV) were calculated for 10 foot regions. Overall, test-retest reliability was excellent (ICCs, 0.82 to 0.95) for all peak pressure variables. CV ranged between 6.3% and 18.3%, and exceeded 15% over the hallux and medial forefoot regions in the ulcer foot (18.3% and 16.4%, respectively). Hallux peak pressure CV was significantly higher over the ulcer foot than over the non-ulcer foot (5.7%, 95% CI, 1.7%-10.2%). Peak pressure CV over the forefoot also tended to be higher over the ulcer foot (medial forefoot: 6.1%, 95% CI, -0.5%-14.5%; lateral forefoot: 4.1%, 95%CI, -0.7%-11.1%). SIGNIFICANCE: Peak plantar foot pressure may be useful to distinguish between groups of patients with peripheral neuropathy and healed plantar DFU. However, clinical decisions based on ulcer foot hallux and forefoot peak pressure measurements should be interpreted with caution.

Comparison of Plantar Pressure Distribution Between Postoperative Hallux Valgus Feet and Healthy Feet.

BACKGROUND: Proximal crescentic osteotomy (PCO) in patients with moderate-to-severe hallux valgus (HV) is a well-established and effective procedure for correcting the deformity. However, there are no published studies comparing plantar pressure in postoperative HV feet with healthy feet. This study aimed to compare the plantar pressure distribution in postoperative HV feet with healthy feet. METHODS: Twenty-six patients were included in the HV group, and 24 healthy participants were included in the control (C) group. All patients in the HV group underwent unilateral PCO. After undergoing PCO, this group was defined as the OP group. All subjects were women with no significant differences in age, height, weight, and body mass index. There were no significant differences in demographic characteristics between patients in each group. We divided the subjects' feet into 8 regions and measured the peak pressure (Peak-P), maximum force (Max-F), contact time, contact area, and the force-time integral in each region. RESULTS: All parameters of the great toe were significantly higher in the OP group than in the HV group. All forefoot parameters were not significantly different between the 2 groups. No parameter of the great toe was significantly different between the OP and C groups. However, mean Peak-P and Max-F of the central forefoot were significantly higher in the OP group than in the C group. CONCLUSION: PCO can improve the plantar pressure of the great toe in patients with moderate-to-severe HV to a level similar to that in healthy subjects. LEVEL OF EVIDENCE: Level III, comparative study.