[Study on the correlative factors of the pain under the second metatarsal in patients with hallux valgus].

OBJECTIVE: To analyze the correlation between the hallux valgus angle and arch X-ray parameters change, plantar pressure by measuring the X-ray indexes and foot-pressure indexes in patients with hallux valgus, as well as to study the main cause factors for the pain under the second metatarsal head. METHODS: A retrospective study of 254 patients(477 feet) treated in Wangjing Hospital from January 2012 to June 2013 was performed. The pain under the second metatarsal head and age distribution were recorded. All the patients were divided into two groups according to the second plantar bone pain: pain group and no pain group. The following indexes were measured and compared: HAVA(hallux abductor valgus angle), IMA1-2(the inter-metatarsal angle between the first and second metatarsals), IMA1-5(the inter-metatarsal angle between the first and fifth metatarsals), TAOTMLA (top angle of the medial longitudinal arch), AAOTMLA (anterior angle of the medial longitudinal arch), SMRL (the second metatarsal relative length than the first), and the plantar pressure indicators including TPUM (touch the ground time percentage under the second metatarsal head), PPUM (peak pressure under the second metatarsal head), and IUM(impulse under the second metatarsal head). All the factors were evaluated by Logistic regression analysis. RESULTS: Spearman rank correlation test showed that there were statistical significance in correlation between HAVA and IMA1-2, IMA1-5, TAOTMLA, AAOTMLA, TPUM(P<0.05, r=0.647, 0.553, 0.127, -0.165, 0.158). Factors including the HAVA, SMRL and the TPUM were the risks for the pain under the second metatarsal head in patients with hallux valgus(P<0.05, ORj=1.030, 1.069, 1.060). CONCLUSIONS: Increase of the hallux valgus angle causes the collapse of hallux valgus arch, extending the weight bearing time of the second metatarsal and increasing the possibility of the pain under the second metatarsal.

[Correlative analysis on metatarsalgia and the X-ray measurement indexes under weight-bearing and non-weight-bearing of hallux valgus].

OBJECTIVE: To study changes in the radiographic appearance during weight-bearing and non-weigh-bearing in hallux valgus, and to analyse the correlation between the elasticity of plantar soft tissue of hallux valgus and the pain under the metatarsal head. METHODS: From May 2012 to October 2012, 240 feet of 120 patients with hallux valgus were enrolled in the study. The degrees of the pian under the metatarsal head of all the patients were observed. AP and lateral X-ray films of feet were taken on the condition of weight-bearing and non-weight-bearing. So the hallux valgus angle (HVA), the inter-metatarsal angle between the first and second metatarsals (IM1-2), the inter-metatarsal angle between the first and fifth metatarsals (IM1-5), top angle of the medial longitudinal arch (TAOTMLA),and anterior angle of the medial longitudinal arch (AAOTMLA) were measured on the X-ray films. The differences of HVA, IM1-2, IM1-5, TAOTMLA and AAOTMLA between two groups were compared, and the correlation between the changes of IM1-2, IM 1-5, TAOTMLA, AAOTMLA and the degree of the pain under the metatarsal head were analysed. RESULTS: One hundred and forty-eight feet had the pain under the metatarsal head. The IM1-2, IM1-5 and TAOTMLA increased on weight-bearing position compared with those on non-weight-bearing position, but the HVA and AAOTMLA decreased on weight-bearing position compared with those on non-weight-bearing position. There was a moderate relationship between the changes of IM 1-2,IM1-5 and the degree of the hallux valgus deformity, as well as the relationship between the different of IM1-5 and the degree of the pian under the metatarsal head. CONCLUSION: The degree of the collapse of the arch of foot with hallux valgus becomes serious with its deformity increasing. The pain under the metatarsal head of hallux valgus increases with the increased changes of IM 1-2,IM 1-5 and TAOTMLA. Analysis of the X-ray observation indexes of hallux valgus on weight-bearing position and non-weight-bearing position has important significance in evaluating the degree of the collapse of the arch of foot with hallux valgus,preventing and curing the the pain under the metatarsal head.

Clinical treatment of the stenosing tenovaginitis of flexor digitorum by micro-wound technique using hooked needle-shaped surgical knife.

OBJECTIVE: To observe the therapeutic effect and safety of using the hooked needle-shaped knife to treat the stenosing tenovaginitis of flexor digitorum. METHODS: Sixty outpatients were divided into a treatment group of 30 cases treated by using the hooked needle-shaped knife, and a control group of 30 cases treated by block therapy. 6 months later, the alleviation of pain in the affected finger during movement, under pressure, traction and finger-bending anti-resistance was compared before and after treatment. RESULTS: The alleviation of pain during movement, under pressure, traction and finger-bending anti-resistance was much better in the treatment group than that of the control group (P < 0.01), with a effective rate of 93.3% in the treatment group and 80.0% in the control group (P < 0.01). CONCLUSION: The micro-wound technique using the hooked needle-shaped knife has definite effect and safety for stenosing tenovaginitis of flexor digitorum.

[Effects on VEGF and VEGF mRNA expression of the tissues of periosteum in three-period treatment of TCM for the fractures in rabbit].

OBJECTIVE: To observe the effects of the three-period treatment theory of bone fracture in TCM (Traditional Chinese Medicine) on VEGF and VEGF mRNA expression in the issues of outer periosteum, endosteum and bone marrow of rabbits, and to explore the rationality of phasing method in TCM in treating fracture. METHODS: 3 mm bone defection were made at lower one third part of both radius in 140 male healthy rabbits. The rabbits were randomly divided into four groups, including three-period treatment group (TTG), one-period treatment group(OTG), positive medicine treatment group(PTG) and model control group (MCG). The rabbits in TG were treated with three-period treatment, rabbits in OTG were treated with one-period treatment, rabbits in PTG were fed by Guzhe-Cuoshangsan (a Chinese patent medicine which was used to treat bone fracture), rabbits in model control group were given no prescription or drug but distilled water as same dose as that of other groups. At day 3, 6, 9, 14, 28, 42 and 56, five rabbits from every group were randomly selected and were killed by aeroembolism. The left radiuses were taken out as the research object. Immunohistochemistry stain and in situ hybridization stain were performed to examinate the VEGF and VEGF mRNA expression in the outer periosteum, endosteum and bone marrow. RESULTS: The VEGF and VEGF mRNA expression of all TCM treatment groups were enhanced in the outer periosteum, endosteum and bone marrow at different time points in fracture healing. The VEGF and VEGF mRNA expression in the three tissues of TTG had the tendency of higher than that of the other groups at the most time points after operation. CONCLUSION: Treating fracture in stages has more predominant effect on the expression of VEGF and VEGF mRNA in the outer periosteum, endosteum and bone marrow than that of treating fracture with single prescription or drug.

Long term efficacy of minimal incision osteotomy for hallux abducto valgus.

OBJECTIVE: To observe and evaluate the long-term results of minimal incision osteotomy for hallux abducto valgus. METHODS: From February 1995 to May 1999, 372 cases (705 feet) with hallux abducto valgus were treated with minimal incision osteotomy. Seventy-nine patients (150 feet) were followed up for more than five years (mean 7.5; range, 5.3-13.2 years) after surgery. The preoperative and postoperative hallux abducto valgus angles (HVA), intermetatarsal angles (IMA), tibial sesamoid position (TSP), American Orthopaedic Foot And Ankle Society (AOFAS) score, range of movement of the first metatarsophalangeal joint and lateral metatarsalgia were observed, measured and evaluated. RESULTS: Based on clinic curative effect evaluation criterion, 56 feet (37.3%) were excellent, 88 feet (58.7%) good, 6 feet (4.0%) fair. The postoperative mean AOFAS score was 84.20 ± 4.32 points. The mean HVA decreased from 33.28° to 12.31° and the mean IMA1-2 from 11.75° to 6.80°. The TSP was corrected from an average preoperative grade of 4.29 to a grade of 3.07 by final follow-up. There was no nonunion or delayed union, no avascular necrosis, no infection, and no hallux varus. Numbness in the big toe was found in 4 feet (2.7%). The range of motion of the first metatarsophalangeal joint decreased from 70.20° to 69.53°. Of 97 feet (64.7%) with pre-operative 2-5 metatarsalgia, this had disappeared in 35 feet, improved in 54 feet and was aggravated in 8 feet postoperatively. CONCLUSION: Minimal incision osteotomy is a simple and reliable technique for treating hallux abducto valgus with minimal complications.

[Case control study of hook needle knife for the treatment of stenosing tenovaginitis of flexor digitorum].

OBJECTIVE: To investigate the effect and safety of the hook needle knife for the treatment of stenosing tenovaginitis of flexor digitorum. METHODS: From September 2007 to September 2008, 60 outpatients with stenosing tenovaginitis of flexor digitorum were randomized divided into the treatment group and the control group, 30 cases in each group. Among the patients, 44 patients were female and 16 patients were male, aged from 34 to 69 years, averaged 56 years, the duration of disease ranged from 1 month to 1 year, averaged 3 months. All the patients were treated with hook needle knife and local-blocking respectively. The patients were followed up for 6 months, and the relief of moving-pain, tender-pain, stretching-pain and resist-ing--pain were observed respectively. All the patients were evaluated by the symptoms with numerical rating scale. RESULTS: The relief of moving-pain, tender-pain, stretching-pain and resisting-pain in the treatment group were significantly better than those of the control group; and the therapeutic effects of treatment group were better than those of the control group. CONCLUSION: The method for treating stenosing tenovaginitis of flexor digitorum with hook needle knife has advantages of definite effects, micro-invasion and safety.

[Swanson double-stem silicone implant arthroplasty in the treatment of Freiberg disease].

OBJECTIVE: To observe the short-term results of Swanson double-stem silicone implant arthroplasty in the treatment of late stage Freiberg disease. METHODS: From July 2006 to December 2007, Swanson double-stem silicone implant arthroplasty was performed on 13 patients, 11 male (1 foot) and 12 females (17 feet), suffering from late stage Freiberg diseases. All the cases were the second metatarsophalangeal joints. According to the Smillie classification, 11 feet present with grade 4 osteonecrosis, 7 feet with grade 5. The AOFAS scoring system was used for clinical assessment. All the patients were followed up for an average of 11.3 months (3 to 17 months). RESULTS: The mean preoperative and postoperative AOFAS scores were (50.06 +/- 9.59) and (77.50 +/- 4.99), respectively (P<0.05). The complaint of pain with joint motion was decreased in all patients. The postoperative passive range of motion of joints improved significantly. CONCLUSION: Swanson double-stem silicone implant arthroplasty yields satisfied short-term results in late stage Freiberg disease, which is effective to improve range of motion and relieve pain of joint.

[Treatment of capsulitis of little toe with minimal incisional osteotomy and manipulations].

OBJECTIVE: To study therapeutic effects of capsulitis of little toe treated with minimal incisional osteotomy and manipulations procedures. METHODS: From 2003.7 to 2008.6, 90 patients (160 feet) with capsulitis of little toe including 3 male (5 foot) and 87 female (155 foot) ranging in age from 17 to 76 years(average of 49.2 years).The average medical history was 10.1 years ranging from 1 to 32 years. All patients with capsulitis of little toe were treated with minimal incisional osteotomy and manipulations procedures adopting the modified Coughlin standard to evaluation. RESULTS: All patients were followed up, the duration of follow-up raunged from 3 to 36 months with averagement of 15.7 months. According to the modified Coughlin standard, 80 cases obtained an excellent result, 8 good, 2 fair and 0 poor, the effective rate was 97.8%. However,two patients were found delayed union after operation, the distal fragments healed following the time of fixation were delayed. CONCLUSION: The treatment of capsulitis of little toe with minimal incisional osteotomy and manipulations procedures is easy to operate and its therapeutic effect is convincing.

[Observation on pathological changes of the medial aspect of the first metatarsal head of hallux valgus].

OBJECTIVE: To observe pathological characteristic of bone and soft tissue of the medial aspect of the first metatarsal head in order to investigate the pathogenesis of hallux valgus. METHODS: One hundred and twenty-three patients with hallux valgus (235 feet) were obtained from August 2003 to December 2004 in our department. The bone and soft tissue of the medial aspect of the first metatarsal head were taken out from the incision. The pathological conditions of specimen were observed by HE stain. RESULTS: The pathological changes included: degeneration and desmoplasia around the attachment point of tendon and joint capsule, reactive hyperplasia of periost, decreasing of bone trabecula, cartilaginification of periost, cortical bone and tendon insertion, bone formation and osteoclasts response. CONCLUSION: The pathological changes of the medial aspect of the first metatarsal head of hallux valgus presented extensive chronic inflammation.

[Effects on VEGF and VEGF mRNA expression in issues of callus in treating fracture of rabbit with three-period treatment theory of bone fracture in traditional Chinese medicine].

OBJECTIVE: To observe the effects of the three-period treatment theory of bone fracture in traditional Chinese medicine (TCM) on VEGF and VEGF mRNA expression in the issues of callus of rabbits. And to explore the rationality of phasing method in TCM in treating fracture. METHOD: one hundred and forty male and healthy rabbits were made 3 mm wide bone defection at lower one third part of both radius as fracture healing model. Then those rabbits were divided into four groups randomly, which are three-period treatment group (TTG), one-period treatment group (OTG), positive medicine treatment group (PTG) and model control group (MCG). Those rabbits in TTG were treated with three-period treatment. Those in OTG were treated with one-period treatment. Those in PTG were feed by guzhecuoshangsan, a Chinese patent medicine which is used to treat bone fracture. Those in model control group were given no prescription or drug but distilled water as same dose as that of other groups. At day 3, 6, 9, 14, 28, 42 and 56, five rabbits were selected from every group randomly and were killed by aeroembolism respectively. Their radius were taken out and the left one was taken as the research object. Immunohistochemistry stain and in situ hybridization stain were performed to examinate the VEGF and VEGF mRNA expression in the haematoma, fibrous callus and soft callus. RESULT: All TCM treatment groups can enhance the VEGF and VEGF mRNA expression in the haematoma, fibrous callus and soft callus at different time points in fracture healing. The VEGF and VEGF mRNA expression in the three issues of TTG had the tendency of higher than that of the other groups at the most time points after operation. CONCLUSION: TCM can promote the VEGF and VEGF mRNA expression in the haematoma, fibrous callus and soft callus. Different Chinese medicines play various roles on VEGF and VEGF mRNA expression at different stage of fracture healing. Treating fracture in three-period treatment has more predominant effect on the expression of VEGF and VEGF mRNA in the haematoma, fibrous callus and soft callus than that of treating fracture with single prescription or drug. It is necessary to treat fracture in stages.