Limitación de la flexión dorsal del tobillo y del hallux en nadadores de categoría máster / Limitation of ankle dorsiflexion and hallux in master category swimmers

Objetivos: Los objetivos son observar qué variables de las estudiadas presentan diferencias al realizar comparación entre nadadores que presentan test de Lunge positivo, dolor en tríceps sural y musculatura plantar y los nadadores que no presentan dolor. Pacientes y métodos: Se trata de un estudio observacional, descriptivo, de corte transversal que se ha realizado sobre una muestra de veinte nadadores de categoría máster (12 hombres y 8 mujeres) y que presentan de forma habitual dolor en pie (musculatura plantar) y pierna (tríceps sural) durante el nado. Resultados: Los resultados han mostrado que las variables extensión de rodilla (p = 0.020), flexión dorsal de tobillo (p = 0.006) y ángulo poplíteo (p = 0.003) son las que mayores diferencias significativas tienen entre los nadadores con y sin dolor en tríceps sural y entre aquellos con test de Lunge positivo y negativo. Las variables de flexión dorsal de la primera articulación metatarsofalángica (AMTF) (p = 0.039) y plantar flexión del primer radio (p = 0.011) con las que han presentado mayor diferencia estadística entre nadadores con test de Lunge positivo y negativo. Conclusiones: Al comparar nadadores que presentan dolor en tríceps sural y musculatura plantar entre nadadores que no presentan dolor, los deportistas que sí presentan dolor, son aquellos cuyos valores de media en las variables flexión dorsal de tobillo, flexión dorsal de la primera AMF, extensión de rodilla y plantarflexión del primer radio, son menores en comparación con los que no presentan dolor, presentándose diferencias entre ambas extremidades (AU)

Objectives: The objectives are to observe which of the variables studied present differences when comparing swimmers who present a positive Lunge Test, pain in the triceps surae and plantar muscles and swimmers who do not present pain. Patients and methods: This is an observational, descriptive, cross-sectional study that has been carried out on a sample of twenty master category swimmers (12 men and 8 women) who regularly present foot pain (plantar muscles) and leg (triceps surae) during swimming. Results: The results have shown that the variables knee extension (p = 0.020), ankle dorsiflexion (p = 0.006) and popliteal angle (p = 0.003) are the ones with the greatest significant differences between swimmers with and without pain in the ankle, triceps surae and between those with positive and negative Lunge Test. The variables dorsiflexion of the first metatarsopahlangeal (MTP), joint (p = 0.039) and plantar flexion of the first ray (p = 0.011) are those that have presented the greatest statistical difference between swimmers with a positive and negative Lunge test. Conclusions: When comparing swimmers who present pain in the triceps surae and plantar muscles with swimmers who do not present pain, the athletes who do present pain are those whose average values in the variables ankle dorsiflexion, first MTP dorsiflexion, knee extension and plantar-flexion of the first ray are lower compared to those who do not present pain, with differences between both limbs (AU)

Influencia del tratamiento quirúrgico para el hallux abductus valgus en la movilidad del primer radio / Influence of surgical treatment of hallux abducto-valgus on first ray mobility

Objetivo: El objetivo principal de este trabajo es determinar la variación de movilidad pre y postquirúrgica del primer radio. Pacientes y métodos: El diseño corresponde a un estudio prospectivo de series de casos en pacientes sometidos a cirugía de hallux valgus. Se valoró en 13 pies la movilidad del primer radio con el medidor del primer radio, la flexo-extensión de la primera articulación metatarsofalángica, el ángulo de Clarke y el “Arch Index” en pedigrafías, los ángulos hallux valgus e intermetatarsal I-II en radiografías dorsoplantares en carga, y la postura general del pie mediante el “Foot Posture Index” antes y después de ser sometidos a cirugía de hallux valgus. Todo ello con un periodo de seguimiento de 6 meses. Resultados: El rango total de movilidad del primer radio pasó de 11.74 ± 1.88 mm a 6.72 ± 2.20 mm; y el de la primera articulación metatarsofalángica pasó de 79.62° ± 22.33° a 48.69° ± 18.69° tras la cirugía. Los ángulos radiográficos de hallux valgus y ángulo intermetatarsal disminuyeron una media de 19.07° ± 8.20° y 7.23° ± 2.97°, respectivamente. El ángulo de Clarke cambió de 41.31° ± 10.79° a 38.31° ± 11.00°. El “Arch Index” cambió de 0.24 ± 0.06 a 0.25 ± 0.05. Y el “Foot Posture Index” pasó de 6.70 ± 3.33 de media antes de la cirugía a 5.46 ± 3.86 tras la misma. Conclusión: En los participantes incluidos en este estudio se observó una disminución generalizada de todas las variables examinadas tras la cirugía, a excepción de los parámetros valorados en las pedigrafías, que no llegaron a presentar diferencias relevantes.(AU)

Objectives: The main aim of this work is to determine the variation of first ray mobility before and after surgery. Patients and methods: The design corresponds to a prospective case series of patients operated of hallux valgus. A total of 13 feet have been included in this study. Measurements of the first ray mobility were obtained using the first ray mobility measurer. Furthermore, we assess the flexo-extension of the first metatarsophalangeal joint. The Clarke’s angle and the Arch Index were evalued on weightbearing footprints. The hallux valgus angle and intermetatarsal I-II angle were made on weightbearing dorsal-plantar projection radiographs. And finally, the general posture of the foot was quantified using the Foot Posture Index. All this with pre and post measurements of hallux valgus surgery and with a follow-up period of 6 months. Results: The total range of motion of the first ray decreased from 11.74 ± 1.88 mm to 6.72 ± 2.20 mm; and the range of motion of the first metatarsophalangeal joint underwent from 79.62° ± 22.33° to 48.69° ± 18.69° after surgery. The hallux valgus angle and intermetatarsal I-II angle decreased by a mean of 19.07° ± 8.20° and 7.23° ± 2.97°, respectively. The Clarke’s angle changed from 41.31° ± 10.79° to 38.31° ± 11.00°. The Arch Index changed from 0.24 ± 0.06 to 0.25 ± 0.05. And the Foot Posture Index went from 6.70 ± 3.33 before surgery to 5.46 ± 3.86 after it. Conclusion: In the participants included in this study, a generalized decrease was observed in all the examined variables after surgery, except for the parameters assessed in the pedigraphs, which did not present relevant differences.(AU)

Serious sequellae of the hallux valgus surgery: More options for its surgical treatment. / Secuelas graves de la cirugía del hallux valgus: opciones quirúrgicas para su tratamiento.

OBJECTIVE: The purpose of this study is to present a method for treating the serious consequences that result from failure of corrective techniques used for hallux valgus, which produces severe shortening of the first ray, and makes it difficult to perform the third rocker. MATERIAL AND METHODS: In this study, conducted in 2 hospitals in Madrid and Barcelona, an assessment was made of the clinical and radiological results of 40 cases, of which 97.5% were female. Technically it involves making a metatarsophalangeal arthrodesis after bone distraction with an external mini-fixation, and then inserting an iliac crest bone graft, stabilising it with a plate or the mini-fixator. RESULTS: The pre-operative shortening was 2.5cm. and elongation obtained was between 1.5 and 3.0cm. Clinical and radiological bone graft integration was achieved at 2-4 months, although full integration occurred after one year. Falliner and Blauth criteria were used to evaluate the results at 6 and 12 months follow-up, and using Visual Analogue Scale (VAS score/pain, scale 1-10), being favourable in 80%, and not changing over time. The failure rate was 7.5%, which included the non-integration of the graft and infection, requiring additional surgery. DISCUSSION: There are not many publications on the number and type of complication for hallux valgus surgery, or guidelines established, only the treatment by conventional fusion. The problem arises when the patient presents a severe shortening of the ray, and direct fusion would aggravate the insufficiency of the first ray and the transference metatarsalgia. In these cases, these procedures would be indicated.