Dissertation
Dissertation > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery

Correlation study of pain and deformity of hallux valgus hallux plantar seed degree of arthritis and plantar

Author ZhangYongChao
Tutor SangZhiCheng
School China Academy of Traditional Chinese Medicine
Course Traditional Chinese Medicine
Keywords Hallux Valgus Deformity Sesamoid Pain Deformity Correlation
CLC R687.3
Type Master's thesis
Year 2012
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1BackgroundHallux valgus deformity is a common disease of foot surgery, and the main clinical manifestations are malformation, pain and callus. Except the capsulitis of the first metatarsophalangeal joint, the main reason of the pain below the head of the first metatarsal in hallux valgus is the abnormality of the stress below the metatarsal heads. In hallux valgus, besides varus, uplifting and pronation of the first metatarsal and the out-shifting of the sesamoids, the relaxation of the interosseous metatarsal ligment and the stress and overstrain of the great toe abduct muscle can lead to abnormal weight bearing of the first metatarsal through the sesamoid, and then the pain appears. Also it is reported that the abnormal of the first ray is the main reason of the other pathological changes. However, it is found that there are extensive radiologic manifestation and clinic symptoms of osteoarthritis in the metatarsal-sesamoid joint of the patient with hallux valgus from prophase research. So it is believed that sesamoiditis may be one of the reasons causing the pain of patients with hallux valgus deformity.Generally, there are two sesamoids below the head of the first metatarsal. Sesamoids are embraced in the short flexor muscle of hallux, located below the plantar surface of the head of the first metatarsal. In the process of flexion and extension of the hallux, function of the sesamiods is to increase the strength of the short and the long flexor muscles and the strength of backward stroke. On the other hand, sesamoids play important roles in maintaining the height of medial longitudinal arch and anterior transverse arch of foot to make the distribution of the plantar pressure reasonable.Metatarsal-sesamoid joint is composed of the head of the first metatarsal and the two sesamoids below it. Two sesamoids, divided by sesamoid ridge, locate in the sesamoid ditch below the first metatarsal, and they make of the metatarsal-sesamoid joint. There is synovial membrane in the joint. The surface of the joint is covered by hyaline cartilage and the edge of the joint is adhered by joint capsule.We find that the metatarsal-sesamoid joint below the head of the first metatarsal is similar to the patellofemoral joint after long term clinical work for two sesamoids below the head of the metatarsal are similar to the patella and the articular surface below the first metatarsal is similar to the patella surface of the femoral condyle. The sesamoids can slide on articular surface, and the sesamoid ridge will be smooth after long-term friction. Moreover, the outside dislocation will be aggravated by bowstring effect in hallux valgus deformity. The equilibrium condition of force between medial and lateral side of the sesamoids will be disrupted, for the interface of the metatarsal-sesamoid joint and the direction of the line of force of tendons around the sesamoids change. So radiological appearances, such as asymmetry narrow of the joint space, osteosclerosis and cystic degeneration of subchondral bone, and clinical appearances, such as pain, tenderness and grinding pain will appear.However, there are no further study on the correlation between the degree of pain below the first metatarsal and deformities of hallux valgus and the degree of sesamoiditis. So we think it’s necessary to make further study on these problems and analysis the factor causing the pain below the first metatarsal of the patient with hallux valgus to guide clinical applications.2ObjectivesThe objective of research is to observe the exiting and appearance of sesamoidities of hallux valgus deformity, to deepen the understanding of the factors causing pain of hallux valgus and to provide new ideas of treating pain of hallux valgus. Moreover, through the research the relationship between the degree of sesamoidities and the degree of hallux valgus deformity, pain below the first metatarsal, the range of motion, to emphasize the effects of sesamoids in hallux valgus, and provide theoretical support to that sesamoids is regarded as an important part of efficacy evaluation and that sesamoidities should be early intervened to improve the efficiency of treating hallux valgus.3Methods85patients (155feet), including84women (154feet) and1man (1foot), who were treated for hallux valgus in Wangjing Hospital were collected. The age is from23to77years, and the average age is52years. This study used prospective clinical observation to analysis the correlations between the degree of sesamoidities and the severity of pain below the first metatarsal, the degree of deformity and the appearance in X ray imagines.4Results4.1In the85patients (155feet), the degree of hallux valgus deformity of26feet are slight,76moderate and53serious.125feet accord to the diagnostic criteria of sesamoiditis, accounting for80.64%of all155feet collected and there is no sesamoidities in other30feet. There are12feet with slight sesamoidities,37feet with moderate sesamoidities and76feet with serious sesamoidities. In all feet, the pain index:painless21feet, slight pain31feet, moderate pain67feet and serious pain36feet. Metatarsal-sesamoid grinding test is negative in62feet and is positive in the other 93feet. Tenderness index:20feet were grade0,72feet grade1,55feet grade2,8feet grade3. Positions of tibial hallux sesamoid:1foot was grade1,2feet grade2,20feet grade3,30feet grade4,37feet grade5,45feet grade6and20feet grade7. Range of motion:dorsal extension range is from10°to80°, and the average is45.48°; Plantar flexion range is from-20°to60°, and the average is25.23°.4.2Through Spearman rank correlation test, there is no statistical significance in the correlation between the degree of sesamoiditeies and the slight, moderate and serious hallux valgus deformity(P>0.05, r=0.078). After combined the slight and the moderate hallux valgus deformity, there is statistical significance in the correlation between the degree of sesamoiditeies and the degree of hallux valgus deformity through Spearman rank correlation test(P<0.05, r=0.32).4.3Through Spearman rank correlation test, there is statistical significance in the correlation between the degree of sesamoiditeies and the pain index(P<0.01, r=0.548)and tenderness index(P<0.01, r=0.550).4.4Through Spearman rank correlation test, there is no statistical significance in the correlation between the degree of sesamoiditeies and the positions of tibial hallux sesamoid (P>0.05, r=0.060).4.5The dorsal extension range of the group without sesamoidities is44.93°±13.83°, and the slight group is44.17°±13.29°, and the moderate group is46.66±14.00°, and the serious group is44.91°±13.48°. There is no statistical difference between the groups after ANOVA analysis (P>0.05).4.6The Plantar flexion range of the group without sesamoidities is28.27°±11.70°, and the slight group is23.33°±13.87°, and the moderate group is29.03°±10.59°, and the serious group is23.50°±11.94°. There is no statistical difference between the groups after ANOVA analysis (P>0.05).4.7Through Spearman rank correlation test, there is statistical significance in the correlation between the degree of hallux valgus deformity and the positions of tibial hallux sesamoid (P<0.05, r=0.312).4.8The IMA angle of slight hallux valgus deformity is9.65°±2.54°, and the IMA angle of moderate hallux valgus deformity is11.43°±2.36°, and the IMA angle of serious hallux valgus deformity is12.63°±2.92°. There is statistical difference between the groups after Spearman rank correlation test,(P<0.05, r=0.366).4.9Through Spearman rank correlation test, there is statistical significance in the con-elation between the degree of hallux valgus defomiity and the pain index around the metatarsal-sesamoid joint (P<0.05, r=0.256), and there is statistical significance in the correlation between the degree of hallux valgus deformity and the tenderness index around the metatarsal-sesamoid joint (P<0.05, r=0.244).4.10Through Spearman rank correlation test, there is statistical significance in the correlation between the positions of tibial hallux sesamoid and the pain index around the metatarsal-sesamoid joint (P<0.05, r=0.161), and there is statistical significance in the correlation between the degree of hallux valgus deformity and the tenderness index around the metatarsal-sesamoid joint (P<0.05, r=0.167).5Conclusions5.1There are sesamoidities in patients with hallux valgus deformity and sesamoidities is one of the reasons causing pain of patients with hallux valgus deformity.5.2In a certain degree, the degree of sesamoidities become serious with the aggravation of hallux valgus deformity.5.3Sesamoidity is not the main reason affecting the range of motion of metatarsophalangeal joint.

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