О связи системной гипермобильности суставов и вальгусного отклонения первого пальца

Purpose: to evaluate correlation between generalized joint hypermobility, forefoot deformities and elasticity of the first ray of the foot. Material and methods. We examined 138 patients with complaints related with deformities at the forefoot level. During this study the medical history was obtained, the elasticity type of the feet was defined and the degree of motion of the medial metatarsal-cuneiform joint was evaluated. Forefoot elasticity was identified by bringing together the heads I and V metatarsal bones with fingers. If convergence occurred with little resistance, those feet were called hyperelastic. The convergence of the heads I and V metatarsal bones of the foot with an average type of elasticity occurred with resistance. It was impossible to converge the heads of I and V metatarsal bones. Due to the results of weight-bearing and non-weight bearing X-ray, analysis of the main radiographic angles of the foot was performed: between I and V metatarsal bones, between the first and second metatarsal bones and between the first metatarsal bone and proximal phalanx of the great toe. Calculation formula of the forefoot flatness index, showing the average ratios of basic radiographic angles of the foot on the x-ray images (weight-bearing and non-weight bearing) was created. An assessment of total joint hypermobility using Beighton scale and evaluation of first ray deformity using DuPont scale were performed. Statistical analysis of obtained data was performed, as a result of which significantly strong correlation between total joint hypermobility, forefoot elasticity and valgus deviation of the great toe were revealed. Results. 11% of the feet were hyperelastic. Calculation of the index of forefoot flatness showed that forefoot flatness wasn’t significant for a rigid foot - 5.6 %, for the feet with an average degree of mobility it was 6.0% and it was expressed for hypemobile feet - 12.3 %. Strong correlation relation between the forefeet mobility degree, the number of points on a DuPont scale and the degree of sagittal mobility of the medial metatarsal-cuneiform joint were revealed. Conclusion. Our study demonstrates that generalized joint hypermobility, horizontal and sagittal first ray mobility and forefoot deformities are directly proportional.Цель исследования - оценить взаимосвязь системной гипермобильности суставов, деформации передних от делов стопы и эластичности первого луча стопы. Материал и методы. обследовано 138 пациентов с деформациями на уровне переднего отдела стоп. В ходе исследования был собран анамнез, оценена степень мобильности медиального плюснеклиновидного сочленения, определен тип эластичности переднего отдела стопы. Эластичность переднего отдела стопы определяли, сближая головки I и V плюсневых костей пальцами руки. Если сближение происходило лишь с небольшим сопротивлением, то такие стопы называли гиперэластичными. Сближение головок I и V плюсневых костей стопы со средним типом эластичности происходило с сопротивлением. Головки I и V плюсневых костей сблизить не удавалось при ригидном типе стоп. На снимках, выполненных под нагрузкой и без нагрузки, произведен анализ основных рентгенографических углов стопы - между I и V плюсневыми костями, между I и II плюсневыми костями и между I плюсневой костью и проксимальной фалангой I пальца. Разработана формула вычисления коэффициента распластывания переднего отдела стопы, которая показывает среднее арифметическое соотношений основных рентгенографических углов стопы на снимках, выполненных без нагрузки и с нагрузкой на передний отдел стоп. оценены системная гипермобильность суставов по шкале Бейтона и деформация первого луча по шкале DuPont. Произведен статистический анализ полученных данных, в результате которого была выявлена достоверно сильная корреляционная связь между системной гиперэластичностью соединительных тканей, гиперэластичностью переднего отдела стопы и вальгусным отклонением первого пальца стопы. Результаты. Гиперэластичными были признаны 11% обследованных стоп. Расчет коэффициента распластывания k переднего отдела стопы, рассчитываемый по составленной нами формуле, показал, что распластывание переднего отдела незначительно для ригидных стоп (k = 5,6) и для стоп со средней степенью эластичности (k = 6,0), но более выражено для гиперэластичных стоп (k = 12,3). Выявлены сильные корреляционные связи между степенью мобильности переднего отдела стопа, количеством баллов по шкале DuPont и степенью сагиттальной мобильности медиального плюснеклиновидного сустава. Заключение. Исследование показывает, что системная гипермобильность суставов, горизонтальная и сагиттальная мобильность первого луча и деформация переднего отдела стопы имеют прямую зависимость

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ВАЛЬГУСНОГО ОТКЛОНЕНИЯ ПЕРВОГО ПАЛЬЦА СТОПЫ И ЕГО ВОЗМОЖНЫЕ ОСЛОЖНЕНИЯ (ОБЗОР ЛИТЕРАТУРЫ)

Hallux valgus surgery remains the most important direction of modern orthopedics. In this article authors analyzed the history of Hallux valgus surgical treatment development observing the details of different types of methods directing on various pathogenic parts of pathology as well as complications occurring with different types of methods. Main tendencies of development and improvements of hallux valgus surgery are described.Лечение вальгусного отклонения первого пальца стопы на сегодняшний день является одним из важных направлений современной ортопедии. Представлена история развития лечения данной патологии с анализом методик лечения, направленных на разные звенья патогенеза, а также осложнений, возникающих при использовании разных методик. Описаны основные тенденции развития и пути совершенствования методик лечения вальгусного отклонения первого пальца стопы

Long-term functional results of first metatarsophalangeal joint arthrodesis for hallux rigidus

Introduction First metatarsophalangeal joint (MTPJ) osteoarthritis hallux rigidus (HR) is the most common arthritic condition in the foot and occurs in 2.5-7.8 % of the population over 50 years. First MTPJ arthrodesis is currently considered to be the gold standard for the treatment of end-stage HR. When treating the advanced stage of HR, arthrodesis has long been established as an effective surgical procedure providing very predictable and satisfying results. Although the surgical authors prefer joint-sparing procedures first MTPJ fusion when required is the joint destructive procedure of choice in severe HR to eliminate or minimize pain, stabilize the first MTPJ and allow the hallux to bear weight. Functional outcomes achieved with fusion are also consistent with those from other surgical procedures. The purpose of this study is to evaluate long-term functional outcomes of first MTPJ arthrodesis. Material and methods Clinical and functional outcomes of MTPJ arthrodesis performed for 19 patients (25 feet) with grade 3 or 4 HR using the Coughlin and Shurnas Classification System between September 2010 and December 2017 were reviewed. The patients' mean age was 60 years (range, 35 to 86 years). The median interval between surgery and the last follow-up was 5 years (interquartile range, 1.5 to 8 years). Ultimately, outcome assessment relied on patient satisfaction, radiographic examination, visual analogue scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) and the Foot and Ankle Ability Measure (FAAM) scores. Results AOFAS score was rated as good in 92 % of the cases (23/25), as fair in 8 % (2/25) with neither excellent nor poor results recorded. The median AOFAS score increased from preoperative 43.0 to postoperative 85.0 that was statistically significant (p < 0.05). Postoperative median FAAM Activities of Daily Living (ADL) was 99 %, median subjective ADL was 90 %, median FAAM sport was 84 %, and median subjective sport was 80 %. Patient subjective assessment was scored as "excellent" in 36 % of cases (9/25), "good" in 56 % (14/25), "fair" in 8 % (2/25) with no "poor" results recorded. The median VAS pain score decreased from 6 at baseline to 1 point postsurgery (p < 0.05). Conclusion First MTPJ arthrodesis was shown to be a very effective, reliable and lasting primary procedure for severe HR that provided 92% of good outcomes in our series. The procedure can be advocated as a predictable and excellent option for Coughlin and Shurnas grades 3 and 4 HR facilitating high success rates in pain relief and restoration of function. © 2020 lchenko D.V., Korolev A.V., Kardanov A.A

CORRELATION BETWEEN GENERALIZED JOINT HYPERMOBILITY AND HALLUX VALGUS

Purpose: to evaluate correlation between generalized joint hypermobility, forefoot deformities and elasticity of the first ray of the foot. Material and methods. We examined 138 patients with complaints related with deformities at the forefoot level. During this study the medical history was obtained, the elasticity type of the feet was defined and the degree of motion of the medial metatarsal-cuneiform joint was evaluated. Forefoot elasticity was identified by bringing together the heads I and V metatarsal bones with fingers. If convergence occurred with little resistance, those feet were called hyperelastic. The convergence of the heads I and V metatarsal bones of the foot with an average type of elasticity occurred with resistance. It was impossible to converge the heads of I and V metatarsal bones. Due to the results of weight-bearing and non-weight bearing X-ray, analysis of the main radiographic angles of the foot was performed: between I and V metatarsal bones, between the first and second metatarsal bones and between the first metatarsal bone and proximal phalanx of the great toe. Calculation formula of the forefoot flatness index, showing the average ratios of basic radiographic angles of the foot on the x-ray images (weight-bearing and non-weight bearing) was created. An assessment of total joint hypermobility using Beighton scale and evaluation of first ray deformity using DuPont scale were performed. Statistical analysis of obtained data was performed, as a result of which significantly strong correlation between total joint hypermobility, forefoot elasticity and valgus deviation of the great toe wer

РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЕЗНИ ХАГЛУНДА

Objectives. The article presents the results assessment of open calcaneal excision compared to percutaneous excision of patients with Haglund’s disease. Materials and methods. Twenty-one patients (26 feet) underwent the surgical treatment during the period from 2010 to 2012. The clinical diagnosis was confirmed by axial load radiography estimated with “Fowler-Philip” and “posterior pitch lines” methods. Eight feet were treated with open calcaneal excision and 18 feet - with percutaneous procedure. The mean duration of follow-up was 21,8 months. Clinical evaluation criteria were deformity and/or bursitis recurrence, tenderness, pain by wearing shoes, return to the sport training, patient satisfaction, presence/absence of major complications. Results. Good results were reported for 21 patients; fair results - for 4 patients; and poor results - for one patient. No significant differences in results depending on the method of intervention have been identified.Цель - оценить результаты операций открытой и чрескожной краевой резекции пяточной кости у пациентов с синдромом Хаглунда. Материал и методы. В период с 2010 по 2012 год прооперирован 21 пациент (26 стоп), средний срок наблюдения составил 21,8 месяца. Всем пациентам была выполнена рентгенография под нагрузкой в боковой проекции, измерения проводились по методикам наклонных параллельных линий и по Fowler - Philip. Открытая краевая резекция пяточной кости выполнена на 8 стопах, чрескожная краевая резекция - на 18 стопах. Оценка клинических результатов проведена по следующим критериям: рецидив деформации, рецидив бурсита, боль при пальпации, боль при ношении обуви, возможность возвращения к занятиям спортом, удовлетворенность пациента результатом, наличие или отсутствие значимых осложнений. Результаты. Получен 21 хороший, 5 удовлетворительных и 1 неудовлетворительный результат. Значимых отличий результатов в зависимости от способа вмешательства не выявлено

CORRELATION BETWEEN GENERALIZED JOINT HYPERMOBILITY AND HALLUX VALGUS

Purpose: to evaluate correlation between generalized joint hypermobility, forefoot deformities and elasticity of the first ray of the foot. Material and methods. We examined 138 patients with complaints related with deformities at the forefoot level. During this study the medical history was obtained, the elasticity type of the feet was defined and the degree of motion of the medial metatarsal-cuneiform joint was evaluated. Forefoot elasticity was identified by bringing together the heads I and V metatarsal bones with fingers. If convergence occurred with little resistance, those feet were called hyperelastic. The convergence of the heads I and V metatarsal bones of the foot with an average type of elasticity occurred with resistance. It was impossible to converge the heads of I and V metatarsal bones. Due to the results of weight-bearing and non-weight bearing X-ray, analysis of the main radiographic angles of the foot was performed: between I and V metatarsal bones, between the first and second metatarsal bones and between the first metatarsal bone and proximal phalanx of the great toe. Calculation formula of the forefoot flatness index, showing the average ratios of basic radiographic angles of the foot on the x-ray images (weight-bearing and non-weight bearing) was created. An assessment of total joint hypermobility using Beighton scale and evaluation of first ray deformity using DuPont scale were performed. Statistical analysis of obtained data was performed, as a result of which significantly strong correlation between total joint hypermobility, forefoot elasticity and valgus deviation of the great toe wer

НАШ ОПЫТ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ВАЛЬГУСНОГО ОТКЛОНЕНИЯ ПЕРВОГО ПАЛЬЦА СТОПЫ ПОСРЕДСТВОМ ОСТЕОТОМИИ SCARF

Eighty-seven patients with hallux valgus (124 feet) were examined. The mean follow-up was 2 years and 3 months. The SCARF technique was associated sometimes with correcting osteotomy. Every patient had a clinical examination with anterioposterior and lateral X-ray films. 84,7 % of the patients had excellent and good results. The correlation between the patients' satisfaction and the clinical signs like metatarsalgia, hallux stiffness and exostosis pain was found. A significant correction of hallux valgus was determined and the patients who underwent correcting osteotomy had the better results. A significant shortening of the first metatarsal bone as well as a decrease in its attack angle were found. The authors determined some limiting values of deformities after that it is difficult to obtain satisfactory correction. The S С ARF technique is reliable and essentially functional. The satisfaction of the patients was linked to some clinical symptoms. The addition of correcting osteotomy allows to improve the radiological result. The rotation of the plantar fragment guarantees a better control of the orientation of the articular surface but to the detriment of the correction of the displacement. This operation must be rigorous performed because the elevation of the first metatarsal bone or its excessive shortening provokes the occurrence of metatarsalgia and poses problems for the obtaining of satisfactory corrections if the initial deformities are significant.Мы изучили отдаленные результаты оперативного лечения вальгусного отклонения I пальца стопы посредством остеотомии SCARF у 87 пациентов (124 стопы), в том числе в комбинации с корригирующей остеотомией проксимальной фаланги I пальца. Средний срок наблюдения составил 2 года 3 месяца. Каждый пациент был осмотрен с контрольными рентгенограммами в прямой и боковой проекциях. Отличные и хорошие отдаленные результаты зафиксированы в 84,7% наблюдений. Отмечена корреляция между субъективной оценкой результата пациентами и такими клиническими симптомами, как тугоподвижность в плюс-нефаланговом суставе, метатарзалгия, боль в области медиального экзостоза. Установлено стойкое сохранение достигнутой интраоперационно коррекции, которая сочеталась с укорочением первого луча и уменьшением угла атаки первой плюсневой кости. Нами определена критическая величина варусного отклонения плюсневой кости, после которой данная техника не позволяет достичь удовлетворительной коррекции деформации. Оперативная техника SCARF является надежной и функциональной, что подтверждается положительным клиническим ответом со стороны пациентов. Комбинация данной операции с варизирующей остеотомией проксимальной фаланги I пальца позволяет улучшить косметический и рентгенологический результаты. Ротация подошвенного фрагмента плюсневой кости позволяет манипулировать ее суставной поверхностью, однако в ущерб латеральному смещению. Технику операции необходимо соблюдать неукоснительно, так как избыточное тыльное смещение головки или чрезмерное укорочение диафиза плюсневой кости провоцирует возникновение метатарзал-гий и создает трудности для дальнейших вмешательств

Complex approach to the conservative treatment of hallux rigidus [Комплексный подход к консервативному лечению пациентов с остеоартрозом первого плюснефалангового сустава]

Introduction. Hallux rigidus (HR) is a common source of forefoot pain, which leads to progressive loss of range of motion in the first metatarsophalangeal (MTP1) joint and pathologically affects biomechanics of the whole lower limb. HR is characterized by degeneration of the articular surfaces of MTP1 joint with the formation of bone growths, cysts and erosions, osteochondral defects and loose bodies. The frequency of occurrence of HR is 1 in 40 adults older than 50 years, and this localization of osteoarthritis is the most common among all joints of the foot. The aim of this article is to improve the results of conservative treatment of HR through the use of physical rehabilitation methods, such as manual therapy, therapeutic exercises and foot orthotics. Materials and methods. This study included retrospective cases of 24 patients (28 feet), who underwent a single course of conservative treatment of HR at the European Clinic for Sports Traumatology and Orthopedics (ECSTO) of the European Medical Center (EMC) since January 2014 to December 2018. The patients' mean age was 51 years (range, 41 to 69 years). Median time between the beginning of treatment and final examination was 26 months (interquartile range from 17 to 36 months). Patient satisfaction, VAS pain scale, AOFAS and FAAM questionnaires and MTP1 dorsiflexion were evaluated in this study. Results. According to AOFAS scale, we obtained 18% (5/28) of excellent, 78% (22/28) of good, 4% (1/28) of fair and no poor results. Median AOFAS score significantly increased from 58.5 points before treatment to 87.0 points on the final examination (p<0.05). Median FAAM daily activity subscale showed 98% of functional outcome with median subjective score of 95%, median FAAM sports score was 97% and median subjective sports score rate was 90%. Patient's satisfaction at the final examination was “excellent” in 57% (16/28), “good” in 39% (11/28), “fair” in 4% (1/28) of cases and no poor results were obtained. Median VAS pain scale decreased from 5 points before treatment to 1 point at the final examination (p<0.05). Median angle of the MTP1 dorsiflexion significantly increased from 23° before treatment to 30° on the final examination (p<0.05). Conclusion. Described approach of the conservative treatment of HR is an effective method of treatment of early stages of the disease with high patient satisfaction rate and functional outcome. © 2021 Ima-Press Publishing House. All rights reserved