Cheilectomy surgery has been shown to provide pain relief for patients with hallux rigidus [1], however limited data exists regarding the effectiveness of this surgery in re-establishing normal first metatarsophalangeal (1st MTP) joint kinematics. A recent dynamic gait study has reported only modest improvement in 1st MTP motion following surgery, thus implicating the persistence of altered joint mechanics [2]. The purpose of this study was to evaluate in vivo joint motion changes using MRI under 1st MTP loaded conditions in patients who received cheilectomy surgery. These data were compared to dynamic alterations during gait measured in a second cohort of subjects who previously underwent surgery.
Methods
20 subjects were enrolled for the MRI analysis. Pre- and post-operative data of 10 subjects with hallux rigidus (HR) were compared to a healthy control group of 10 subjects. Using a validated loading harness, all subjects underwent an MRI evaluation at varying angles of 1st MTP dorsiflexion, pre and post surgery (>3 months). Image J software was used to derive MRI measurements: 1st MTP dorsiflexion, instant centers of rotation, and sagittal translations of the proximal phalanx/1st metatarsal. Outcome measures were assessed using the Foot Function Index (FFI). MRI changes were compared to 3D gait analysis previously acquired on a second cohort of 20 surgical subjects using a magnetic tracking device.
Results
All subjects had a significant decrease in FFI scores indicating an improvement in pain relief and function (p < .01).
Table 1 shows pre- and post-op data compared to the control subjects. No significant differences were found between pre- and post-op measures for peak 1st MTP dorsiflexion, instant center of rotation (ICR), and sagittal translations of the hallux relative to the first metatarsal. Values for the cheilectomy group all remained significantly different from the control group (p < 0.001 for all variables).
Table 1
Controls, Pre- and post-op MRI values
Variable
Pre-op
Post-op
Controls
1stMTP dorsiflexion
35.0° ± 8.8°
31.3° ± 10.0
64.4° ± 7.8°
ICR
8.9 ± 1.3 mm
8.6 ± 1.6 mm
4.2 ± 0.6 mm
Sagittal translation
1.6 ± 0.8 mm
1.5 ± 0.7 mm
5.5 ± 0.9 mm
These data can be compared to kinematic changes during gait, measured on a second cohort of subjects. Differences were found between pre- and post-op values, although still significantly less than normative values for 1st MTP motion [2]. Figure 1.
Figure 1
1st MTP dorsiflexion during neutral/rest, active motion and gait.
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Conclusion
Joint mechanics are significantly altered in patients with hallux rigidus. Although cheilectomy resulted in favorable outcomes as measured by FFI scores, surgery did not re-establish normal 1st MTP joint kinematics. Long term follow up of these patients will determine if altered kinematics lead to progressive arthritis over time and may suggest alternative intervention strategies.
Open AccessThis article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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