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Method: 33 cases with elective operation for hallux valgus were prospectively investigated. All blocks were performed with the aid of a peripheral nerve stimulator, and 0.5% pucaine was injected in a dose of 1.5 mg/kg when minimal stimulator output still elicited a slight motor response of the foot. In evaluating the analgesics effects of the nerve block, the intensity of pain was assessed by using VAS before, immediately after, and at given time intervals during 36 hours. In the control group, the pain scores were assessed after immediate post-operation and at the given time intervals during 36 hours. The nerve block group rated their level of satisfaction at the first visit of out-patient clinic after discharge.
Results: There was significant pain-control effect at least during 24 hours after the nerve block. The patient's satisfaction was high and they had no severe complications.
Conclusion: Block of sciatic nerve in the popliteal fossa provides high satisfaction as the safe effective pain-control method after hallux valgus surgery, so it may be available method for postoperative analgesia after another foot surgery. (J Korean Acad Rehab Med 2003; 27: 102-105)
Objective: The purpose of this study was to evaluate the correlation between each variable on occupational condition and foot deformity by Harris mat footprint.
Method: Subjects were 227 labors having no neurologic or musculoskeletal problems. They were evaluated by clinical history and Harris mat footprint. Three optional parameters of footprints were medial arch angle, metatatarsal arch grade, and hallux valgus angle.
Results: 1) Hallux valgus angles were significantly increased in group of female, above 39 years old, labor, and duration of duty more than 6 years. 2) Medial arch angles were signifi-
cantly decreased in female, above 39 years old, obese person, and labor. 3) Metatarsal arch grades were significantly increased in group of female, above 39 years old, and more than 20 numbers of conveyance, less than 6 years of duration of duty. Foot pain was not related to medial arch angle, metatatarsal arch grade, and hallux valgus angle, respectively.
Conclusion: These results suggest that deformity of foot were related to female, above 39 years old, obese person, position of duty, duration of duty, and standing time. So these peoples maybe helpful for weaning proper modified shoes. (J Korean Acad Rehab Med 2002; 26: 187-192)
Foot problems are common in elderly patients, and the relief of foot pain can increase the rehabilitative potential for patients with chronic diseases, impairments, or disabilities. The author presents a detailed description of techniques for the clinical management of hallux valgus, plantar fascitis, callosities, and myofascial pain syndrome. The focus is clinical and practical, i.e., based upon common foot conditions seen in clinical practice.
Objective: We used the radiologic foot mapping system to evaluate the characteristics of hallux valgus.
Method: We studied the radiographs of 47 feet of 29 patients who had the hallux valgus. The weight bearing foot AP and lateral views of both sides were taken. The hallux valgus angle, first and second, first and fifth, and second and fifth metatarsal angles were measured with conventional methods. In addition we measured metatarsus primus varus (MPV) and proximal first metatarsal inclination (PFMI) angles. On lateral views, we measured calcaneal pitch, talar pitch and arch depth. By mapping system, we marked T1 through T5, MH1 through MH5, MB1 through MB5, CC, TN and NC, respectively.
Results: The first and fifth metatarsal angles were significantly larger in the patients with hallux valgus (p＜0.05). The metatarsus primus varus angle was significantly larger in the patients with hallux valgus (p＜0.05). The X coordinates at T1 and MH1 were significantly larger in the patients with hallux valgus (p＜0.05). The Y coordinates of the MB1, NC and TN were significantly larger negative values in the hallux valgus patients (p＜0.05).
Conclusion: In hallux valgus, the first metatarsocuneiform joint is the site of origin of metatarsus primus varus. The lateral splaying was present from the 5th toe to tarsal bones in hallux valgus groups.
Objective: To show the prevalence of the dorsomedial cutaneous nerve (DMCN) injury in the hallux valgus and to evaluate whether the sensory nerve damage contributes to pain and sensory impairment in the great toe.
Method: Sixty feet of healthy adults (normal group) and 26 feet of patients with hallux valgus (hallux valgus group) were evaluated with sensory nerve conduction study of DMCN. The prevalence of the nerve injury was compared between the two groups. Sensory nerve action potentials of DMCN in hallux valgus feet were analyzed and compared according to the patient's symptom and the severity of the radiographic measurements of the feet.
Results: The prevalence of DMCN injury was 42.3% of the hallux valgus group. The peak latency of the DMCN sensory action potential of the symptomatic feet showed statistically significant delay compared to the asymptomatic group (p＜0.05). Delay of the peak latency and decrement of the amplitude of the DMCN were statistically significant among the three groups as the valgus deformity worsened (p＜0.05).
Conclusion: DMCN injury should be considered in addition to soft tissue injury or arthritis in the differential diagnosis of the pain, burning sensation or numbness associated with hallux valgus.
Objective: To evaluate outcomes of treatment of hallux valgus and its associated foot deformities with shoe and insole modification
Method: We present the short-term follow-up of 32 symptomatic hallux valgus deformities in 20 patients. The patients were all female and 32 to 77 years in age at the time of modification of shoe and insole. Twenty patients were evaluated on an average of 4 weeks following their shoe and insole modification. Hallux valgus angles and first-second intermetatarsal angle were evaluated as well as the range of motion of the first metatarsophalangeal joint and patient's satisfaction. Outcome was measured using changes in visual analogue scale (VAS) on twenty occasions during 4 weeks.
Results: Hallux valgus was commonly associated with the lesser (2nd∼5th) toe deformity (21 cases, 65.5%), pes planus (12 cases, 37.5%), Achilles tightness (12 cases, 37.5%) and great toe pronation (10 cases, 31.5%). The result obtained was highly significant (p＜0.002), suggesting that the shoe and insole modification were as effective in reducing the level of pain due to hallux valgus and its associated foot deformities.
Conclusion: The shoe and insole modification can be an effective treatment of reducing pain of hallux valgus and its associated deformities.
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