Anatomical study and analysis of the biomechanics of the forefoot's fist and second ray and correlation with hallux valgus deformity (Doctoral thesis)

Ηλιού, Καλλιόπη

Aim The purpose of this doctoral dissertation was the anatomical study and mechanical analysis of the foot first and second ray in patients with hallux valgus and their comparison with individuals without hallux valgus. Another aim of this doctoral dissertation was to evaluate the hallux valgus degree with respect to the severity of that deformity. Subjects and Methods The study sample included 181 feet of 122 patients with hallux valgus and 424 feet of 212 individuals without hallux valgus deformity as a control group. The severity of the hallux valgus disorder was classified according the Manchester scale. Hallux valgus and first intermetatarsal angles were measured. The AOFAS score was determined on all individuals in the hallux valgus and the control group by a trained professional to use the instrument. Plantar loading patterns were determined on all individuals in the hallux valgus and the control group as they stood barefoot across a pressure platform which was designed by the Comex S.a. company. The measuring system (software) of the pelmatographer used in this study was the Biomec 2011. The study sample included also 12 cadaveric limbs with HV and 10 cadaveric limbs without HV deformity as a control group. Hallux valgus angle ( HVA), first to second intermetatarsal angle (IMA) and first to fifth IMA were measured. The shape of the first metatarsal head and the position - orientation of the sesamoid bones were recorded. Results The AOFAS scores differed statistically significant between the four grades of the Manchester scale. Strong negative correlations were found between the AOFAS score, the hallux valgus angle and the first intermatatarsal angle as well. Statistically significant differences between the four grades of Manchester grading scale were present only for the mean pressures under the hallux (T1), the first (M1) and second (M2) metatarsal heads. Strong positive correlations were found between hallux valgus angle and first-second intermetatarsal angle with the pressures under the first metatarsal head, the second metatarsal head and hallux. As the value of the angle increases, the mean pressure value is higher. There was a statistically significant difference between the cadaveric material of HV feet and normal feet regarding the position of the sesamoid ossicles and the first to fifth IMA but at the same time the mean ¬value of that angle was found to be normal in both groups. Although the round shape of the first metatarsal head was in numerical predominance in HV group, there was no statistically significant difference of the first metatarsal head shape between the above two groups. Conclusions The Manchester grading scale could be a useful clinical tool because, providing information not only about the severity of the hallux valgus, but also about the general condition of the foot, pain and gait parameters. The foot width is increased in patient with HV, however, the assessment of first to fifth IMA does not constitute a reliable and useful tool for the determination of the degree of the HV deformity.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Subject classification: Δάκτυλα -- Τραύματα και κακώσεις
Keywords: Γωνία απαγωγής μεγάλου δακτύλου,Γωνία πρώτου-δεύτερου μεταταρσίου,Κλίμακα Manchester,Σησαμοειδή οστά,Hallux valgus angle,First-second intermetatarsal angle,Manchester scale,Sesamoid ossicles
Appears in Collections:Διδακτορικές Διατριβές

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