Postoperative Rehabilitative Care For Hallux Valgus

Designing rehabilitative programmes for a patient following a corrective first metatarsal osteotomy involves the consideration of changes to physiological gait patterns caused by alteration to the angular values of the first metatarsophalangeal (MTP) joint.

With a decrease in peak pressures and loading parameters observed in the hallux and first metatarsal region after surgery, measuring plantar pressure distribution has been recommended by Schuh et al. as a proper method of assessing the functional outcome of hallux valgus surgery.

This was further proved in their study which involved thirty patients who had undergone Austin and Scarf osteotomy for correction of mild to moderate hallux valgus deformity.

The individuals received a multimodal rehabilitation programme four weeks after surgery, with plantar pressure analysis performed both preoperatively and postoperatively; the first metatarsophalangeal joint range of motion was also measured for each patient. 

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Measurements taken before surgery indicated a decreased load of the first ray, with an increase in weightbearing of the first ray observed six months after surgery.

In addition to this, the authors reported significantly decreased plantar pressure parameters in the region of the first and second metatarsal heads after four weeks of surgery compared to preoperative results.

These findings highlight the importance of physical therapy and gait training in the postoperative period for restoring function in weightbearing and ambulation after hallux valgus surgery.

However, as stated by Massimiliano Polastri from the Unit of Physical Medicine and rehabilitation at the Bologna University Hospital, it is essential for a rehabilitative programme to also provide for early mobilisation of the ankle and the second to fifth metatarsals to allow for a steady restoration of normal gait patterns.

The efficacy of using postoperative immobilisation orthosis for surgically corrected hallux valgus was proved by Unver et al. by fitting a 52-year-old female patient with customised orthosis after a bilateral operation for hallux valgus deformity.

With the orthosis applied after surgery, the patient was allowed to walk postoperatively on the first day; exercises for second to fifth toes and ankle joints were also encouraged from postoperative day one.

The authors established orthosis to be an effective solution for patients who had undergone hallux valgus surgery and who needed to be ambulated immediately after surgery to reduce complications related to immobilisation while maintaining the corrected position.

The far-reaching benefits of an orthotic intervention include the optimal distribution of plantar pressure in post-surgical feet to prevent ‘hotspots’ and to promote the effective movement of lower limbs without compromising on comfort and fit for the individual.

MASS4D® customised foot orthotics are made from a specialised casting process to reflect an accurate depiction of the foot morphology while providing for changes that may have occurred after surgery; this implies that the patient receives a product that is truly customised and can be integrated seamlessly into any rehabilitative programme to promote ambulation.

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