Preventing Postsurgical Hallux Valgus Recurrences with Plantar Pressure Assessment

Alterations in forefoot kinematics found in the presence of a hallux valgus deformity make it essential to assess plantar pressure distribution both preoperatively and following a reconstructive procedure.

Such an assessment helps clinicians gain an insight into the lateral shift of load that occurs in feet with hallux valgus and the biomechanical factors that could be associated with this abnormal distribution of pressure such as hyperpronation.

As mentioned in the Lower Extremity Review, pedobarometric analysis can be used to compare outcomes of different surgical interventions; for instance, a study revealed that plantar pressures after a Lapidus bunionectomoy were found to be more evenly distributed across the five metatarsal heads as compared to a chevron osteotomy, even though both sets of patients showed improvements after surgery.

Data collected from such an analysis can also be utilised as a clinical tool in restoring overall foot and lower extremity alignment by comparing changes in plantar pressure from the preoperative and postoperative results.  

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A study conducted by Galica et al. focused on evaluation of differences in plantar pressure and force during gait in patients with hallux valgus; study participants were members of the Framingham Foot Study with complete foot biomechanical data and foot disorder data.

The findings of the study established reduced loading in the hallux region with maximum force in the lesser toe area, lower centre of pressure excursion index values and higher modified arch index values; the last two factors are indicative of a more pronated type of foot during gait.

These results signify the potential effectiveness of using plantar pressure as a biomechanical tool in detecting weak load distribution that can contribute to the development of hallux valgus.

Post-surgical rehabilitative strategies, in this regard, need to include plantar pressure assessment for identifying and addressing any underlying biomechanical disturbances such as hyperpronation that can increase the risk of hallux valgus recurrences in the patient.

The efficacy of custom made orthotics such as MASS4D® in the optimal redistribution of plantar pressure makes its inclusion in preventative and treatment strategies important for the long-term management of hallux valgus to minimise stress on the affected regions and promote speedy recovery.

Plantar pressure distribution can be a valuable input in the customisation process helping to produce an orthotic that is capable of offloading pressure from the metatarsal heads, if the patient experiences any pain in this region postoperatively.

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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References:

1. Black, H. (2015) Hallux Valgus and Plantar Pressure Measurement. Lower Extremity Review: March 2015. Retrieved from: http://lermagazine.com/
2. Galica, A. M., Hagedorn, T. J., Dufour, A. B., Riskowski, J. L., Hillstrom, H. J., Casey, V. A., Hannan, M. T. (2013) Hallux Valgus and Plantar Pressure Loading: the Framingham Foot Study. Journal of Foot and Ankle Research: October 2013, Vol. 6, No. 42. https://doi.org/10.1186/1757-1146-6-42

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