Query: bunion/ hallux valgus physical therapy intervention

title: The Road to Recovery for Bunion Surgery
abstract: Bunion, Midfoot/Forefoot  Patient reported outcomes (PROs) can provide information on individual patient's progress throughout a treatment course and additionally, with common surgeries, powerful numbers can be generated to provide data analytic curves to provide a recovery road map for patients and surgeons. Those who deviate negatively from the predicted path may have a complication and early intervention can be initiated. Those who deviate positively have the potential to need less physical therapy, early return to sports or work. Hallux valgus (HV) is a common condition of the foot with 4.4 million patients seeking care yearly and surgery is equally common. The purpose of this study was to determine if PROMIS PROs can be used to construct data analytic curves for HV surgery.  PROMIS scores were prospectively obtained from patients evaluated in a specialty foot and ankle clinic between February 2015 and November 2016. Using ICD 9/10 and CPT codes, a total of 65 patients with hallux valgus who underwent a bunionectomy by a single surgeon were identified. Those with less than two month follow up, multiple procedures during the follow up period, as well as incomplete PROMIS assessment scores at any time point were excluded, resulting in 34 patients. Using a previously described method, bunionectomy specific pre operative cut off values to achieve and fail to achieve minimally clinically important differences (MCID) in PF with 95% specificity and 95% sensitivity were determined. We then stratified patients based on their pre operative PF T scores as above or below the MCID cut off. PF was evaluated using two way ANOVA at 4 follow up time periods and pre operative cut offs (above or below MCID cut off) as factors to establish data analytic curves based on pre operative scores.  Bunionectomy specific PF cut off for 95% specificity of exceeding MCID was 39.6 and 50.2 for 95% sensitivity for failing to achieve MCID. Patients were stratified based on PF T scores above (n 13) or below (n 21) the MCID cut off of 50.2. Data analytic curves were generated for above the PF cut off and below PF cut off.  Pairwise comparison demonstrated that those starting with a T score above the bunionectomy specific cut off had significantly better PF pre operatively (p 0.01) and again at 6 12 week follow up (p 0.02) There were no differences at 1 week or 3 4 week follow up time points.  This data confirms pre operative PROMIS PF scores are significant post operative predictors. While patients with pre operative scores below the bunionectomy specific cut off met MCID changes in PF, their T scores were significantly lower at 6 12wk follow up than patients with high pre operative T scores. Although longer term follow up is desirable, this short term follow up suggests a significant clinical impact of using PROMIS scores for pre surgical decisions as well as provides a road map for recovery for patients and surgeons.

title: The use of the Therapy Taping (r) Method for the Correction of the Hallux Valgus
abstract: AbstractHallux valgus, popularly known as "bunion" presents lateral deviation of the proximal phalanx of the hallux on the head of the first metatarsal bone. In children, the congenital deviation of the first metatarsal bone, which makes the forefoot large, called metatarsus primus varus, appearing already in the beginning of the development of young individuals still in bone growth. The objective was to evaluate the effect of elastic bandage by Therapy Taping (r) Method in the positioning of the hallux valgus.  year old patient, female, with treatment duration of 04 months, occurring 24 applications with 2 weekly changes. The technique chosen for the treatment was with 03 strips of elastic bandage within the concept of the Therapy Taping (r) Method aiming to improve the hallux positioning. 7 day rest of skin after 12 applications to avoid injury to the skin was respected. The data of the evolution were compared through pictures, being the first at the beginning of the applications, after 12 (twelve) applications and after 24 (twenty four) applications. This study persisted for approximately 04 months in duration, being carried out 24 applications, following 07 days of rest after the 12 applications suggested by the method and after a comparative analysis of the photos. An improvement in the correction of the hallux valgus bilaterally was observed with the use of the Therapy Taping Method(r)  Hallux Valgus. Athletic Tape. Child. ResumoHalux valgo, popularmente conhecido como "Joanete" apresenta desvio lateral da falange proximal do halux sobre a cabeca do primeiro metatarsico. Em criancas, o desvio congenito do primeiro metatarsico, que torna o ante pe largo, denominado metatarso primo varo, aparecendo ja no inicio do desenvolvimento do individuo jovens ainda em crescimento osseo. O objetivo foi avaliar o efeito da bandagem elastica pelo Metodo Therapy Taping(r) no posicionamento do halux valgo. Tipo de Estudo: Estudo de caso. Paciente de 10 anos, sexo feminino, com duracao do tratamento de 04 meses, ocorrendo 24 aplicacoes com 2 trocas semanais. A tecnica escolhida para o tratamento foi com 03 tiras de bandagem elastica dentro do Conceito do Metodo Therapy Taping(r) visando melhorar o posicionamento do halux. Foi respeitado 7 dias descanso da pele apos 12 aplicacoes para evitar lesao na pele. Os dados da evolucao foram comparados atraves de fotos, sendo a primeira no inicio das aplicacoes, apos 12 (doze) aplicacoes e apos 24 (vinte e quatro) aplicacoes. Esse estudo persistiu por aproximadamente 04 meses de duracao, sendo realizadas 24 aplicacoes, respeitando 07 dias de repouso apos as 12 aplicacoes sugerido pelo metodo e apos uma analise comparativa das fotos. Evidenciou se uma melhora na correcao do halux valgo bilateral com a utilizacao do Metodo Therapy Taping(r) Palavras chave: Hallux Valgus. Fita Atletica. Crianca.

title: Physical therapy post hallux abducto valgus correction.
abstract: This article discusses physical therapy considerations after hallux valgus correction. Hallux valgus is a fairly common occurrence, and corrective surgery is an option when conservative measures fail. Symptoms such as pain, swelling, and difficulty walking may persist after surgical correction of bunion deformity that addresses soft tissue and bone structure. Physical therapy is helpful after corrective hallux valgus surgery to address impairments and continued dysfunction and to improve overall patient outcome expectations. This article describes the benefits of a multifaceted physical therapy program after hallux valgus correction.

title: [Minimally invasive therapy for hallux valgus with deformity of little toe varus]
abstract: To explore clinical effect of minimally corrective osteotomy for the treatment of hallux valgus with deformity of little toe varus through small incision.  From January 2013 to June 2016, 168 hallux valgus patients with deformity of little toe varus were treated by minimally corrective osteotomy through small incision. Among them, 7 males and 161 females were aged from 22 to 75 years old with an average of(59.3+ 3.5) years old. Preoperative clinical manifestation mainly focus on red and swollen of bunion, pain around with metatarsal bones, and diagnosed as hallux valgus with deformity of little toe varus through small incision. Operative time, postoperative complications, pre and post operative IMA(angle between the first and the second metatarsal bones) HVA (hallux valgus angle) LDA(valgus angle of the fifth metatarsal bones) MPA(valgus angle of little toe) IM4 5 (angle between the forth and the fifth metatarsal bones) and PASA(fixed angle of proximal joint) postoperative AOFAS score were used to evaluate foot function.  One hundred and sixty eight patients were followed up for 6 to 48 months with an average of (28.6+ 3.2) months. All wounds were healed well without infection, sinus tract and other complications. Operative time ranged from 16 to 28 min with an average of (18.3+ 2.1) min. IMA, HVA, LDA, MPA and IM A 4 5 were (10.1+ 2.1)deg, (32.6+ 4.2)deg, (6.9+ 2.3)deg, (18.5+ 5.2)deg, (15.1+ 2.9)degpreoperatively, improved to (8.3+ 2.2)deg, (10.9+ 2.9)deg, (2.7+ 0.4)deg, (6.5+ 1.6)deg, (8.9+ 1.8)deg postoperatively, and had significant differences before and after operation. While there was no difference in PASA before (9.1+ 2.1)degand after operation(8.7+ 1.9)deg. AOFAS score were improved from (31.6+ 3.9) before operation to(83.7+ 5.2) after operation, but no significant difference(P>0.05) According to AOFAS score, 147 patients obtained excellent results, 13 good, 6 moderate and 2 poor.  Minimally corrective osteotomy for the treatment of hallux valgus with deformity of little toe varus through small incision could obtain satisfied clinical effect, and has advantages of small incision, no stitches, beautiful appearance, shorter operation time, and rapid recovery. It is worth popularization in clinical practise.

title: Rationale and design for a phase 2 trial of abobotulinumtoxinA (Dysport(r) in the management of hallux valgus
abstract: 1. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and metaanalysis.  Interventions for treating hallux valgus (abductovalgus) and bunions.  Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the fi rst ray during the stance phase. Phys Ther 2009;89(9):934 945. 4. Arinci Incel N, Genc H, Erdem HR, Yorgancioglu ZR. Muscle imbalance in hallux valgus: an electromyographic study.  The pathogenesis of hallux valgus.  with botulinum toxin A. J Am Podiatr Med Assoc 2008;98(1):61 65. 7. Wu KP, Chen CK, Lin SC, et al. Botulinum Toxin type A injections for patients with painful hallux valgus: a doubleblind, randomized controlled study.

title: Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore Weight Bearing of the First Ray During the Stance Phase
abstract: Operative treatment of people with hallux valgus can yield favorable clinical and radiographic results. However, plantar pressure analysis has demonstrated that physiologic gait patterns are not restored after hallux valgus surgery.  The purpose of this study was to illustrate the changes of plantar pressure distribution during the stance phase of gait in patients who underwent hallux valgus surgery and received a multimodal rehabilitation program.  This was a prospective descriptive study.  Thirty patients who underwent Austin (n=20) and scarf (n=10) osteotomy for correction of mild to moderate hallux valgus deformity were included in this study. Four weeks postoperatively they received a multimodal rehabilitation program once per week for 4 to 6 weeks. Plantar pressure analysis was performed preoperatively and 4 weeks, 8 weeks, and 6 months postoperatively. In addition, range of motion of the first metatarsophalangeal joint was measured, and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot questionnaire was administered preoperatively and at 6 months after surgery.  The mean AOFAS score significantly increased from 60.7 points (SD=11.9) preoperatively to 94.5 points (SD=4.5) 6 months after surgery. First metatarsophalangeal joint range of motion increased at 6 months postoperatively, with a significant increase in isolated dorsiflexion. In the first metatarsal head region, maximum force increased from 117.8 N to 126.4 N and the force time integral increased from 37.9 N*s to 55.6 N*s between the preoperative and 6 month assessments. In the great toe region, maximum force increased from 66.1 N to 87.2 N and the force time integral increased from 18.7 N*s to 24.2 N*s between the preoperative and 6 month assessments.  A limitation of the study was the absence of a control group due to the descriptive nature of the study.  The results suggest that postoperative physical therapy and gait training may lead to improved function and weight bearing of the first ray after hallux valgus surgery.

title: Correction of foot deformities with hallux valgus by transversal arch restoration
abstract: The paper presents the effects of the application of a new technical solution along with medical procedures. This approach aims to correct the collapsed transverse arch of the foot and thus restore the physiological course of the anatomical structures. In this way, the alignment of the toes is achieved, thus also eliminating valgus of the big toe. In the article are presented results for 19 patients with stage I and 22 patients with stage II of the foot deformities. Patients applied the orthosis at 5 7 h daily per one year. Physical examination and X ray scans were used to assess correction progress. Angles between individual bones of the foot were compared. Correction of the transverse arch of the foot reduces the remain toes deformities of the foot (II V) The HV angle in the group of patients with the degree I deformity before and after the therapy was 18.3deg (3.1deg) and 15.2deg 2.6deg) respectively, and for patients with degree II deformity it was 19.2deg 2.9deg) and 16.3. 3.2deg) The correction deficit was reduced in stage I from 22% to 1.33% and in stage II from 28% to 8.6% (p

title: Recurrent Hallux Valgus
abstract: Obtaining effective long term results for the surgical correction of hallux valgus perhaps epitomizes most of any deformity within the foot and ankle, the adage that surgery is both art and science. The effective long term correction of recurrent hallux valgus therefore adds levels of complexity and challenges both technically for the surgeon as well as expectation wise for the patient. Patients electing to undergo surgery for the correction of their painful bunion deformity have fairly basic desires. They would like the correction to look good, feel good, and be lasting with minimal disruption to their everyday life. By its very presence, the outcome of an index surgery that later necessitates a second intervention has failed all those patient desires. This heightens tremendously the importance of effective surgeon patient communication and realistic appraisals by the surgeon as to their own personal skill set, knowledge base, and specifically those patient's expectations. A viable outcome formula characterizing the interplay between these variables may be considered as outcome surgeon knowledge multiplied by surgical execution divided by patient expectations. Clinical experience by the author has led to the additional surgical adages of a prudent reconstructive effort that seeks "to do the least possible and yet the most necessary" and the realization that "almost everything can work incompletely, and almost nothing works completely."

title: Minimally Important Difference in the Foot and Ankle Outcome Score Among Patients Undergoing Hallux Valgus Surgery
abstract: Patient reported outcomes are increasingly used as measures of effectiveness of interventions. To make the tools more useful, therapeutic thresholds known as minimally important differences have been developed. The objective of this study was to calculate minimally important differences for the domains of the Foot and Ankle Outcome Score for hallux valgus surgery.  The study was based on a retrospective analysis of patients newly scheduled for bunion correction surgery and completing patient reported outcomes between October 2013 and January 2018. This study used anchor and distribution based approaches to calculate the minimally important difference for the instrument's 5 domains. Confidence intervals were calculated for each approach. There were 91 participants included in the study.  Using anchor and distribution based approaches, the minimally important difference for the pain domain ranged from 5.8 to 10.2, from 0.3 to 6.9 for the symptoms domain, 8.3 to 10.3 for the activities of daily living domain, 7.4 to 11.1 for the quality of life domain, and from 7.0 to 15.7 for the sports and recreation domain. Small differences in the activities of daily living domain may be more clinically important for patients with better function.  The range of minimally important difference values for each domain indicate how the Foot and Ankle Outcome Score corresponded to bunion correction surgery. The sports and recreation domain showed considerable variability in the range of values and may be associated with the domain's lack of responsiveness. Overall, most minimally important difference values for the domains of FAOS ranged from above 4 to below 16.

title: Mitchell's osteotomy augmented with bio absorbable pins for the treatment of hallux valgus: A comparative finite element study
abstract: There is an inadequacy of conventional means to assess the surgical outcomes of a bunion surgery. We used the Finite Element Analysis for evaluating the typical Mitchell's procedure outcomes with or without bio absorbable pins.  We developed a 3D FE model based on the CT images of a female volunteer with hallux valgus. A typical procedure was simulated on the foot model and two pins were virtually inserted for enhancing the fixation. We validated our model by comparing the predicted pressure results with the plantar pressure measured by a specific platform.  The comparison of the plantar pressure distribution revealed similar patterns. A greater displacement was observed on the medial side of the osteotomy, but it was decreased after using pins. The maximum average pressure under the 1st metatarsal head was decreased after the osteotomy. The respective pressure under the 3rd and 5th metatarsal head was decreased more after using pins, while, under the 2nd and 4th metatarsal head, an increase was developed.  The use of pins had no significant influence on the healing process but gave additional stability inside the osteotomy and could be used in cases where enhancement is needed. The surgeon should be familiar with the expected stress rising to the other metatarsal, considering the concomitant pathology or the additional interventions that should be performed.