Fig. 1.
Data extraction from reviewed articles for HV plantar pressure variable
| Study | Intervention | Purpose of the study | Study group/age (years) Test conditions/Equipment | Results |
|---|---|---|---|---|
| Martínez-Nova et al., 2008[27]Scale | Percutaneous distal soft tissue release (DSTR)-Akin procedure. | Describing the effects of the percutaneous DSTR-Akin procedure on plantar pressure distribution, clinical outcome, and radiographic parameters measured at a minimum of 12 months postoperatively. | 26 women (16 right and 14 left). | Peak pressure in the hallux, decreased significantly. |
| All participants used the appropriate size of the same brand of shoes, pressure insoles. | Mean pressure in the hallux decreased significantly. | |||
| To analyze the pressure distribution, the foot was divided by the software into 9 areas corresponding to heel, midfoot, first through fifth metatarsal heads, hallux, and lesser toes [second to fifth]. | No significant changes were found for the other areas. | |||
| The average follow-up was 12.1 months. | ||||
| Schuh et al., 2009[28]Scale | 10 scarf osteotomy and20 Austin osteotomy | Illustrate the changes of plantar pressure distribution during the stance phase of gait in patients who underwent HV surgery and received a multimodal rehabilitation program. | 20 persons aged: (58.4 ± 13.8) underwent Austin and 10 patients – scarf osteotomy for correction of mild to moderate HV deformity. | The mean contact area in the greater toe between the preoperative examination and the assessment 6 months after surgery was statistically significant. |
| Pressure platform. Areas of the great toe, second toe, first metatarsal head, and second metatarsal head, as well as the total foot were analysed. | In the first metatarsal head region and the great toe region, there were an increase of maximum force and the force-time integral between the preoperative and 6-month assessments. | |||
| AOFAS score and ROM of the first MTP joint were evaluated preoperatively and 6 months after surgery. Plantar pressure analyses were performed preoperatively and 4, 8 weeks, and 6 months after surgery. | ||||
| Schuh et al., 2010[29]Scale | Chevron osteotomy | Determine if apostoperative rehabilitation program helped to improve weightbearing of the first ray after chevron osteotomy for correction of HV deformity. | 29 patients with a mean age of 58 with mild to moderate HV deformity. | In the great toe, the mean maximum force increased1 year after surgery. |
| Pressure platform. | There was a significant increase in the mean contact area for the total foot and in the mean for the great toe region. | |||
| Preoperative and one-year postoperative plantar pressure distribution parameters including maximum force, contact area and force-time integral were evaluated. | The mean force-time integral increased significantly at one-year follow-up for the great toe region. There was a significant increase of this parameter for the second metatarsal head region. | |||
| Additionally, the AOFAS score, ROM of the first MTP joint and plain radiographs were assessed. | ||||
| Areas of the great toe, second toe, first metatarsal head, and second metatarsal head, as well as the total foot were analyzed. | ||||
| Schuh et al., 2010[29]Scale | Chevron osteotomy | Determine if a postoperative rehabilitation program helped to improve weightbearing of the first ray after chevron osteotomy for correction of HV deformity. | 29 patients with a mean age of 58 with mild to moderate HV deformity. | In the great toe, the mean maximum force increased1 year after surgery. |
| Pressure platform. | There was a significant increase in the mean contact area for the total foot and in the mean for the great toe region. | |||
| Preoperative and one-year postoperative plantar pressure distribution parameters including maximum force, contact area and force-time integral were evaluated. | The mean force-time integral increased significantly at one-year follow-up for the great toe region. There was a significant increase of this parameter for the second metatarsal head region. | |||
| Additionally, the AOFAS score, ROM of the first MTP joint and plain radiographs were assessed. | ||||
| Areas of the great toe, second toe, first metatarsal head, and second metatarsal head, as well as the total foot were analyzed. | ||||
| Martinez-Nova et al., 2011[14]Scale | Medial eminence of first MTH was removed, DSTR)-Akin procedure | 1. To elucidate whether a difference existed in the forefoot dynamic plantar pressure distribution after surgery [when compared with an age – matched healthy control group]; | 79 patients, aged: (54.7 ± 12.5) and 98 controls. | No statistical difference post-operatively vs. pre-operatively in cadence and whole foot contact time. |
| 2. To establish which clinical, radiological, and anthropometric factors deter – mine the post-operative plantar pressures values. | Plantar pressure insoles. All subjects had the same type of shoe. | Significant increase in the mean pressures the 4th, 5th MTHs and significant decrease for the hallux. | ||
| The final clinical, plantar pressure, and radiographic examinations were done at a minimum follow-up of 2 years [mean: 28.1 months; range: 24–33 months] with no loss at follow-up. | No significant differences were found between control group and the HV group. The post-operative plantar pressures showed significantly lower 4th and 5th MTH pressures in the controls than the post-operative values. Nosignificant differences occurred in the hallux pressures. | |||
| Chopra, Moerenhout and Crevoisier, 2016[17]Kinem, * | Modified Lapidus procedure | In maximum vertical force parameter for the preoperative versus postoperative comparison significant difference was reported only at thelateral toes – decrease and hallux regions – decrease. | ||
| In maximum peak pressure parameter for the preoperative versus postoperative comparison significant difference was seen in forefoot central – decrease and lateral toe regions – decrease. | ||||
| Total contact duration was postoperatively: decreased in hallux, forefoot central regions and increased in hindfoot lateral, hindfoot medial, midfoot lateral, forefoot lateral regions. | ||||
| Moerenhout, Chopra and Crevoisier, 2019[19]Kinem, Scale, * | Modified Lapidus procedure | At 12 months follow-up, total contact time at hindfoot lateral was the only parameter reporting significant increase compared to the preoperative value. | ||
Quality assessment scores of included studies
| Question | Canseco et al., 2012 [15] | Sadra et al., 2013 [16] | Chopra, Moerenhout and Crevoisier, 2016 [17] | Klugarova et al., 2016 [18] | Moerenhout, Chopra and Crevoisier, 2019 [19] | Defrino et al., 2002 [20] | Brodsky et al., 2007[21] | Nawoczenski, Ketz and Baumhauer, 2008[22] | Canseco et al., 2009b [23] | Smith et al., 2012[24] | Kuni et al., 2014[25] | Stevens et al., 2016 [26] | Martínez-Nova et al., 2008[27] | Schuh et al., 2009[28] | Schuh et al., 2010[29] | Martinez-Nova et al., 2011[14] |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reporting (questions: 1–10) | ||||||||||||||||
| 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| 2 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| 3 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| 4 | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| 5 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 6 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| 7 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 11 | 1 | 1 | 1 | 0 |
| 8 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 9 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 1 | 0 | 1 | 0 | 1 | 1 | 1 | 1 |
| 10 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Sum | 7/11 | 7/11 | 7/11 | 6/11 | 8/11 | 8/11 | 8/11 | 7/11 | 8/11 | 7/11 | 8/11 | 7/11 | 8/11 | 8/11 | 8/11 | 7/11 |
| External validity (questions: 11–13) | ||||||||||||||||
| 11 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
| 12 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
| 13 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 1 | 1 | 1 |
| Sum | 0/3 | 1/3 | 0/3 | 0/3 | 0/3 | 0/3 | 1/3 | 0/3 | 0/3 | 0/3 | 1/3 | 1/3 | 0/3 | 1/3 | 1/3 | 3/3 |
| Internal validity – bias (questions: 14–20) | ||||||||||||||||
| 14 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 15 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 16 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| 17 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 |
| 18 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| 19 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| 20 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Sum | 4/7 | 4/7 | 4/7 | 4/7 | 4/7 | 4/7 | 4/7 | 4/7 | 4/7 | 4/7 | 4/7 | 4/7 | 5/7 | 5/7 | 5/7 | 5/7 |
| Total | 11/21 | 13/21 | 11/21 | 10/21 | 12/21 | 12/21 | 13/21 | 11/21 | 12/21 | 11/21 | 13/21 | 12/21 | 13/21 | 14/21 | 14/21 | 15/21 |
Data extraction from reviewed articles for HR kinematic parameters
| Study | Intervention | Purpose of the study | Study group/age (years) Test conditions/Equipment | Results |
|---|---|---|---|---|
| Defrino et al., 2002 [20]Kinet, PP, Scale | MTP I arthrodesis | Quantify the effects of first metatarsophalangeal arthrodesis on gait and plantar pressures. | 4 women and 4 men with an average age of 56 [38–72]. | The patient’s operated limb was found to have a significantly decreased step length when normalized for height. There was no significant change in the hip or knee kinematics. |
| Motion capture system, force platform. | ||||
| 3 trials were obtained both pre – and post-operatively for each patient. The mean time to follow-up was 34 months (26 – 44). | ||||
| Brodsky et al., 2007[21]Kinet, PP, Scale | MTP I arthrodesis | Evaluate the effects of MTP I joint arthrodesis on gait. | 23 patients aged (58 ± 9.5) with symptomatic HR refractory to non-operative treatment were treated with first MTP joint arthrodesis. | Comparison pre – vs. post-operatively. |
| Motion capture system, force plate. | The kinematic analysis revealed no significant changes in sagittal ankle ROM. | |||
| Follow-up – 1.46 (1 – 2.9) years after surgery | A significant increase in single-limb time support was observed in the involved extremity pre – vs. post-operation. A significant decrease was noted in step width from pre – vs. post-operation. | |||
| Nawoczenski, Ketz and Baumhauer, 2008 [22]PP, Scale | Cheilectomy | Assessement in vivo dynamic first MTP joint kinematics and plantar pressures. | 20 patients (9 females, 11 males) aged (34 – 63) were prospectively evaluated prior to undergoing cheilectomy for grades I–III HR. | Significant increases pre – vs. post-operation in dorsiflexion and hallux abduction were found for active motion and during gait. |
| Eleven subjects were surveyed at 6 years. Plantar pressure data were acquisition. Dynamic pedobarograph. | ||||
| Electromagnetic was used to track 3D position and orientation of the calcaneus, the first metatarsal and the hallux during quiet standing, active ROM during weight bearing and walking. | ||||
| Canseco et al., 2009b[23]Scale | Cheilectomy | Investigation the temporal and kinematic characteristics of segmental foot motion in a group of patients with HR before and after cheilectomy. | 19 subjects (11 males, 8 females) 50.5 (34–75). All subjects demonstrated mild to moderate HR. | Post-cheilectomy, walking speed, cadence, and stride length significantly increased, stance duration was significantly shortened as compared to the preoperative. |
| A comparison of patients with HR to healthy ambulators showed that the pre-op group had significantly longer stance duration. | ||||
| Motion capture system – Milwaukee Foot Model. | After surgery, MTP IROM remained significantly decreased in load response and initial swing, but improved during the rest of the gait phases. | |||
| MTP IROM was not significantly different postoperatively in the coronal or transverse planes. | ||||
| Pre-operative evaluation was done at an average of 33 days prior to surgery. Post-operative evaluation was done at an average of 1.5 years after surgery. Post – operative testing was conducted only after complete clinical return to a stable ambulatory pattern. | Postoperatively, hallux sagittal position improved towards normal, reaching significant levels from initial swing to mid-swing. | |||
| No significant differences in hallux segment positions were found in the coronal or transverse planes before or after surgery. | ||||
| Smith et al., 2012 [24]Kinet, Scale | First MTP cheilectomy. The cheilectomy did not resect the dorsal third of the MTH, rather the head was resected no more than to the level of the dorsal cortex of the metatarsal shaft | Testing the hypothesis that cheilectomy for HR improves gait by increasing ankle push-off power. | 17 (8 women, 9 men), aged: 47.4 (37 – 64). Motion capture system, force plate. | There were no significant changes in either velocity or sagittal plane ankle ROM. |
| Gait analysis was performed within 4 weeks prior to surgery and then repeated at least 1 year after surgery. | First MTP passive motion significantly increased post-operation. | |||
| The average follow-up was (1.8 ± 0.9) (1.02 – 3.58) years. | ||||
| Kuni et al., 2014 [25]Scale | Cheilectomy | Investigation the kinematic characteristics of multi-segmental foot motion in patients with HR before and after cheilectomy both when walking on level ground as well as on stairs. | 8 patients (6 women, 2 men) aged: (59.1 ± 6.4). | The hallux dorsi/plantarflexion ROM was significantly lower than in controls in level walking and descending stairs pre – and postoperatively. |
| At least 6 stair ascents and descents on a custom-made 80-cm-wide staircase which consisted of 5 steps of 15 cm in height and a step distance of 32 cm. | In the comparison between preoperative and postoperative state, the hallux dorsi/plantarflexion ROM significantly decreased by 2.5degin level walking. | |||
| Motion capture system. | The analysis of level gait sub-phases showed only postoperatively significant differences between patients and controls for the maximum hallux dorsiflexion in pre-swing – controls: (38.2± 5.8) deg; patients preoperatively: (29.6± 6.0) deg. | |||
| Postoperative evaluation was done at (1.1 ± 0.3) years after the operation. | Pre – and postoperative walking speeds matched in the patient group in level walking and in walking up the stairs. | |||
| Postoperatively, patients significantly reduced their speed when walking down the stairs as compared to the preoperative speed. | ||||
| Stevens et al., 2016[26]PP, Scale | MTP I arthrodesis | Checking where the foot compensates for the loss of motion after an MTP1 arthrodesis in order to restore the gait pattern toward a normal gait pattern. | 8 patients (59.4 ± 8.3): 6 underwent aunilateral MTP1 arthrodesis, 2 abilateral MTP1 arthrodesis. Total of 10 feet with MTP1 arthrodesis. | Step width was significantly smaller in the MTP I arthrodesis group compared to the healthy controls. |
| 12 healthy subjects (43.1±18.2): 9 were measured bilaterally, 3 unilaterally. | The MTP I arthrodesis group showed a significantly increased ROM in the terminal stance phase in the transverse plane in the hindfoot-tibia segment, which was the result of a more internally rotated hindfoot. | |||
| Total of 21 feet without arthrodesis. Force plate, motion capture system. | A significantly decreased ROM was observed after a MTP I arthrodesis in the frontal plane during midstancein the hindfoot-tibia segment, due to diminished eversion of the hindfoot. | |||
| Gait analysis took place at a median follow-up of 27 months (range: 18–60 months) postoperatively. | Evaluation of motion patterns of the segments of interest and proximal joints showed no major differences between unilateral and bilateral treated patients. | |||
| Transverse plane motion showed a significantly reduced ROM after a MTP I arthrodesis in the forefoot-hindfoot segment during pre-swing, due to diminished adduction of the forefoot in this phase. In addition, significantly smaller plantarflexion was observed during midstance and terminal stance in this segment, which resulted in a significantly reduced ROM in the sagittal plane in the MTP I arthrodesis group. A significant increase in ROM after a MTP I arthrodesis, as a result of increased supination of the forefoot, was detected in the frontal plane during pre-swing in the forefoot-hindfoot segment. | ||||
| Significantly decreased ROM of the hallux was observed in the loading response and terminal stance phase in the MTP I arthrodesis group, which was the result of less plantarflexion of the hallux during loading response and less dorsiflexion of the hallux during terminal stance. | ||||
Data extraction from reviewed articles for HV and HR scales
| Study | Deformity | Intervention | Type of scale | Results |
|---|---|---|---|---|
| Martínez-Nova et al., 2008 [27]HVPP, †† | HV | DSTR-Akin procedure | HVA, IMA, AOFAS hallux metatarsophalangeal-interphalangeal | The average AOFAS score improved significantly post-op. |
| Mean HVA and IMA significantly decreased post-op. | ||||
| Schuh et al., 2009[28]HVPP, †† | HV | 10 scarf osteotomy | AOFAS | The average AOFAS score improved significantly 6 months after surgery. |
| 20 Austin osteotomy | First metatarsophalangeal joint ROM increased at 6 months postoperatively, with a significant increase in isolated dorsiflexion. | |||
| Schuh et al., 2010[29]HVPP, †† | HV | Chevron osteotomy | AOFAS | The average AOFAS score improved significantly post-op. |
| HVA, | Mean HVA and IMA significantly decreased post-op. | |||
| IMA | ||||
| Martinez-Nova et al., 2011 [14]HVPP, †† | HV | Medial eminence of first MTH was removed, percutaneous distal soft tissue release (DSTR)-Akin procedure | IMA, HVA | The average AOFAS score improved significantly post-op. |
| AOFAS hallux–metatarsophalangeal–interphalangeal | Mean HVA and IMA significantly decreased post-op. | |||
| Canseco et al., 2012[15]HVKinem, † | HV | No data | Changes in static deformity were evaluated based on measurements of the HVA and IMA on weight-bearing AP plain radiographs. | Mean HVA and IMA significantly decreased post-op. Average metatarsal length was also found to be significantly shorter. |
| SF-36 Health Survey. | SF-36, statistically significant improvement was seen in Physical Functioning. | |||
| Chopra, Moerenhout and Crevoisier, 2016[17]HVkinem, † | HV | Modified Lapidus procedure | AOFAS forefoot score and FAAM – activity of daily living (ADL). | Significant improvement in the IMA and HVA. |
| IMA, HVA and distal metatarsal articular angle (DMAA). | FAAM-ADL – no significant changes. | |||
| AOFAS – significant improvement in pain and function. | ||||
| Moerenhout, Chopra and Crevoisier, 2019[19]HVkinem, PP, † | HV | Modified Lapidus procedure | AOFAS. | The FAAM-ADL outcome reported non-significant improvement at 12 months. The AOFAS, reported significant improvement from six months onwards, and continued to show improvement at 12 months postoperatively. |
| ADL part of the Foot and Ankle Ability Measure (FAAM). | Compared with the preoperative values, significant improvement was achieved in IMA and HVA at six months postoperatively. Values between six months and 12 months did not change significantly. DMAA showed no significant improvement postoperatively. | |||
| IMA, HVA and distal metatarsal articular angle (DMAA) | ||||
| Defrino et al., 2002[20]HRkinem, HRkinet, HRPP, * | HR | MTP I arthrodesis | AOFAS Hallux MTP-IP scale | The average AOFAS improved significantly post-op. Of the 10 arthrodesis procedures performed, four patients reported no pain, and minimal/occasional pain was reported in the other six. |
| Preoperative and post-operative radiographs were measured for IMA, HVA and interphalangeal/Fitzgerald score. | The preoperative and postoperative values for the IMA and IP/Fitzgerald were not significantly different from each other. The HVA was significantly reduced postoperatively. | |||
| Brodsky et al., 2007[21]HRkinem, HRkinet, * | HR | MTP I arthrodesis | No data | There was no clinical or radiographic evidence of hallux interphalangeal joint arthritis at the time of final follow-up in any patient in the study. All patients responded that the operation had a positive effect on their lives and that given the same circumstances they would again choose to have surgery. |
| Nawoczenski, Ketz and Baumhauer, 2008[22]HRkinem, HRPP, * | HR | Cheilectomy | VAS | At the time of the mid-term follow-up, the average postoperative VAS score[“worst pain”] was 5.1, representing an overall improvement of 20% in self-reported pain. |
| Canseco et al., 2009b[23]HRkinem, * | HR | Cheilectomy | SF-36 | The difference between preoperative and postoperative pain score was statistically lower post-op. |
| AOFAS | MTP IROM was significantly greater post-op. | |||
| SF-36 score changes were not statistically significant. | ||||
| Smith et al., 2012[24]HRkinem, HRkinet, * | HR | Cheilectomy | AOFAS | The average AOFAS score improved significantly post-op. |
| Clinical evaluation demonstrated significant changes in postoperative ROM of the MTP I joint and AOFAS Hallux scores. | ||||
| Kuni et al., 2014[25]HRkinem, * | HR | Cheilectomy | AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale | The average AOFAS score improved significantly post-op. |
| No significant difference in paint assessment could be detected pre and post-op. | ||||
| Stevens et al., 2016[26]HRkinem, HRPP, * | HR | MTP I arthrodesis | IMA, HVA | Radiographic angles are presented in showing a significant decrease in IMA and HVA after MTP Iarthrodesis. |
Data extraction from reviewed articles for HR plantar pressure variables
| Study | Intervention | Results |
|---|---|---|
| Defrino et al., 2002 [20 ]Kinet, Scale, * | MTP I arthrodesis | None of the pedobarographic measurements in the MTH regions were different between preoperative and postoperative evaluations. The maximum force and peak pressure under the hallux significantly increased between the preoperative and postoperative evaluations. The contact area under the entire foot and under the hallux significantly increased between the preoperative and postoperative evaluations. |
| Nawoczenski, Ketz and Baumhauer, 2008 [22]Kinem, Scale, * | Cheilectomy | Four out of 15 patients showed increased lateral metatarsal loading preoperatively. Pressures shifted medially following surgery, but no significant changes were recorded. |
| Stevens et al., 2016 [26]Scale, Kinem, * | MTP I arthrodesis | Significantly higher plantar pressures were observed beneath the lesser toes, second, third, fourth, and fifth metatarsal head areas and midfoot in the MTP I arthrodesis group. Evaluation of the pressure-time integral showed a significantly lower pressure-time integral in the hallux area, while a significantly higher pressure-time integral was observed in the fourth metatarsal and midfoot area in the MTP I arthrodesis group comparing to healthy controls. |
Data extraction from reviewed articles for HV kinematic parameters
| Study | Intervention | Purpose of the study | Study group/age (years) Test conditions/Equipment | Results |
|---|---|---|---|---|
| Canseco et al., 2012 [15]Scale | No information | Analyze changes in multi-segmental foot and ankle kinematics in patients after operative correction of HV. | 19 adults: 52.5 (24–72) | Postoperative comparisons to the normal population showed that only walking speed and stride length were significantly smaller. |
| 24 feet (15 lefts and 9 rights). Motion capture system. | ||||
| Sadra et al., 2013[16] | Scarf procedure | Does the corrective HV surgery improves gait and balance performance in an adult patient population? | 10 adults post-operative: (50 ± 9.4 years) | No significant difference in step length and support time. |
| 19 adults pre-operative: (44.3±11.9) | No difference in walking speed between pre-operative group and a control group. Significant reduction in walking speed compared to preoperative and control group. | |||
| 11 control participants: (22.9 ± 1.9) | ||||
| Sensor technology (LEGSys; BioSensics) | ||||
| Evaluation: Preoperative 10 ± 2.3 weeks post-operative. | ||||
| Chopra, Moerenhout and Crevoisier, 2016[17]PP | Modified Lapidus procedure | Assessment of the outcome of modified Lapidus at 6 months postoperatively, using gait assessment method to determine if the specified gait parameters effectively relate to the clinical scores and the radiological results. | 10 females: (51.3 ± 10.3) with moderate to severe HV deformity | The postoperative versus preoperative comparison showed a significant difference in push-off duration and toe-off pitch angle. |
| Control group:11 healthy female volunteers (50.4 ± 7.1) with no sign of HV deformity. Gait assessment was performed, once for controls and twice for the case group-preoperatively and 6 months post-operatively. | Spatio-temporal parameters after surgery were significantly worse than in the control group. | |||
| Pressure insoles, accelerometers and gyroscopes. | MTP I: In the sagittal plane, ROM in both HV and post modified Lapidus groups was significantly reduced in comparison to the healthy controls. In the coronal plane, significantly reduced ROM was reported in HV group in comparison to controls. | |||
| Klugarova et al., 2016[18] | First metatarsal osteotomy | Compare spatiotemporal parameters, lower limb and pelvis kinematics during the gait cycle in patients with HV before and after surgery and in relation to a control group. | 17 females (51.5 ± 11.4) with clinical and x-ray diagnosed HV deformity | HV surgery resulted in significantly greater decrease in the walking speed and increase of step time. |
| The postoperative gait analysis evaluation – 4 months postoperatively. | HV surgery did not influence the lower limb kinematics. | |||
| After the surgery, agypsum fixation was used for 4–6 weeks, followed by physical therapy. | The maximum of plantar flexion during toe off was significantly decreased. A smaller maximum of hip abduction with pelvis elevation at the beginning of the stance phase and a greater maximum of hip adduction with pelvis depression at the end of stance phase in the operated leg as compared to the non-operated leg were found. | |||
| Motion capture system. | In the non-operated leg after HV surgery. Significantly decreased cadence and walking speed. Step length of the non-operated leg became significantly shorter and took more time, which resulted in significantly increased duration of single support and double support phases. However, there were no significant changes in lower limb and pelvis kinematics on the non-operated leg after HV surgery. | |||
| Moerenhout, Chopra and Crevoisier, 2019[19]PP, Scale | Modified Lapidus procedure | Assessment the midterm outcome following modified Lapidus procedure by comparing the radio-clinical and gait outcomes at preoperative, 6 months and 12 months following surgery. | 10 female patients with signs of moderate to severe HV: (51.3±8.2) | At 6 months follow up, the toe-off pitch angle showed significant deterioration from the preoperative status. At 12 months, load duration during the stance phase and heel strike pitch angle were found to have significantly increased compared to the pre-operative values. |
| Pressure insoles, radiological, and gait assessment. | Compared to the pre-operative outcome, significant reduction in motion was recorded at forefoot-shank motion in the coronal plane at 6 and 12 months follow – up. | |||
Data extraction from reviewed articles for HR kinetic parameters
| Study | Intervention | Results |
|---|---|---|
| Defrino et al., 2002 [20]Kinem, PP, Scale, * | MTP I arthrodesis | In evaluation of the ankle kinetics in the sagittal plane, a reduction in both plantar flexor torque and power during toe-off as compared to the non-operative and the healthy control limbs was found. |
| Comparison to the patient’s normal limb and the healthy control showed that there were no significant differences in knee and hip kinetics. | ||
| Brodsky et al., 2007 [21] Kinem, Scale, * | MTP I arthrodesis | The kinetic analysis of gait parameters indicated a significant increase in maximal ankle push-off power. |
| Smith et al., 2012 [24] Kinem, Scale, * | MTP I cheilectomy | A significant difference was found between pre – and postoperative peak sagittal plane ankle push-off power. The peak sagittal plane ankle push-off power significantly increased post-op. |