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Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore Weight Bearing of the First Ray During the Stance Phase

R. Schuh, CM, is Research Fellow, Gait Analysis Laboratory, Foot and Ankle Center Vienna, Alserstrasse 43/8D, 1080 Vienna, Austria.
S.G. Hofstaetter, MD, is Senior Resident, Department of Orthopaedic Surgery, Klinikum Wels-Grieskirchen, Grieskirchnerstrasse 43, Wels, Austria.
S.B. Adams Jr, MD, is Senior Resident, Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
F. Pichler, PT, is affiliated with Foot and Ankle Center Vienna.
K.-H. Kristen, MD, is Senior Surgeon, Foot and Ankle Center Vienna.
H.-J. Trnka, MD, PhD, is Associate Professor of Orthopaedic Surgery, Foot and Ankle Center Vienna.

Address all correspondence to Mr Schuh at: reini.schuh{at}gmx.at

Background: 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.

Objective: 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.

Design: This was a prospective descriptive study.

Methods: 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.

Results: 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.

Limitations: A limitation of the study was the absence of a control group due to the descriptive nature of the study.

Conclusions: 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.

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