Foot kinematics in walking on a level surface and on stairs in patients with hallux rigidus before and after cheilectomy

Benita Kuni, Sebastian Immanuel Wolf, Felix Zeifang, Marc Thomsen, Benita Kuni, Sebastian Immanuel Wolf, Felix Zeifang, Marc Thomsen

Abstract

Background: Walking down stairs is a clinically relevant daily activity for older persons. The aim of this pilot study was to investigate the impact of cheilectomy on walking on level ground and on stairs.

Methods: 3D motion analysis of foot kinematics was performed in eight patients with hallux rigidus and 11 healthy control participants with a 12-camera system, using the Heidelberg foot measurement method before and one year after surgery. The clinical results were documented using the AOFAS Scale.

Results: The range of motion of the first metatarsophalangeal joint did not improve after the operation under any gait condition. Preoperatively, hallux dorsi-/plantarflexion in level walking was 11.9° lower in patients than in controls (p = 0.006), postoperatively 14.5° lower (p = 0.004). Comparing walking conditions in patients, hallux dorsi-/plantarflexion was significantly higher in level walking than in climbing stairs (difference up stairs - level: -8.1°, p = 0.018).The AOFAS Scale improved significantly from 56.9 ± 19.9 points (mean ± SD), preoperatively, to 75.9 ± 13.9 points, postoperatively (p = 0.027).

Conclusions: Cheilectomy is appropriate for reducing symptoms of hallux rigidus. However, neither a positive influence on the range of motion in walking on level ground and on stairs nor a functional improvement was observed in this group of patients.

Trial registration: NCT01804491.

Figures

Figure 1
Figure 1
Marker placement according to the Heidelberg Foot Measurement Method*. Hallux (HLX), metatarsal heads (DMT1, DMT2 and DMT5), proximally at the 1st and 5th metatarsal (PMT1, PMT5), navicular (NAV), lateral malleolus (LML), dorsal (CCL), medial and lateral (MCL, LCL) calcaneus, lateral epicondyle (LEP), tibial tuberosity (TTU), shin (SH1/2) markers; the medial epicondyle (MEP) and medial malleolus (MML) markers are not shown. *Reprinted from Gait & Posture, 23 (4), J. Simon, L Doederlein, A.S. McIntosh, D. Metaxiotis, H.G. Bock, S.I. Wolf, The Heidelberg foot measurement method: Development, description and assessment, Page 414, 2006, with permission from Elsevier.
Figure 2
Figure 2
Pre- and postoperative hallux dorsiflexion/plantarflexion. Pre- and postoperative hallux dorsiflexion/plantarflexion given as angles (in degrees) with time of the gait cycle (0-100%) for patients compared to the control participants in all gait conditions. Heavy lines: mean values, dashed lines: standard deviation. Positive values indicate dorsiflexion.

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