Estudio de casos y controles para la evaluación de la asociación de parametros morfológicos del pie y la presencia de Hallux Rigidus

Identifier:  TDX:502

Handle: https://hdl.handle.net/20.500.11797/TDX502

Authors:  Calvo de Cos, Alberto

Abstract:
INTRODUCTION Limitation of movement in the sagittal plane and pain in the first metatarsophalangeal joint was named 'hallux flexus' for the first time in 1887 by Davies-Colley. In 1888 Cotterill was the first to use the term 'hallux rigidus' to describe this condition. After hallux valgus, hallux rigidus is the disease that most commonly affects the first metatarsophalangeal joint, and can be more disabling for the patient.More than 100 years after this initial description, the debate on the etiology of this disease remains open. OBJECTIVESOur objective is to specify, by means of a scientific methodology, the anatomical variations that influence the pathogenesis of hallux rigidus. MATERIAL AND METHODSA retrospective study of cases and controls was performed.The cases were a series of patients afflicted with hallux rigidus operated on in several centres (Hospital Universitari de Tarragona Joan XXIII, Hospital Comarcal de Mora d'Ebre, Hospital de San Rafael and Hospital de Sant Pau i Santa Tecla). Out of a total 248 cases of hallux rigidus examined, 132 were chosen, the remainder being ruled out for various reasons. A control group with clinically and radiologically normal feet was established. Both groups were comparable in terms of side, sex and age.The following variables were studied:A- Clinical and Morphological Variables: 9 variables were collected from each foot. B- Radiological Measurements: 14 weight-bearing dorsoplantar projection measurements and 7 weight-bearing lateral projection measurements were taken of each foot. The statistical methodology included a descriptive analysis, univariable analysis, an analysis of measurement accuracy and a multivariable analysis.RESULTSA comparative statistical analysis of the resulting measurements between the group of patients with hallux rigidus and the control group was carried out. The results obtained from the differentiation according to sex, age, degree of hallux rigidus, metatarsal formula and digital formula were likewise described. Limit and cut off values were calculated for the parameters showing statistical significance. Finally a multivariable analysis of the latter was performed. DISCUSSIONA comparison of our results for each variable with those of previous bibliography is carried out.CONCLUSIONS · The flattened shape of the first metatarsal head is associated with the presence of hallux rigidus, constituting the most discriminating cut off point.· The increased length of the first metatarsal is associated with the presence of hallux rigidus.· The Metatarsophalangeal Angle is greater than 14º in feet suffering from hallux rigidus. · A Metatarsophalangeal Angle of the Second Toe greater than -8º is related to the presence of hallux rigidus. · A greater distance between the sesamoids and the metatarsophalangeal angle of the hallux is linked to the presence of hallux rigidus.· In our series, medial cortical hypertrophy of the second metatarsal was not observed in cases of hallux rigidus.· We have not found a statistically significant relationship between Dorsal Flexion of the First Metatarsal and the presence of hallux rigidus.· We have not found a statistically significant relationship between Plantar Flexion of the Hallux and the presence of hallux rigidus.· We have not found a statistically significant relationship between Rearfoot Disorders and the presence of hallux rigidus.· We have not found a statistically significant relationship between the occurrence of Flat Feet and the presence of hallux rigidus.