Footand Ankle Surgery 1998 4:35-41 Plantar foot pressure distribution in patients with Hallux valgus treated by distal soft tissue procedure and proximal metatarsal osteotomy M. NYSKA, A. LIBERSON*, C. McCABEt, K. LINGEq- AND L. KLENERMANt Department of Orthopaedic Surgery, Hadassah Medical Centre, Hebrew University, Jerusalem; * Department of Orthopaedic Surgery, Bnai-Zion Medical Centre, Haifa, Israel; and t University Department of Orthopaedic and Accident Surgery, Royal Liverpool University Hospital, Liverpool, UK Summl~l/~j The combination of a distal soft tissue procedure and proximal crescentic osteotomy of the first metatarsal corrects the main pathological deformities in Hallux valgus. Common complications of operations for Hallux valgus are transfer metatarsalgia and limitation of great toe function. Seventeen patients (29 feet) who had correction of Hallux valgus with a distal soft tissue procedure and proximal osteotomy were evaluated prospectively. The EMED system was used for an objective functional evaluation of plantar foot pressures. Clinical results: the average preoperative pain score was 2.5 points (maximal pain score 3 points). It was reduced to 1.17 points postoperatively. The score regarding difficulties in wearing shoes decreased from 2.68 (maximal score 3 points) to 1.65 points whilst for the cosmetic satisfaction decreased from 2.93 to 1.44 points. Nine feet in five patients were graded fair before the operation and the rest scored 'bad'. Following the surgery 27 feet were graded good and two feet had a fair result. Plantar foot pressures: at the hallux the area of ground contact, the ground reaction force and the force time integral all were lower in patients with Hallux valgus compared to normal subjects. Pressure-time and force-time integrals were increased on the mid-forefoot. These changes are typical of the pattern seen in patients with Hallux valgus. After operation the hallux had a longer contact time and exerted more force on the ground than before the operation. There was an increase in both pressure-time and force-time integral in the mid-forefoot region, indicative of increased loading. It is concluded that a distal soft tissue procedure and proximal osteotomy yields good clinical results and does not interfere in the function of the great toe; however, it leads to increased loading of the mid-forefoot. While performing the osteotomy this forefoot loading might be decreased by minimal plantar flexing the first metatarsal. Keywords- foot; plantar pressures; Hallux valgus Correspondence to: M. Nyska, MD, Department of Orthopaedic Surgery, Hadassah University Hospital, POB 12000, Ein~Kerem, Jerusalem 91120, Israel. © 1998 Blackwell Science Ltd 35