■掌趾关节(MTPJ)疼痛非常常见,然而潜在的病因仍然未知。先前的临床研究和生物力学研究表明,狭窄的长屈肌(FHL)肌腱炎是可能的原因。这项研究的假设是,仅专注于减轻限制性FHL偏移的治疗对患有halluxMTPJ疼痛的患者有益。
这是对2009年1月至2018年12月在足踝部接受治疗的患者进行的回顾性研究,这些患者被诊断为FHL肌腱炎并伴有HalluxMTPJ疼痛。人口统计,合并症,检查结果,成像结果,疼痛评分,治疗开始,结果来自电子病历。主要结果是疼痛评分(视觉模拟量表[VAS])的改善。如果手术患者的手术仅与FHL(后内侧踝关节松解术±s三角切除术)有关,则将其包括在内。使用人口统计学通过单变量和多变量统计来分析手术的决定,合并症,和临床发现作为潜在因素(P<0.05)。
■在75%(79英尺中的59英尺)中,FHL狭窄的非手术治疗导致患者感到满意的疼痛评分降低.FHL释放的手术组显示出90%的疼痛减轻(20英尺中的18英尺)。多变量分析确定了固定的需要(OR9.8,95%CI1.8-55.2,P=.009),参加田径运动(OR8.7,95%CI1.8-42.2,P=.007),和较高的初始VAS(OR1.7,95%CI1.3-2.3,P<.001)与手术决策相关。
■先前的生物力学研究表明,狭窄的FHL滑膜炎可导致halluxMTPJ关节内负荷增加。目前的临床研究支持这一假设,证明在某些情况下,专注于缓解限制性FHL偏移的治疗可以改善halluxMTPJ的疼痛。
UNASSIGNED: Pain in the
hallux metatarsophalangeal joint (MTPJ) is very common, yet the underlying etiology remains unknown. Previous clinical research and biomechanical research has implicated stenosing flexor hallucis longus (FHL) tendonitis as a possible cause. The hypothesis of this study was that treatment solely focusing on alleviating restricted FHL excursion would be beneficial in patients with
hallux MTPJ pain.
UNASSIGNED: This is a retrospective study of those treated in the Foot & Ankle Division between January 2009, and December 2018, who were diagnosed with FHL tendonitis with associated pain in the
hallux MTPJ. Demographics, comorbidities, examination findings, imaging results, pain scores, treatment instituted, and outcome was obtained from the electronic medical record. The primary outcome was the improvement in the pain score (visual analog scale [VAS]). The surgical patients were included if their procedure was solely related to the FHL (posteromedial ankle release ± os trigonum resection). The decision to have surgery was analyzed by univariate and multivariable statistics using demographics, comorbidities, and clinical findings as potential factors (P < .05).
UNASSIGNED: In 75% (59 of 79 feet), nonoperative treatment of FHL stenosis resulted in a decrease in pain scores that the patients felt was satisfactory. The operative group that had an FHL release showed decreased pain in 90% (18 of 20 feet). Multivariable analysis identified the need for immobilization (OR 9.8, 95% CI 1.8-55.2, P = .009), participating in athletics (OR 8.7, 95% CI 1.8-42.2, P = .007), and higher initial VAS (OR 1.7, 95% CI 1.3-2.3, P < .001) as being associated with the decision for surgery.
UNASSIGNED: Previous biomechanical studies have suggested that stenosing FHL synovitis can cause increased intraarticular loading in the
hallux MTPJ. The current clinical study supports this hypothesis, demonstrating that treatment focused on relieving restricted FHL excursion can ameliorate pain in the
hallux MTPJ in select cases.