TOE PLANTARFLEXION EXERCISE FOR METATALSALGIA

Transcription

1 TOE PLANTARFLEXION EXERCISE FOR METATALSALGIA St. luke s international hospital and *Kogakuin university KENTARO AMAHA M.D. *KUNIO HORIUCHI EISHI KURODA

2 TOE PLANTARFLEXION EXERCISE FOR METATALSALGIA My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 BACKGROUND Toe plantarflexion weakness has been suggested to be associated with forefoot deformities and disorders. Endo M: J Gerontol Common conditions that will cause forefoot pain is metatarsalgia. DiPreta JA: Med Clin North Am Relationship between toe plantarflexion weakness and metatarsalgia is poorly understood. There are no validated measures for assessing toe weakness in the clinical setting.

4 OBJECTIVE we developed a new device that measures toe plantarflexion strength as strength to press the floor. The aim of this study was to assess the hypothesis that toe plantarflexion exercise can affect metatarsalgia.

5 PATIENTS AND METHOD Patients 20 patients (17 women and 3 men) were enrolled. To be included in this study, the patients had to present a characteristic history of metatarsalgia continuosly for at least 2 months. Method Clinical trial with a 8-week toe plantarflexor muscle exercise training program. Before and after training program, toe plantarflexion strength was measured using push-type toe grip strength meter in both upright and sitting position. Every patient was measured both feet twice on the same day. Reliability of the device was assessed with Brand-Altman plot using the intraclass correlation coefficient (ICC)

6 OUTCOME MEASURES 1 st assessment 2nd assessment 8-week toe plantarflexor muscle exercise Patients were assessed using the visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, number of marble pickup with toes. The Wilcoxon signed-rank test was used to compare the outcomes.

7 RESULTS The ICC of the device was excellent (0.88~0.96). The mean age was 61 (45-78). 6 patients had bilateral and 14 patients had unilateral metatarsalgia. In the unilateral cohort, toe plantarflexion strength of the symptomatic foot was weaker (P<0.05) than asymptomatic foot in upright position (47.1N and 71.0N). After 2 months training program, toe plantarflexion strength was significantly increased both upright and sitting position(p=.01 and p=.03). plantarflexion strength before upright sitting after

8 RESULTS The mean VAS score decreased from 5.2 to 2.5(p=.00), AOFAS score improved from 67.2 to 77.1(p=.00), number of marble pickup with toes also improved from 7.7 to 9.5(p=.00) before VAS after AOFAS score before after marble pickup with toe before after No adverse events were reported.

9 DISCUSSION During the toe off of the gait cycle, only the forefoot is in contact with the ground active and passive components of toe plantarflexion have significant effect on the load distribution across the forefoot at toe-off stance. Hamel et al., 2001 Weakening toe plantarflexion interrupts the physiologic weightbearing mechanism between metatarsal heads and toes. This pathologic conditions produce metatarsalgia. Our study indicates gaining the toe plantarflexion strength will provides physiologic balance between metatarsal heads and toes.

10 DISCUSSION An advantage of the push-type toe grip strength meter is that toe flexor muscle strength is measured as strength of weight-bearing. The toe flexor muscle strength decreased with age result in loss of balance during gait. This device can be applied to the prevention of falls in elderly individuals. Limitations of this study Relatively small sample size, furthermore, gender disribution is skewed, with few men(15%). a clear cut-off strength value was not identified. Future studies will focus on the establishment of normal values in a large population.

11 CONCLUSION The toe strength exercise program can be one of the means to treat metatarsalgia in addition to insole and metatarsal osteotomies. The the push-type toe grip strength meter provides an accurate clinical assessment of the toe flexor muscle strength

12 REFERNCES 1. Coughlin MJ. Common causes of pain in the forefoot in adults. J Bone Joint Surg Br Aug;82(6): DiPreta JA; Metatarsalgia, lesser toe deformities, and associated disorders of the forefoot. Med Clin North Am 2014 Mar; 98(2): Endo M, Aston-Miller JA, Alexander NB: Effects of age and gender on toe flexor muscle strength.j Gerontology 2002, 57A(6): Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. J Am Acad Orthop Surg Aug;18(8): Espinosa N, Maceira E, Myerson MS. Current concept review: metatarsalgia. Foot Ankle Int Aug;29(8): Hamel AJ, Donahue SW, Sharkey NA. Contributions of active and passive toe flexion to forefoot loading. Clin Orthop Relat Res Dec;(393): Maestro M, Besse JL, Ragusa M, Berthonnaud E. Forefoot morphotype study and planning method for forefoot osteotomy. Foot Ankle Clin N Am. 2004;8(4) Munro BJ, Lord SR, Menz HB, Steele JR. Toe weakness and deformity increase the risk of falls in older people. Clin Biomech (Bristol, Avon) Dec; 24(10): Soysa, A., Hiller, C., Refshauge, K., & Burns, J. Importance and challenges of measuring intrinsic foot muscle strength. J Foot Ankle Res Nov 26;5(1):29