Trends in hallux valgus surgery continue to evolve. Basal metatarsal osteotomy theoretically provides the greatest correction, but is under-represented in the literature. This paper reports our early experience with a plate-fixed, opening- wedge basal osteotomy, combined with a new form of distal soft tissue correction (in preference to Akin phalangeal osteotomy). Thirty-three patients are reported here. The basal metatarsal osteotomy is fixed with the ‘Low Profile’ Arthrex titanium plate. No bone graft or filler is required, providing the osteotomy is within about 12mm of the base. Distal soft tissue correction comprised a full lateral release, and then proximal advancement of a complete capsular ‘sleeve’ on the medial side. The plate serves as a rigid anchoring point for the tensioning stitches. Using this technique, almost any degree of hallux valgus can be corrected, and there is even potential for over-correction. Functional outcome was assessed using the Manchester-Oxford foot and ankle score (MOXF). Radiographically the intermetatarsal angle was evaluated pre-operatively and at least 6 months postoperatively. Patients’ satisfaction and complication rates were recorded.Introduction
Materials and Methods
Poor trunk extensor endurance is implicated in low back pain; less, however, is known about contributions of left and right sides and upper and lower parts to maximum torque production following fatigue. This study examines torque and electromyographic (EMG) activity in different parts of the left and right trunk extensors before and following a maximal voluntary contraction (MVC) hold. 16 student rowers participated and written informed consent was obtained. Testing was performed in a Cybex isokinetic dynamometer with synchronous bilateral EMG recordings (during brief MVCs) from the left and right the erector spinae (ES) muscles at vertebral levels T12 and L4, prior to and immediately after, and 1, 5 and 10 minutes after a 60 second MVC. A small decrease in maximum torque was observed during 60s MVC, followed by a non significant step-wise increase. The torque at 10 minutes post MVC was the highest value recorded. EMG activity rose in the right upper back 5 and 10 mins following the fatigue. Furthermore, the ratios of left:right EMG activity revealed an increase compared to pre-fatigue values in the lower back but a decrease in the upper back, suggesting the task involved differential use of left and right sides in addition to upper and lower back muscles. These results suggest that 60s MVC induces differential activation of left and right sides and upper and lower parts of the trunk extensors. The apparent potentiation in force and asymmetry of activation following the 60s MVC task requires further investigation.
