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The Study on the Influence of the Foot with Toe Amputation

Author: WuZuo
Tutor: JiaTangHong
School: Shandong University
Course: Orthopedics
Keywords: Toe Defect Follow up studies Foot Pressure distribution time gait analysis Amputation Gait analysis
CLC: R658.3
Type: PhD thesis
Year: 2011
Downloads: 10
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Abstract

Background:The foot is the most intimate weight loading organ. Its main function is weight loading and walking. Therefore, the structure of the foot is all involved according to this. The role of the bone and parenchyma in foot is to absorb energy and reduce loading. Formerly, the study is concentrated on the significant domain of foot, for example, heel, instep, the former metatarsus, etc. The focus is not on the assistant toe. Toe damage can be seen often in clinic. The people are easy to give up the "unimportant" toe to exchange "the clinical" cure when the toe injured severely or be pedopath. The general therapia is to amputate it directly. Using the toe or the skin of toe as the donor site in the repairing of hand surgical trauma is commonly. Furthermore, the principle is "reconstruction as possible as you can". The method of repairing the foot donor site is apical stitch. Along with the pervasion of the microsurgical technique, it is not difficult to retain the toe by the technique of flap. But the people accustomed to ignore the function of toe. Whether retaining the length of toe is necessary, or not, the different doctor has different cognition.The study of the influence of toe injury to the foot function is focused on the iatrogenic injury, for example, the finger reconstruction. Because of different doctor has personal proneness to select the method of finger reconstruction and the repairing of donor site. So the study of the influence on donor foot function resulted in the toe defect caused by the finger reconstruction are some kind of definite operation type. It is short of comprehensive and comparing study. Although, the people has thought highly of the change of donor foot day by day, but the consequence of recovery is different using different recovery method in identical wound surface. The condition of the injured foot can be impacted by the local condition of parenchyma, in addition to the amount of toe defect and the length of bone defect. As far as possible to eliminate the interference of local condition of skin, the painful cicatricle and so on, in order to objectively reflect the influence of the toe defect on foot function. Thereby, it can guide us to decide the level of amputation.To study the influence to the function of the foot with toe amputation, we should consider the defect and scar of soft tissue firstly. So all the patients we followed are all with good skin coverd in order to exclude the interference with the pain scarf. Thus we can find the influence to the function of the foot only caused by different level toe amputation. This study is to be expect it can do some help to the surgeon when face repairing the toe injury and finger reconstruction. We will evaluate the function of damaged foot from two parts:subjective and objective. The pain score and movement disorder score are all included in subjective evaluate. With analysis of these quantitative score, we can find the how the function of the foot lost. The objective evaluate is using Footscan gait pressure analysis, the gait cycle, pressure of the under foot, impulse such data should be comparative analysis. All the collected data are comparable. We collect somes of the health person as the pre-test to find whether it has some common change or law in those people. Thus, we can correct some the reasonable deviation when facing the pathological change in the pressure of the foot.Part One Long-term follow up the function of the foot with toes amputationObjectives To study the patient’s subjective reception and the injured foot function in different type of toe defect by questionnaire investigation.Medthods Patients who suffered toes injury between Jan 2003 and December 2009 were followed up. All the patients were divided into seven groups. Team A is partial amputation of the distal hallux. Team B is the skin defect of the distal hallux repaired with flap. Team C is the distal hallux amputation at the interphalangeal joint level. Team D is the second toe amputation. Team E is the single toe amputation range from 3rd to 5th. Team F includes multiple toes amputation range from 2nd to 5th toe. Team G is the middle line toe amputation accompany with arcus pedis transversalis damage. The foot were examined and photoed, meanwhile, Foot function index-verbal rating scales (FFI-5pt) were conducted to these patients. The score is represented with x±s. The outcomes were tested by Mann-Whitney test. Using the conventional definition with alpha=0.05, p-values less than 0.05 are considered as variation.Results One hundred and fifty seven patients were followed up postoperatively. With a mean period of 37 months (range 24-90 months). The painful score was 1.08±1.1 in team A,1.09±1.2 in team B,0.9±1.2 in team C,1.05±1.2 in team D, 0.73±0.9 in team E,1.4±1.1 in team F,1.94±1.4 in team G. The score of action disturbance was 0.33±0.9 in team A,0.93±1.02in team B,1.55±1.1 in team C, 0.61±0.8 in team D,0.33±0.5 in team E,1.9±1.0 in team F,1.37±0.9 in team G. The score of foot disturbance was 1.50±1.8 in team A,2.02±2.1 in team B,2.45±2.0 in team C,1.65±1.7 in team D,0.93±1.2 in team E,3.30±1.5 in team F,3.31±2.1in team G. The influence of toe defect on foot function sort by size was G, F, C, B, D, A, E. The maximum effect was G. The minimum effect was E.Conclusion Different type of the toe damage has different influence on the foot. The influence of the partial distal end of the hallux amputation is similar to the 3rd or 4th toe amputation. The influence of the skin defect of the distal hallux repaired with flap is similar to the second toe amputation. The influence of the toe amputation accompany with arcus pedis transversalis damage is larger than distal hallux amputation.Part Two To study the contribution of the foot pressure in health people with Footscan gait analyse systemObjectives To study the variation of distribution of foot pressure in different time in healthy Jinan people by using Footscan gait analyse system.Medthods To measure and analyse the bipedal pressure data in 50 cases of healthy Jinan people and the same time three months after by using Footscan gait analyse system. The results every time is included of one team. It concluded of two teams. The outcomes were tested by Mann-Whitney test, Using the conventional definition with alpha=0.05, p-values less than 0.05 are considered as variation.Results The distribution of the footplate pressure existed distinction individually. The pressure in different part of the foot lined from large to small is the heel, the 2nd metatarsal bone or the 3rd metatarsal bone, the 4th metatarsal bone, the bid toe, the 1st metatarsal bone, hallux, the 5th metatarsal bone, the 2-5 toes. The pressure-time integral in different part of the foot lined from large to small is the 2nd metatarsal bone, the 3rd metatarsal bone, the heel, the 4th metatarsal bone, hallux, the 1st metatarsal bone, the 5th metatarsal bone, the bid toe, the 2-5 toes. The foot pressure will change with time apart in the same tested people while the change is similar in a pair of foot.Conclusion Tthe foot pressure contribution changes when time apart. The maximum pressure are always observed in the heel and middle parts of the fore-metarsal. The pair the foot change synchronize with pressure changed. These two pair can be refer each other.Part Three Assessment of the function of the foot with toe defect by gait analysis.Objectives To study the influence to the function of the foot with different type of toe injury by the method of gait analysis.Medthods Four groups of patients with different type of toe amputation were followed up and the plantar biomechanical were analyzed by the Footscan plantar biomechanical machine. To use the good foot of the patient as the control.Results The partial amputation of the distal hallux cause the local pressure change. The whole distal hallux amputation can cause the center of gravity retrocession and forefoot push off phase short. The second toe amputation can cause the planta pressure shift outside. The head of metatarsal bone amputation will make the propodium’s pressure increase.Conclusion Each kind of the toe amputation may cause different influence to the kinematics of the foot. The amputation of distal hallux and the head of the second metatarsal bone bring significant change to planta pressure. We should attempt to save it.

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CLC: > Medicine, health > Surgery > Of surgery > Limbs outside the science > Lower limb
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