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Introdução: O Hallux valgus é uma deformidade estrutural do pé, com presumível elevada prevalência, que consiste no desvio lateral do primeiro dedo do pé em que a parte distal do primeiro metatarso se torna proeminente. Após a avaliação diagnóstica, através de parâmetros morfológicos e radiográficos, a decisão do tipo de tratamento poderá ser conservadora ou cirúrgica. Uma das técnicas cirúrgicas utilizadas é a osteotomia de Chevron.
Objetivos e Metodologia: O principal objetivo deste trabalho é o estudo de indivíduos submetidos à osteotomia de Chevron no Centro Hospitalar Cova da Beira. Assim, foi realizado um inquérito, por via telefónica, aos indivíduos que tinham recebido tratamento cirúrgico através da técnica de Chevron, entre janeiro de 2012 e julho de 2015, onde era aferida a satisfação subjetiva do doente, através de parâmetros como a dor, a dificuldade em usar calçado e a estética do pé. Esta foi relacionada com a medição dos ângulos radiográficos do pré e pós-operatório (intermetatarsal angle, Hallux valgus angle e distal metatarsal articular angle), assim como com as fórmulas digitais e metatarsais. O tratamento estatístico das diferentes variáveis foi realizado utilizando os programas IBM SPSS Statistics 23® e Microsoft Excel 2010®. Foram utilizados os testes t-student e do qui-quadrado de Pearson, admitindo-se o nível de significância ? <0,05.
Resultados: A amostra populacional é composta por 41 casos de intervenções em que foi aplicado a osteotomia de Chevron. No entanto, só 38 casos é que responderam ao inquérito, havendo ainda a exclusão de 3, que tinham o diagnóstico de doenças que levam a deformações articulares. Assim, dos 35 casos participantes, 85,71% eram do sexo feminino e 14,29% eram do sexo masculino. A média de idades foi de 55,63 anos e o índice de massa corporal foi de aproximadamente 26,69. Quanto às respostas dadas no inquérito, segundo a dor em repouso, a dor ao caminhar, a dificuldade em usar calçado e a estética do pé, em média, as pessoas consideram estar melhor nestes parâmetros. No que concerne à satisfação, 65,70% estão satisfeitos, 5,70% estão mais ou menos satisfeitos e 28,60% não estão satisfeitos, sendo que, a maioria dos casos que consideram estar satisfeitos, referem estar melhor nos restantes parâmetros inquiridos. Na avaliação anatómica do pé, para a fórmula digital verificou-se a frequência do pé egípcio em 21 casos, do grego em 11 e o quadrado em 3, sendo que em proporção os que têm pé tipo grego são os mais insatisfeitos. Para a fórmula metatarsal, 13 são índex plus minus, 20 são índex minus e 2 são índex plus. Os que se apresentam com fórmula índex minus, em proporção, são aqueles que se apresentam mais insatisfeitos. Para a medição dos ângulos radiográficos, apenas 23 casos dispunham de radiografias pré e pós-operatórias realizadas no Centro Hospitalar Cova da Beira. Assim, os ângulos pré e pós-operatório e a respetiva correção são, em média, para o intermetatarsal angle (normal quando =9º) 11,74º, 9,78º e 1,96º, para o Hallux valgus angle (normal quando =15º) são 30,87º, 21,04º e, aproximadamente, 10,00º e para o distal metatarsal articular angle (normal quando =15º) são 28,30º, 20,17º e 8,13º, respetivamente.
Discussão: Segundo alguma bibliografia, a osteotomia de Chevron deve ser realizada em indivíduos com idade inferior a 50 anos, o que poderá explicar algum resultado negativo, uma vez que a média de idades foi de 55,63 anos. Quanto ao índice de massa corporal, a média foi de 26,69, o que pode pôr em causa os resultados da cirurgia devido ao excesso de carga sobre o pé no pós-operatório. Relativamente ao inquérito realizado a maioria dos indivíduos estão satisfeitos com a cirurgia e apresentam melhoria nos diferentes parâmetros avaliados. No entanto, quando comparados com alguma bibliografia estes resultados não são tão positivos quanto aparentam. A melhoria da dor na zona interna do pé ao nível da primeira articulação metatarsofalângica será o fator que mais contribui para a satisfação dos indivíduos. Na avaliação dos ângulos verificou-se que, na maioria dos casos, a cirurgia realizada diminuiu os três ângulos. Contudo, a média dos ângulos pós-cirúrgicos manteve-se acima do limite da normalidade para os ângulos em causa e as médias de correção do intermetatarsal angle e do Hallux valgus angle foram 1,96º e 9,83º, respetivamente, valores inferiores aos referidos em alguma bibliografia, podendo estes factos serem a explicação de alguns resultados de insatisfação. Outra explicação poderá ser o facto de o outcome cirúrgico não corresponder às expectativas criadas pelos indivíduos.
Conclusão: A maioria dos participantes está satisfeita com a realização da osteotomia de Chevron. Para esta satisfação contribuíram a melhoria estética do pé, a melhoria da dor na zona da articulação metatarsofalângica, tanto em repouso como ao caminhar, assim como a diminuição da dificuldade em usar calçado. Quanto às fórmulas digital e metatarsal não se verifica a existência de um grupo que se relacione melhor com esta satisfação. Dos indivíduos inquiridos, a maioria dos que referem estar satisfeitos com a cirurgia apresentam diminuição ou manutenção dos ângulos radiográficos, não existindo relação clara entre a correção de um ângulo e a satisfação.
Introduction: Hallux valgus is a deformity of the foot structure, with apparent high prevalence, consisting of the lateral deviation of the first toe, in which the distal portion of the first metatarsal becomes prominent. After diagnostic evaluation, through morphological and radiographic parameters, the decision on the type of treatment may be conservative or surgical. One of the used techniques is the Chevron osteotomy. Objectives and Methodology: The main objective of this work is the study of patients undergoing Chevron’s osteotomy in Centro Hospitalar Cova da Beira. Thus, a survey was conducted by telephone, individuals who had received surgical treatment by Chevron’s technique between January 2012 and July 2015, which was assessed the patient subjective satisfaction through parameters such as pain, the difficulty in using footwear and aesthetic of the foot. This was related to the measurement of pre and postoperative radiographic angles (intermetatarsal angle, hallux valgus angle and distal metatarsal articular angle), as well as digital and metatarsal formulas. Statistical analysis of the different variables was performed using IBM SPSS Statistics 23® and Microsoft Excel 2010® programs. The t-student test and Pearson’s chi-square test were used, assuming the level of significance of ? <0.05. Results: The sample population consists of 41 cases of interventions that were applied to Chevron’s osteotomy. However, only 38 cases have responded to the survey and there is still the exclusion of 3, who had the diagnosis of diseases that lead to joint deformities. Thus, of the 35 participant cases, 85.71% were female and 14.29% were male. The average age was 55.63 years and body mass index was approximately 26.69. As for the answers given in the survey, according to pain at rest, pain when walking, difficulties in using footwear and aesthetic of the foot, on average, people consider being best in these parameters. With regard to satisfaction, 65.70% are satisfied, 5.70% are more or less satisfied and 28.60% are not satisfied, and in most cases those who consider to be satisfied, refer to be better in the other respondent parameters. In the anatomical evaluation of the foot, to the digital formula found the frequency of the Egyptian foot in 21 cases, the Greek in 11 and the square at 3, and in proportion, those with Greek type foot are the most dissatisfied. For the metatarsal formula, 13 are index plus minus, 20 is minus index and 2 are index plus. The presenting with index minus formula, in proportion, are those who are most dissatisfied. For the measurement of radiographic angles, only 23 cases had pre and postoperative radiographs performed at Centro Hospitalar Cova da Beira. Thus, the pre and postoperative angles and their correction are, on average, for the intermetatarsal angle (normal when =9º) 11,74º, 9,78º and 1,96º, for Hallux valgus angle (normal when =15º) are 30,87º, 21,04º and approximately 10,00º and distal metatarsal joint angle (normal when =15º) are 28,30º, 20,17º and 8,13º, respectively. Discussion: According to some literature, Chevron’s osteotomy should be performed in individuals under the age of 50 years, which may explain a negative result, since the average age was 55.63 years. For body mass index, the average was 26.69, which may call into question the results of the surgery due to excessive load on the foot postoperatively. Relation to the survey, most people are satisfied with the surgery and show improvement in various parameters evaluated. However, when compared with some literature these results are not as positive as they appear. The improvement of pain in the foot inner zone at the level of the first metatarsophalangeal joint is the most important factor that contributes to the satisfaction of individuals. In the evaluation of angles it has been found that, in most cases, the surgery performed decreased the three angles. However, the mean postoperative angles remained above normal limits for the angles in question and the average correction of the metatarsal angle and the hallux valgus angle were 1,96º and 9,83º, respectively, lower than those referred in some literature, these facts may be the explanation of some results of dissatisfaction. Another explanation could be that the surgical outcome does not meet the expectations created by individuals. Conclusion: The majority of participants are satisfied with the realization of Chevron´s osteotomy. For this contributed the satisfying aesthetic improvement of the foot, the improvement of pain, in the area of the metatarsophalangeal joint, at rest and when walking, as well as reducing the difficulty in using shoes. As for the digital and metatarsal formulas were not verified the existence of a group that relates better with this satisfaction. Of those interviewed, most who report being satisfied with the surgery have decreased or maintenance of radiographic angles and there is no clear relationship between the correction of an angle and satisfaction.
Introduction: Hallux valgus is a deformity of the foot structure, with apparent high prevalence, consisting of the lateral deviation of the first toe, in which the distal portion of the first metatarsal becomes prominent. After diagnostic evaluation, through morphological and radiographic parameters, the decision on the type of treatment may be conservative or surgical. One of the used techniques is the Chevron osteotomy. Objectives and Methodology: The main objective of this work is the study of patients undergoing Chevron’s osteotomy in Centro Hospitalar Cova da Beira. Thus, a survey was conducted by telephone, individuals who had received surgical treatment by Chevron’s technique between January 2012 and July 2015, which was assessed the patient subjective satisfaction through parameters such as pain, the difficulty in using footwear and aesthetic of the foot. This was related to the measurement of pre and postoperative radiographic angles (intermetatarsal angle, hallux valgus angle and distal metatarsal articular angle), as well as digital and metatarsal formulas. Statistical analysis of the different variables was performed using IBM SPSS Statistics 23® and Microsoft Excel 2010® programs. The t-student test and Pearson’s chi-square test were used, assuming the level of significance of ? <0.05. Results: The sample population consists of 41 cases of interventions that were applied to Chevron’s osteotomy. However, only 38 cases have responded to the survey and there is still the exclusion of 3, who had the diagnosis of diseases that lead to joint deformities. Thus, of the 35 participant cases, 85.71% were female and 14.29% were male. The average age was 55.63 years and body mass index was approximately 26.69. As for the answers given in the survey, according to pain at rest, pain when walking, difficulties in using footwear and aesthetic of the foot, on average, people consider being best in these parameters. With regard to satisfaction, 65.70% are satisfied, 5.70% are more or less satisfied and 28.60% are not satisfied, and in most cases those who consider to be satisfied, refer to be better in the other respondent parameters. In the anatomical evaluation of the foot, to the digital formula found the frequency of the Egyptian foot in 21 cases, the Greek in 11 and the square at 3, and in proportion, those with Greek type foot are the most dissatisfied. For the metatarsal formula, 13 are index plus minus, 20 is minus index and 2 are index plus. The presenting with index minus formula, in proportion, are those who are most dissatisfied. For the measurement of radiographic angles, only 23 cases had pre and postoperative radiographs performed at Centro Hospitalar Cova da Beira. Thus, the pre and postoperative angles and their correction are, on average, for the intermetatarsal angle (normal when =9º) 11,74º, 9,78º and 1,96º, for Hallux valgus angle (normal when =15º) are 30,87º, 21,04º and approximately 10,00º and distal metatarsal joint angle (normal when =15º) are 28,30º, 20,17º and 8,13º, respectively. Discussion: According to some literature, Chevron’s osteotomy should be performed in individuals under the age of 50 years, which may explain a negative result, since the average age was 55.63 years. For body mass index, the average was 26.69, which may call into question the results of the surgery due to excessive load on the foot postoperatively. Relation to the survey, most people are satisfied with the surgery and show improvement in various parameters evaluated. However, when compared with some literature these results are not as positive as they appear. The improvement of pain in the foot inner zone at the level of the first metatarsophalangeal joint is the most important factor that contributes to the satisfaction of individuals. In the evaluation of angles it has been found that, in most cases, the surgery performed decreased the three angles. However, the mean postoperative angles remained above normal limits for the angles in question and the average correction of the metatarsal angle and the hallux valgus angle were 1,96º and 9,83º, respectively, lower than those referred in some literature, these facts may be the explanation of some results of dissatisfaction. Another explanation could be that the surgical outcome does not meet the expectations created by individuals. Conclusion: The majority of participants are satisfied with the realization of Chevron´s osteotomy. For this contributed the satisfying aesthetic improvement of the foot, the improvement of pain, in the area of the metatarsophalangeal joint, at rest and when walking, as well as reducing the difficulty in using shoes. As for the digital and metatarsal formulas were not verified the existence of a group that relates better with this satisfaction. Of those interviewed, most who report being satisfied with the surgery have decreased or maintenance of radiographic angles and there is no clear relationship between the correction of an angle and satisfaction.
Description
Keywords
Ângulos Radiográficos Fórmula Digital Fórmula Metatarsal. Hallux Valgus Osteotomia de Chevron