Halluks valgus ile diz ve ayak bileği dizilim bozuklukları arasındaki ilişkinin değerlendirilmesi
Küçük Resim Yok
Tarih
2017
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada halluks valgus (HV) ile diz ve ayak bileği dizilim bozuklukları arasında ilişki olup olmadığını saptamayı amaçladık. Gereç-Yöntem: Haziran 2016-Mart 2017 yılları arasında ayak ön kısmında ağrı şikâyeti ile Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi FTR polikliniklerine müracat eden 18 yaş üzeri hastalar arasından klinik ve radyografik olarak halluks valgus tanısı konan 40 hasta ile yaş ve cins uyumlu 40 kontrol grubu çalışmaya alındı. Hastaların yaş, cinsiyet, boy, kilo, vucut kitle indeksi (kg/m2), meslek, eğitim düzeyi, hastalık süresi, ağrı düzeyleri (vizüel anolog skala: VAS ile) ve fonksiyonel durumları (Manchester-Oxford Ayak Anketi:MOFA ile) belirlendi. PACS (Picture archiving and communication systems) yazılımı ile bilgisayar üzerinde grafilerden halluks valgus açısı (HVA), intermetatarsal açı (IMA), interfalangeal açı (IPA), birinci metatars protruzyon mesafesi (FMPD), kalkeneal inklinasyon açısı (CIA), naviküler yükseklik (NH) , medial proksimal tibial açı (MPTA) , lateral distal tibial açı (LDTA) ölçüldü. Klinik olarak anatomik tibiafemoral açı (ATFA) , Q açısı, kalkeneal tibia açı (CTA), tibia dış rotasyon açısı (ETTA), naviküler kemik düşme testi (NKDT) ölçüldü. Hastaların klinik ve radyografik ölçüm değerleri, kontrol grubunun ölçüm değerleri ile karşılaştırıldı. Bulgular: Çalışmaya katılan 40 hastanın %80'i kadın (n=32), %20'si (n=8) erkek, yaş ortalaması 56.4 ± 10.4 yıl ve ortalama VKİ 29.3 ± 4.6 idi. Kontrol grubunun ise %75'i kadın (n=30), %25'i (n=10) erkek, yaş ortalaması 58.4 ± 8.9 yıl ve ortalama VKİ 29.6 ± 4.6 idi. Hasta ve kontrol grubu yaş (p=0.361), cinsiyet (p=0.790) ve VKİ (p=0.789) açısından benzerdi. Hastalarda ortalama hastalık süresi 7.5 ± 10.1 yıl, ortalama VAS skoru 5.2 ± 2.1 ve ortalama MOFA skoru 23.8 ± 13.6 (0-100 arası metrik sisteme göre 37.2 ± 21.3) idi. Hasta grubunda ortalama HVA 27.60 ± 8.5, ortalama IMA 14.60 ± 2.8, ortalama IPA 8.10 ± 6.2, ortalama FMPD mesafesi 2.5 ± 1.2 mm, ortalama CIA 21.80 ± 3.9, ortalama NH 44.2 ± 8.5 mm idi. Kontrol grubunda ise ortalama HVA 10.20 ± 2.4, ortalama IMA 8.00 ± 1.2, ortalama IPA 5.90 ± 4.9, ortalama FMPD mesafesi 1.6±0.8 mm, ortalama CIA 22.20 ± 3.8, ortalama NH 45.9 ± 6.2 mm idi. Hastaların HVA ve IMA açıları ile FMPD mesafesi kontrollerden anlamlı derecede daha yüksekken, MPTA açısı hasta grubunda daha düşüktü (p=0.024). LDTA, CIA ve NH hasta ve kontrol grubunda benzer düzeydeydi. Klinik ölçümlere bakıldığında ise hastaların ATFA (p<0.001), QA (p=0.005), CTA (p<0.001) ve NKDT (p=0.014) değeri kontroller grubundan yüksekken, ETTA (p=0.019) değeri kontrol grubuna göre daha düşüktü. Hastalarda HVA açısıyla diğer ölçümlerin korelasyonuna bakıldığında, HVA ile IMA, FMPD, ETTA ve NKDT arasında pozitif yönde korelasyon (sırasıyla p=0.001, p=0.005, p=0.004, p=0.021, p=0.043), IPA ve CIA ile negatif yönde korelasyon olduğu (sırasıyla p=0.007, p=0.005) görüldü. Radyografik ölçümler ile demografik ve klinik özellikler arasında korelasyon değerlendirildiğinde, HVA ile VAS (p=0.013) ve MOFA (p=0.031) değerinin pozitif yönde korele olduğu görüldü. Bununla birlikte HVA ile yaş (p=0.196), cinsiyet veya VKİ (p=0.596) arasında ilişki tespit edilemedi. Sonuç: Araştırmamızda halluks valgusu olan hastalardaki diz ve ayak bileğindeki sajittal düzlem dizilim ölçümleri kontrol grubundakilerle karşılaştırıldı. Çalışmamızın sonucunda HV hastaları ile kontrol grubu arasında, diz ekleminde MPTA, ATFA, Q açısı ve ETTA'nın; ayak-ayak bileğinde ise IMA, FMPD, CTA, NKDT ölçümlerinin farklılık gösterdiği görüldü. Bulgularımız ayak-ayak bileği ve diz dizilim bozuklukları ile HV arasında ilişki olduğunu göstermektedir. Bu nedenle dinamik bir deformite olarak kabul edilen HV, lokal bir deformite yerine daha proksimaldeki dizilim bozuklukları ile ilişkisi olan bir patoloji olarak ele alınmalıdır. Diz ve ayak bileğindeki dizilim bozukluklarına engel olunabilir veya düzeltilebilirse HV gelişiminin önlenebileceğini düşünmekteyiz.
In this study, we aimed to determine whether there is a relationship between hallux valgus (HV) and knee and ankle alignment disorders. Materials and Methods: This study was conducted in Physical medicine and rehabilitation outpatient clinics of Necmettin Erbakan University, Meram Medical Faculty, between June 2016 and March 2017. Forty patients over 18 years of age, who applied with complaints of anterior foot pain and diagnosed as hallux valgus clinically and radiographically, and 40 age and sex-matched controls were included in the study. Patients' age, gender, height, weight, body mass index (kg/m2), occupation, education level, duration of illness, pain levels (with visual analogue scale: VAS) and functional status (with Manchester-Oxford Foot Survey:MOFA)were obtained.The measurements and calculations of hallux valgus angle (HVA), intermetatarsal angle (IMA), interphalangeal angle (IPA), first metatarsal protrusion distance (FMPD), calcaneal inclination angle (CIA), navicular height (NH), medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA) were performedwith PACSsoftwareon computer. Clinically, anatomic tibio-femoral angle (ATFA), Q angle, calcaneo-tibial angle (CTA), external tibial torsion angle (ETTA), navicular bone drop test (NKDT) were measured. The results were compared with those of the control group. Results: The patients group was composed of 8 men and 32 women witha mean age of 56.4 ± 10.4 years, while the control group wascomposed of 10 men and 30 women with a mean age of58.4 ± 8.9 years. The groups were statistically similar in terms of age(p=0.361), sex(p=0.790) and BMI (p=0.789). The average duration of disease was 7.5±10.1 years, the average VAS score was 5.2±2,1 and the average MOFA score was 23.8 ± 13.6 (37.2 ± 21.3 VIII with reference to 0-100 metrics system). In patientsgroup, the average HVA was 27.6° ± 8.5, average IMA was 14.6° ± 2.8°, average IPA was 8.1° ± 6.2°, average FMPD distance was 2.5 ± 1.2 mm, average CIA was 21.8° ± 3.9 and average NH was 44.2 ± 8.5 mm. In control group, the average HVA was 10.2° ± 2.4, IMA was 8.0° ± 1.2, IPA was 5.9° ± 4.9, average FMPD distance was 1.6 ± 0.8mm, average CIA was 22.2° ± 3.8 and average NH was 45.9 ± 6.2 mm. In patients group, average HVA, IMA and FMPD values were statistically significantly higher than those of control group while average MPTA measure (p=0.024) was less than control group. Average LDTA, CIA and NH values were similar in each group. When clinical measurements took into account, patients ATFA (p<0.001), QA (p=0.005),CTA (p<0.001) and NKDT (p=0.014) values were higher than control group, but ETTA (p=0.019) was less than control group. In patients group, HVA was positively correlated with IMA, FMPD, ETTAand NKDT(respectively p=0.001, p=0.005, p=0.004, p=0.021, p=0.043)) and negatively correlated with IPA and ICA (respectively p=0.007, p=0.005). In terms of demographic and clinical features HVA was positively correlated with VAS (p=0.013)and MOFA (p=0.031). However, there was no relationship between HVA and age (p = 0.196), gender or BMI (p = 0.596). Conclusions: In our investigation, sagittal plane alignment measurements in the knee and ankle in patients with hallux valgus were compared with those of control group. Our results showed that, MPTA, ATFA, Q angle and ETTA in the knee joint andIMA, FMPD, CTA, NKDT measurementsin the ankle and foot differs between the HV patients and control group. Our findings indicate that there is arelationship between HV and knee and ankle-foot alignment disorders. Therefore, HV which considered as a dynamic deformity should be considered as a pathology related to more proximal alignment disorders instead of local deformity. We think that the development of HV can be avoided if the knee and ankle misalignment can be prevented or corre
In this study, we aimed to determine whether there is a relationship between hallux valgus (HV) and knee and ankle alignment disorders. Materials and Methods: This study was conducted in Physical medicine and rehabilitation outpatient clinics of Necmettin Erbakan University, Meram Medical Faculty, between June 2016 and March 2017. Forty patients over 18 years of age, who applied with complaints of anterior foot pain and diagnosed as hallux valgus clinically and radiographically, and 40 age and sex-matched controls were included in the study. Patients' age, gender, height, weight, body mass index (kg/m2), occupation, education level, duration of illness, pain levels (with visual analogue scale: VAS) and functional status (with Manchester-Oxford Foot Survey:MOFA)were obtained.The measurements and calculations of hallux valgus angle (HVA), intermetatarsal angle (IMA), interphalangeal angle (IPA), first metatarsal protrusion distance (FMPD), calcaneal inclination angle (CIA), navicular height (NH), medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA) were performedwith PACSsoftwareon computer. Clinically, anatomic tibio-femoral angle (ATFA), Q angle, calcaneo-tibial angle (CTA), external tibial torsion angle (ETTA), navicular bone drop test (NKDT) were measured. The results were compared with those of the control group. Results: The patients group was composed of 8 men and 32 women witha mean age of 56.4 ± 10.4 years, while the control group wascomposed of 10 men and 30 women with a mean age of58.4 ± 8.9 years. The groups were statistically similar in terms of age(p=0.361), sex(p=0.790) and BMI (p=0.789). The average duration of disease was 7.5±10.1 years, the average VAS score was 5.2±2,1 and the average MOFA score was 23.8 ± 13.6 (37.2 ± 21.3 VIII with reference to 0-100 metrics system). In patientsgroup, the average HVA was 27.6° ± 8.5, average IMA was 14.6° ± 2.8°, average IPA was 8.1° ± 6.2°, average FMPD distance was 2.5 ± 1.2 mm, average CIA was 21.8° ± 3.9 and average NH was 44.2 ± 8.5 mm. In control group, the average HVA was 10.2° ± 2.4, IMA was 8.0° ± 1.2, IPA was 5.9° ± 4.9, average FMPD distance was 1.6 ± 0.8mm, average CIA was 22.2° ± 3.8 and average NH was 45.9 ± 6.2 mm. In patients group, average HVA, IMA and FMPD values were statistically significantly higher than those of control group while average MPTA measure (p=0.024) was less than control group. Average LDTA, CIA and NH values were similar in each group. When clinical measurements took into account, patients ATFA (p<0.001), QA (p=0.005),CTA (p<0.001) and NKDT (p=0.014) values were higher than control group, but ETTA (p=0.019) was less than control group. In patients group, HVA was positively correlated with IMA, FMPD, ETTAand NKDT(respectively p=0.001, p=0.005, p=0.004, p=0.021, p=0.043)) and negatively correlated with IPA and ICA (respectively p=0.007, p=0.005). In terms of demographic and clinical features HVA was positively correlated with VAS (p=0.013)and MOFA (p=0.031). However, there was no relationship between HVA and age (p = 0.196), gender or BMI (p = 0.596). Conclusions: In our investigation, sagittal plane alignment measurements in the knee and ankle in patients with hallux valgus were compared with those of control group. Our results showed that, MPTA, ATFA, Q angle and ETTA in the knee joint andIMA, FMPD, CTA, NKDT measurementsin the ankle and foot differs between the HV patients and control group. Our findings indicate that there is arelationship between HV and knee and ankle-foot alignment disorders. Therefore, HV which considered as a dynamic deformity should be considered as a pathology related to more proximal alignment disorders instead of local deformity. We think that the development of HV can be avoided if the knee and ankle misalignment can be prevented or corre
Açıklama
Anahtar Kelimeler
Ayak, Foot, Ayak bileği, Ankle, Ayak deformasyonları, Foot deformities
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yalçın, Ş. (2017). Halluks valgus ile diz ve ayak bileği dizilim bozuklukları arasındaki ilişkinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Konya.
