Many patients undergoing surgery to correct hallux valgus (bunion) continue to have difficulty with walking. Few studies, however, have evaluated the effect of exercise after hallux valgus surgery. Australian researchers published a descriptive study on the outcomes of 30 patients after osteotomy to correct mild to moderate hallux valgus. The researchers were interested in the plantar pressures of patients, particularly at the first ray. Despite improvement in clinical and radiographic measures, hallux valgus patients often lack the proper function of the first ray and great toe; this may alter gait patterns well after surgery.

At 4 weeks post-op, patients performed a multi-modal rehabilitation program once a week for 4 to 6 weeks. The treatment protocol included edema control, joint mobilization, soft tissue mobilization, and gait training. In addition, patients performed exercises with Thera-Band® resistance bands.  The specific exercises were designed to reduce pressure on the metatarsophalangeal (MTP) joints. Patients had to flex the MTP joints without bending the distal and proximal interphalangeal (IP) joints; then the exercise was combined with active pronation.

After rehabilitation, patients improved in range of motion and plantar pressure distribution; however, the study was limited by the lack of a control group. Subsequent studies should include a control group to identify specific effects of the intervention.

The results of this study indicate that physical therapy (including Thera-Band® exercises) following hallux valgus osteotomy may improve function and weight-bearing of the first ray, resulting in improved gait and function.

REFERENCE: Schuh R, et al. Rehabilitation after hallux valgus surgery: importance of physical therapy to restore weight bearing of the first ray during the stance phase. Phys Ther. 2009 Sep;89(9):934-45.

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