Disorders of the First Ray: Part 2 Hypermobility, Functional Hallux Limitus, and Hallux Rigidus

2020 ◽  
pp. 139-168
Author(s):  
Douglas H. Richie Jr
Keyword(s):  
Hallux Rigidus ◽  
Hallux Limitus ◽  
First Ray

Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus

2016 ◽  
Vol 106 (3) ◽  
pp. 172-181
Author(s):  
Andrew F. Knox ◽  
Alan R. Bryant
Keyword(s):  
Metatarsal Head ◽  
Radiographic Evaluation ◽  
Head Shape ◽  
Intrinsic Factors ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Radiographic Measurements ◽  
Angle Data ◽  
Significant Difference ◽  
First Ray

Background: Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. Methods: Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. Results: Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ2 tests: P > .05). Conclusions: No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

Disorders of the forefoot

2011 ◽  
Author(s):  
Andrew H.N. Robinson ◽  
Maneesh Bhatia
Keyword(s):  
Surgical Treatment ◽  
Hallux Valgus ◽  
Early Mobilization ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Indications For Surgery ◽  
Forefoot Surgery ◽  
First Ray

♦ The aim of modern forefoot surgery is to refunction the first ray, and balance the lesser rays around it♦ The indications for surgery in hallux valgus are of pain over the bunion, or of pain with subluxation or dislocation of the lesser rays as a result of first ray insufficiency♦ Hallux valgus surgery aims to reposition the metatarsal head over the sesamoids whilst maintaining length. The osteotomy should be stable to allow early mobilization♦ The mainstays of the surgical treatment of hallux rigidus are dorsal cheilectomy and fusion of the first MTPJ♦ 96% excellent and good results in reconstruction of the rheumatoid forefoot have been reported with fusion of the first MTPJ and resection of the lesser metatarsal heads.

A Retrospective Analysis of 772 Patients with Hallux Limitus

2002 ◽  
Vol 92 (2) ◽  
pp. 102-108 ◽  
Author(s):  
John F. Grady ◽  
Timothy M. Axe ◽  
Emil J. Zager ◽  
Lori A. Sheldon
Keyword(s):  
Retrospective Analysis ◽  
Surgical Procedures ◽  
Conservative Management ◽  
Hallux Rigidus ◽  
Activity Levels ◽  
Conservative Care ◽  
Hallux Limitus ◽  
Surgical Treatments ◽  
Corticosteroid Injections ◽  
Expected Outcomes

In this retrospective analysis of 772 patients with symptomatic hallux limitus, 428 patients (55%) were successfully treated with conservative care alone; of these 428 patients, 362 (84%) were treated with orthoses. Corticosteroid injections and a change in shoes allowed 24 patients (6% of conservatively treated patients) and 42 patients (10%), respectively, to have less discomfort and return to previous activity levels. Overall, 47% of the patients in this analysis were successfully treated with orthoses. Surgical procedures were performed on 296 patients (38% of all patients) who did not respond to conservative care. In this analysis, 48 of the patients (6% of all patients) who did not respond to conservative care either refused surgery or were not surgical candidates. These data are intended to provide podiatric physicians with expected outcomes for conservative care of hallux limitus. The etiology, symptoms, conservative management, and surgical treatments of hallux limitus and hallux rigidus are also reviewed. (J Am Podiatr Med Assoc 92(2): 102-108, 2002)

scholarly journals Sensitivity and Specificity of the Functional Hallux Limitus Test to Predict Foot Function

2002 ◽  
Vol 92 (5) ◽  
pp. 269-271 ◽  
Author(s):  
Craig Payne ◽  
Vivienne Chuter ◽  
Kathryn Miller
Keyword(s):  
Sensitivity And Specificity ◽  
Metatarsophalangeal Joint ◽  
Clinical Test ◽  
Joint Function ◽  
Compensatory Mechanisms ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
First Ray ◽  
Foot Function ◽  
Midtarsal Joint

Functional hallux limitus is an underrecognized entity that generally does not produce symptoms but can result in a variety of compensatory mechanisms that can produce symptoms. Clinically, hallux limitus can be determined by assessing the range of motion available at the first metatarsophalangeal joint while the first ray is prevented from plantarflexing. The aim of this study was to determine the sensitivity and specificity of this clinical test to predict abnormal excessive midtarsal joint function during gait. A total of 86 feet were examined for functional hallux limitus and abnormal pronation of the midtarsal joint during late midstance. The test had a sensitivity of 0.72 and a specificity of 0.66, suggesting that clinicians should consider functional hallux limitus when there is late midstance pronation of the midtarsal joint during gait. (J Am Podiatr Med Assoc 92(5): 269-271, 2002)

Position of the first ray and motion of the first metatarsophalangeal joint

1996 ◽  
Vol 86 (11) ◽  
pp. 538-546 ◽  
Author(s):  
TS Roukis ◽  
PR Scherer ◽  
CF Anderson
Keyword(s):  
Quantitative Analysis ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
First Metatarsophalangeal Joint ◽  
First Ray

The authors present a quantitative analysis of the effect that first ray position has on motion of the first metatarsophalangeal joint. A goniometer was constructed to measure the degrees of first metatarsophalangeal joint dorsiflexion with the first ray in three positions: weightbearing resting position, dorsiflexed 4 mm from the weightbearing resting position, and dorsiflexed 8 mm from the weightbearing resting position. First metatarsophalangeal joint dorsiflexion decreased 19% as the first ray was moved from the weightbearing resting position to 4 mm dorsiflexed, 19.3% as the first ray was moved from 4 mm dorsiflexed to 8 mm dorsiflexed, and 34.7% as the first ray was moved from the weightbearing resting position to 8 mm dorsiflexed. The biomechanical significance of decreased first metatarsophalangeal joint dorsiflexion that results from first ray dorsiflexion is discussed, and proposed bases for the pathomechanics of hallux abducto valgus and hallux rigidus deformities are presented.

scholarly journals First Metatarsal Phalangeal Joint Arthrodesis without the Use of Hardware after Failed Arthroplasty: A Case Report

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peter Adamson ◽  
Cory Janney ◽  
Jie Chen ◽  
Vinod Panchbhavi
Keyword(s):  
Case Report ◽  
Bone Loss ◽  
Screw Fixation ◽  
Hallux Rigidus ◽  
Allograft Bone ◽  
Salvage Procedure ◽  
High Failure Rate ◽  
Unique Case ◽  
First Metatarsal ◽  
First Ray

Introduction: First metatarsal phalangeal joint (MTPJ) arthroplasty has a high failure rate due to aseptic loosening, which leads to bone loss. The salvage procedure is conversion to an arthrodesis, but bone loss can make obtaining screw fixation difficult. Herein, we report a unique case of revision first-metatarsal arthrodesis without the use of hardware after a failed arthroplasty. Case Report: A 60-year-old women presented to us with first MTPJ pain in the setting of failed arthroplasty. We performed an arthrodesis; however, intraoperatively, hardware fixation could not be obtained due to bone loss. We utilized allograft bone struts to maintain first ray length and to hold the correct hallux position during arthrodesis maturation. Conclusion: Bone loss is a frequently encountered problem in revision surgery to a first MTPJ arthrodesis. An arthrodesis can be obtained without the use of hardware in scenarios where bone loss precludes screw fixation. Keywords: Hallux rigidus, revision, bone loss, arthrodesis

scholarly journals Comparison between Hemiarthroplasty in the First Proximal Phalanx and Keller's Arthroplasty. A Finite Element Study

2018 ◽  
Vol 6 ◽  
Author(s):  
Mario Alberto Madrid Pérez ◽  
Javier Bayod López
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Hallux Rigidus ◽  
Element Analysis ◽  
Finite Element Study ◽  
First Ray ◽  
Element Study

Hallux valgus and hallux rigidus are the most common pathologies in the first ray of the foot. Arthroplasty can restore the mobility of the joint but is a destructive procedure. This paper presents three finite element analysis of the foot studying two different kinds of arthroplasty.

Average 4-Year Outcomes of Distal Oblique First Metatarsal Osteotomy for Stage 1 to 3 Hallux Rigidus

2021 ◽  
pp. 107110072110522
Author(s):  
Maurise Saur ◽  
Julien Lucas y Hernandes ◽  
Pierre Barouk ◽  
Lorena Bejarano-Pineda ◽  
Carlos Maynou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Hallux Rigidus ◽  
Aofas Score ◽  
First Metatarsal ◽  
Subjective Satisfaction ◽  
First Ray ◽  
Shortening Rate ◽  
Stage 1

Background: Hallux rigidus is the second most frequent pathology of the first ray. Surgical options for degenerative metatarsophalangeal joint disease are either joint destructive or conservative procedures. The hypothesis was that oblique distal shortening osteotomy of the first metatarsal is an effective conservative technique for the management of stage 1 to 3 hallux rigidus. Methods: We conducted a retrospective cohort study of 87 feet with Coughlin and Shurnas’s stage 1-3 hallux rigidus, operated between 2009 and 2019. The cohort consisted in 72 patients (87 feet) with an average age of 57±9 (30/79) years; 22 of 87 (25.3%) feet had the first metatarsal surgery performed in isolation; 65 of 87 (74.7%) had concomitant forefoot procedures, including 31 of 87 (35.6%) with Akin phalangeal osteotomies and 34 of 87 (39.1%) with Moberg phalangeal osteotomies. We evaluated the American Orthopaedic Foot & Ankle Society (AOFAS) Scale, subjective satisfaction, joint amplitudes, shortening rate, and occurrence of postoperative complications with a mean follow-up of 51 months (16/134). Results: The AOFAS score increased from 54.2±11.3 (25/70) preoperatively to 92.2±7.8 (62/100) postoperatively ( P < .001). Patients reported excellent or good outcome in 95.4% of cases. The 40-point self-reported pain subscale score improved from 19.6 (± 10.0) to 37.4 (± 5.4), P < .001. The overall range of motion increased from 61±21 (20/110) degrees to 69±17 (35/120) degrees ( P < .001). The mean first metatarsal shortening rate (SRpo) was 9.6%. Neither the Coughlin grade, the metatarsal index, or the SRpo influenced the AOFAS score. At 6-month follow-up, 15 patients had transfer metatarsalgia compared with 5 at last follow-up without requiring another surgical procedure. The risk was not significantly different according to Coughlin's stage, preoperative metatarsal index, or SRpo. Conclusion: Oblique distal osteotomy of the first metatarsal for stage 1-3 hallux rigidus, often in combination with other first ray procedures, performed well during our follow-up time period, with a high subjective satisfaction rate and few complications. Level of Evidence: Level III, retrospective cohort study.

An Assessment of Hallux Limitus in University Basketball Players Compared with Noncompetitive Individuals

2014 ◽  
Vol 104 (5) ◽  
pp. 468-472 ◽  
Author(s):  
Paul Trégouët
Keyword(s):  
Range Of Motion ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Artificial Turf ◽  
Basketball Players ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
Significant Difference ◽  
Turf Toe ◽  
The Difference

BackgroundInjuries of the first metatarsophalangeal joint have lately been receiving attention from researchers owing to the important functions of this joint. However, most of the studies of turf toe injuries have focused on sports played on artificial turf.MethodsThis study compared the range of motion of the first metatarsophalangeal joint in collegiate basketball players (n = 123) and noncompetitive individuals (n = 123).ResultsA statistically significant difference (P &lt; .001) in range of motion was found between the two groups. The difference between the two sample means was 21.35°.ConclusionsWith hallux rigidus being a potential sequela of repeated turf toe injuries, it seems likely that subacute turf toe injuries occur in basketball players, leading to degenerative changes that result in hallux limitus.

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