Development and Reliability of a Measurement Device for Flexion Force of the First Metatarsophalangeal Joint

2003 ◽  
Vol 19 (3) ◽  
pp. 271-278 ◽  
Author(s):  
Jaap Swanenburg ◽  
Karel H. Stappaerts ◽  
Bart Tirez ◽  
Daniel Uebelhart ◽  
Geert Aufdemkampe
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Measurement Device ◽  
Good Reliability ◽  
First Metatarsophalangeal Joint ◽  
Healthy Female ◽  
The Right ◽  
Leg Dominance ◽  
Flexion Force

The purpose of this study was to present a method for repeated measurement of flexion force of the hallux in the metatarsophalangeal joint. The reliability of this measurement device was also examined. This device is suitable for situations where weight-bearing is contraindicated or when it is not possible for patients to bear load on their toes, such as hallux valgus patients. Since most such patients are female, the participants in this study were 24 healthy female volunteers. Age, weight, height, and leg dominance were determined for each. Muscle strength was measured using a device with a built-in MicroFET dynamometer. The result for the left hallux was ICC(3,1).89 (95% CI .77–.95). The result for the right hallux was ICC(3,1).94 (95% CI .87–.97). In the Bland and Altman plots, the reliability again appeared to be sufficient. The Pearson product-moment correlations gave poor results for the association between body weight, height, age, and mean force of the four trails. The test results indicate good reliability of the measurement device as used in this study. The advantage of this testing device is that it makes it easier to standardize measurements as opposed to the MicroFET used as a hand-held dynamometer. Also, patients can be tested in a nonload situation, which makes it possible to test hallux valgus at any time, and therefore it is possible to monitor variations in progression (or regression).

Correlation analysis of the x-ray and functional parameters from the results of chevron (Austin) osteotomy for hallux valgus

2020 ◽  
pp. 54-63
Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova
Keyword(s):  
Hallux Valgus ◽  
Rating Scale ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
The Right ◽  
Bone Structures

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.

scholarly journals The impact of functional excess of footwear on the foot shape of 7-year-old girls and boys

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11277
Author(s):  
Ewa Puszczalowska-Lizis ◽  
Aleksandra Lukasiewicz ◽  
Sabina Lizis ◽  
Jaroslaw Omorczyk
Keyword(s):  
Regression Analysis ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Rank Test ◽  
Chi Square ◽  
First Metatarsophalangeal Joint ◽  
Longitudinal Arch ◽  
Transverse Arch ◽  
The Right ◽  
The Impact

Background Properly fitted shoes can support the development of growing feet and prevent problems and pathologies, not only in childhood, but also in adulthood. This points to the need to conduct research on the impact of shoe fitting on the structure of the foot in order to raise awareness and importance of this problem, to enable proper decisions regarding the purchase and use of shoes. The aim of this study was to analyze indoor footwear fit and its impact on foot structure in 7-year-old schoolchildren. Methods The CQ-ST podoscope and the Clevermess device were used for measurements. The analysis was carried out using the Mann Whitney U test, Wilcoxon signed-rank test, Chi-square test, regression analysis. Results About 40% of girls and boys had shoes that were incorrectly fitted in length, while as many as 74% of girls and 66% of boys wore shoes that were incorrectly fitted in width. Regression analysis demonstrated a statistically significant influence of the footwear length on longitudinal arch of the right and left foot and the transverse arch of the right foot. In boys, the length of the shoes shows associations with the right and left hallux valgus angle. Conclusion A significant percentage of the studied 7-year-olds, regardless of gender, wears inappropriately fitted shoes. In both sexes, the length of the footwear influenced the longitudinal arch of the right and left foot and the transverse arch of the right foot. Due to the deformity of the first metatarsophalangeal joint, the boys with hallux valgus require footwear which is wider and therefore their shoes need to be bigger in size.

scholarly journals PREOPERATIVE ANALYSIS OF RADIOGRAPHIC FINDINGS IN 516 PATIENTS WITH HALLUX VALGUS DEFORMITY

2019 ◽  
Vol 27 (1) ◽  
pp. 16-19
Author(s):  
Marco Götze ◽  
Sandra Elisabeth Hasmann ◽  
Ulf Krister Hofmann ◽  
Christian Walter ◽  
Falk Mittag
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Young Patients ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Osteotomy ◽  
First Metatarsophalangeal Joint ◽  
Radiographic Findings ◽  
Plain Radiographs ◽  
Operative Correction

ABSTRACT Objective: This is a descriptive study to report our method of operative correction for patients with hallux valgus deformities. Methods: From 2006 to 2012, 516 consecutive patients (601 feet) with hallux valgus deformities were treated surgically in our department after conservative treatments were exhausted. The hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and degree of osteoarthritis in the first metatarsophalangeal joint were measured on preoperative plain radiographs of the weight-bearing forefoot. Results: Young patients with severe intermetatarsal deviation received a combined proximal and distal osteotomy of the first metatarsal (n = 21). Patients with low intermetatarsal deviation received a distal metatarsal chevron osteotomy (n = 196), whereas patients with severe intermetatarsal deviation and less flexible deformities without osteoarthritis received a basal metatarsal osteotomy with a distal soft tissue procedure (n = 173). Elderly active patients with osteoarthritis in the first metatarsophalangeal joint received an arthrodesis (n = 100) or resection arthroplasty (n = 58). Conclusion: Determining a few simple angles on plain radiographs of the weight-bearing forefoot in combination with the age and level of activity of patients can help simplify the operative correction method by using the schema we developed. Level of evidence IV, case series.

Medial Deviation of the First Metatarsal Head as a Result of Flexion Forces in Hallux Valgus

Foot & Ankle ◽  
1992 ◽  
Vol 13 (9) ◽  
pp. 515-522 ◽  
Author(s):  
Antal Petrus Sanders ◽  
Christiaan Johannes Snijders ◽  
Bert van Linge
Keyword(s):  
Hallux Valgus ◽  
Statistical Significance ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Flexor Muscles ◽  
Muscle Balance ◽  
Flexion Force

Several questions with regard to the hallux valgus complex, which includes metatarsus primus varus, give rise to discussion. How do bunions develop? Is disturbed muscle balance at the first metatarsophalangeal joint important in the pathogenesis of the hallux valgus complex? What is the relation between dynamic plantar load distribution and pain in the ball of the foot? What is the cause of recurrences of deformity after surgery? To answer these questions, we started with the bio-mechanical model of Snijders et al., 31 which states that contraction of flexor muscles of the hallux worsens its valgus angle and causes medial deviation of the first metatarsal head. The present study was designed to validate the model on patients. When pressing the hallux downward, simultaneously the force under the toe and the medial deviation of the first metatarsal head were measured on preoperative patients and on controls (35 subjects in all). We could demonstrate with statistical significance that (1) when the subjects with hallux valgus push the great toe on the ground, the first metatarsal head moved in medial direction; in other words the foot widened. In the controls, as an average, the foot became narrower. (2) The greater the valgus deviation of the hallux, the greater the effect of the toe flexors, and (3) the greater the valgus deviation of the hallux, the less maximal flexion force it can apply. Implications of these findings on conservative and surgical therapy are discussed. The recurrences of deformity after first metatarsal osteotomies are explained by the action of the hallux flexors. The stable result of arthrodesis of the first metatarsophalangeal joint is expected to be accompanied by narrowing of the foot as a result of contraction of the flexor muscles.

scholarly journals Rehabilitation After Hallux Valgus Surgery: Importance of Physical Therapy to Restore Weight Bearing of the First Ray During the Stance Phase

2009 ◽  
Vol 89 (9) ◽  
pp. 934-945 ◽  
Author(s):  
Reinhard Schuh ◽  
Stefan G. Hofstaetter ◽  
Samuel B. Adams ◽  
Florian Pichler ◽  
Karl-Heinz Kristen ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Plantar Pressure ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Rehabilitation Program ◽  
First Metatarsophalangeal Joint ◽  
Time Integral ◽  
First Ray ◽  
Force Time ◽  
Force Time Integral

Background Operative treatment of people with hallux valgus can yield favorable clinical and radiographic results. However, plantar pressure analysis has demonstrated that physiologic gait patterns are not restored after hallux valgus surgery. Objective The purpose of this study was to illustrate the changes of plantar pressure distribution during the stance phase of gait in patients who underwent hallux valgus surgery and received a multimodal rehabilitation program. Design This was a prospective descriptive study. Methods Thirty patients who underwent Austin (n=20) and scarf (n=10) osteotomy for correction of mild to moderate hallux valgus deformity were included in this study. Four weeks postoperatively they received a multimodal rehabilitation program once per week for 4 to 6 weeks. Plantar pressure analysis was performed preoperatively and 4 weeks, 8 weeks, and 6 months postoperatively. In addition, range of motion of the first metatarsophalangeal joint was measured, and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot questionnaire was administered preoperatively and at 6 months after surgery. Results The mean AOFAS score significantly increased from 60.7 points (SD=11.9) preoperatively to 94.5 points (SD=4.5) 6 months after surgery. First metatarsophalangeal joint range of motion increased at 6 months postoperatively, with a significant increase in isolated dorsiflexion. In the first metatarsal head region, maximum force increased from 117.8 N to 126.4 N and the force-time integral increased from 37.9 N·s to 55.6 N·s between the preoperative and 6-month assessments. In the great toe region, maximum force increased from 66.1 N to 87.2 N and the force-time integral increased from 18.7 N·s to 24.2 N·s between the preoperative and 6-month assessments. Limitations A limitation of the study was the absence of a control group due to the descriptive nature of the study. Conclusions The results suggest that postoperative physical therapy and gait training may lead to improved function and weight bearing of the first ray after hallux valgus surgery.

scholarly journals A Novel Technique for Moderate Hallux Valgus Correction: The BC Osteotomy

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0039
Author(s):  
Gaston Slullitel ◽  
Juan Pablo Calvi ◽  
Victoria Alvarez ◽  
Laura Gaitan ◽  
Valeria Lopez
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Invasive Technique ◽  
First Metatarsophalangeal Joint ◽  
Hallux Valgus Deformity ◽  
Surgical Methods ◽  
The Mean

Category: Bunion Introduction/Purpose: Surgical correction of hallux valgus rebalances the first ray, correcting the various features of the deformity. While several surgical methods are available, consensus regarding the best management has yet to be established. In the last decades, there was an increasing interest in mini-invasive procedures. In this scenario the Bosch technique appears to be a reproducible DMO to achieve proper correction. Theoretically, it allows for fast and safe correction of the deformity, however it was criticized for its unstable nature. We describe a new distal metatarsal osteotomy (DMO) that it is a combination of the (traditional) chevron and the (mini-invasive) Bosch-SERI techniques. The purpose of this investigation is to describe the surgical technique and report the results of this modified procedure at a minimum 2-year follow-up. Methods: Between January 2016 and June 2018, 63 consecutive patients, with mild to moderate hallux valgus deformity underwent corrective surgery using the BC technique. Preoperatively, each patient’s data was recorded and all patients underwent an assessment of functional limitation and pain level as well as a physical examination that included measurement of the passive range of motion of the first metatarsophalangeal joint. At final follow up, the patients were assessed using the American Orthopaedic Foot & Ankle Society’s (AOFAS) hallux- metatarsophalangeal and interphalangeal scale. Additionally, patients were asked to rate their satisfaction with regard to the overall result of the operation according to the Coughlin overall satisfaction scale. Anteroposterior and lateral weight-bearing radiographs were made preoperatively as well as at the short-term and intermediate-term follow-up evaluations. The HVA, the first IMA, and the congruency of the first metatarsophalangeal joint were measured with the technique recommended by the AOFAS. Results: BC osteotomy was performed in 62 patients, including 33 right feet and 29 left feet, with no bilateral procedures. The patient population consisted of 50 females (79%), with an average age of 50.4 years (range 19 to 75) years. The mean follow-up time was 36.5 months (range 23 to 59). The mean AOFAS score improved from 69.3 preoperatively to 88 postoperatively (p<0.001). IMA and HVA pre and postoperative improved from a median of 30.7 degrees to 11.1 degrees for HVA and 13.9 degrees to 6.5 degrees for the IMA (p<0.001). 82.5% of patients were very satisfied / satisfied with the procedure. There were no cases of infection, however we observed two cases of complex regional pain syndrome and two screws that required removal. Conclusion: We believe this osteotomy has a number of advantages: (1) one mini-invasive approach is used; (2) a large correction can be obtained in all directions including the frontal and sagittal planes; (3) blood supply to the metatarsal head is preserved; and (4) intrinsically stable OT, allowing immediate full weight bearing. The merge, of percutaneous techniques and classic stable fixed approach may seems to offer a stable, effective and reproducible correction of hallux valgus deformity with the advantages of a minimally-invasive technique

Modified Austin Procedure for Correction of Hallux Valgus

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Alexander Zembsch ◽  
Hermann Wiesauer ◽  
Marc Hungerford ◽  
Martin Salzer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Soft Tissue Procedure ◽  
Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

scholarly journals First-Tarsometatarsal Joint Alignment After First-Metatarsophalangeal Joint Arthrodesis for Hallux Valgus

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110085
Author(s):  
Christopher Traynor ◽  
James Jastifer
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Medial Cuneiform ◽  
Radiographic Alignment

Background: Instability of the first-tarsometatarsal (TMT) joint has been proposed as a cause of hallux valgus. Although there is literature demonstrating how first-TMT arthrodesis affects hallux valgus, there is little published on how correction of hallux valgus affects the first-TMT joint alignment. The purpose of this study was to determine if correction of hallux valgus impacts the first-TMT alignment and congruency. Improvement in alignment would provide evidence that hallux valgus contributes to first-TMT instability. Our hypothesis was that correcting hallux valgus angle (HVA) would have no effect on the first-TMT alignment and congruency. Methods: Radiographs of patients who underwent first-MTP joint arthrodesis for hallux valgus were retrospectively reviewed. The HVA, 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA) were measured and recorded for all patients preoperatively and postoperatively. Results: Of the 76 feet that met inclusion criteria, radiographic improvements were noted in HVA (23.6 degrees, P < .0001), 1-2 IMA (6.2 degrees, P < .0001), 1MCA (6.4 degrees, P < .0001), MC1A (6.5 degrees, P < .0001), and RCS (3.3 degrees, P = .001) comparing preoperative and postoperative radiographs. There was no difference noted with DMCA measurements (0.5 degrees, P = .53). Conclusion: Our findings indicate that the radiographic alignment and subluxation of the first-TMT joint will reduce with isolated treatment of the first-MTP joint. Evidence suggests that change in the HVA can affect radiographic alignment and subluxation of the first-TMT joint. Level of Evidence: Level IV, retrospective case series.

scholarly journals Hallux Valgus Recurrence After Simple Bunionectomy: Algorithm Treatment

2022 ◽  
Author(s):  
Josep Torrent ◽  
Raúl Figa ◽  
Iban Clares ◽  
Eduard Rabat
Keyword(s):  
Comparative Study ◽  
Hallux Valgus ◽  
Treatment Algorithm ◽  
Metatarsophalangeal Joint ◽  
Salvage Procedure ◽  
Bone Stock ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Retrospective Comparative Study ◽  
End Stage

Abstract Background: Recurrences of hallux valgus can be difficult to manage, especially after a prior simple bunionectomy. This study aimed to present a treatment algorithm for the correction of recurrences after a simple bunionectomy.Methods: This was a single-center, descriptive, and retrospective comparative study. Thirty-four consecutive patients were classified according to the bone stock and the presence or absence of end-stage arthritis of the first metatarsophalangeal joint (MTPJ). According to our algorithm, we only performed an osteotomy as the salvage procedure in cases with sufficient bone stock and absence of or mild arthritis. In the other cases, we performed an MTPJ fusion. Exceptionally, we chose a Keller-Brandes arthroplasty for patients with advanced age and comorbidities. Results: We performed 17 scarf osteotomies (50%), 15 MTPJ arthrodeses (44.1%), and 2 Keller-Brandes arthroplasties (5.9%). Following the algorithm, we achieved an improvement of the AOFAS score of >30 points without severe complications in all groups.Conclusions: The proposed operative algorithm successfully addresses the recurrences considering the lack of bone stock and the presence of MTPJ arthritis.Level of EvidenceLevel 3: retrospective comparative study

Sign in / Sign up

Export Citation Format

Share Document