Biomechanical Evaluation of Hemiarthroplasty in the First Proximal Phalanx. A Finite Element StudyBiomechanical Evaluation of Hemiarthroplasty in the First Proximal Phalanx. A Finite Element Study

Hallux Rigidus ◽

Medical Complications ◽

Element Analysis ◽

Biomechanical Behavior ◽

First Ray ◽

Biomechanical Evaluation

Hallux rigidus produces a decrease in the dorsiflexion of the first metatarsophalangeal joint and is usually associated with the appearance of osteophytes. Hemiarthroplasty in the first proximal phalanx is a recommended surgical procedure in patients with advanced grade of hallux rigidus. Finite element analysis allows us to understand the biomechanical behavior of the foot. The objective of this work is to evaluate the biomechanical effects of an hemi implant placed in first proximal phalanx. Two models of finite elements are going to be compared, one free of pathologies and the other with a hemiarthroplasty in the first ray of the foot. We detected after inserting the prosthesis in the model that passive windlass mechanism is lost, and the lesser toes become overloaded, which leads to a loss of efficiency in gait as well as being able to cause postsurgical medical complications.

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

Jornada de Jóvenes Investigadores del I3A ◽

10.26754/jji-i3a.201802801 ◽

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.

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

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-86-11-538 ◽

1996 ◽

Vol 86 (11) ◽

pp. 538-546 ◽

Cited By ~ 51

Author(s):

TS Roukis ◽

PR Scherer ◽

CF Anderson

Keyword(s):

Quantitative Analysis ◽

Hallux Rigidus ◽

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.

The Effects of Cheilectomy on Dorsiflexion of the First Metatarsophalangeal Joint

Foot & Ankle International ◽

10.1177/107110079701801209 ◽

1997 ◽

Vol 18 (12) ◽

pp. 803-808 ◽

Cited By ~ 21

Author(s):

William A. Heller ◽

Michael E. Brage

Keyword(s):

Proximal Phalanx ◽

Metatarsal Head ◽

Hallux Rigidus ◽

Surface Velocity ◽

Motion Patterns ◽

Custom Made ◽

Fresh Frozen ◽

End Stage

Our purpose in this study was to determine the effects of cheilectomy on the mechanics of dorsiflexion of the first metatarsophalangeal (MTP) joint. Ten fresh-frozen cadaver feet were utilized, of which two demonstrated radiographic evidence of hallux rigidus. Each specimen was rigidly mounted on a custom-made slide tray that was articulated with a hinge mechanism designed to dorsiflex the first MTP joint. Range-of-motion measurements were made on the first MTP joint. Cheilectomy of 30% of the metatarsal head diameter was performed. Lateral radiographs with the beam centered on the MTP joint were taken with the joint at neutral, 20°, 40°, and at the limits of dorsiflexion. This process was repeated after a 50% cheilectomy was performed. The radiographs were examined for changes in joint congruence and in patterns of surface motion as the hallux moved from neutral to full dorsiflexion. Instant centers of rotation were determined by a method first described by Rouleaux. We constructed surface velocity vectors to describe patterns of motion of the first MTP joint. The mean dorsiflexion of the first MTP joint was 67.9° and increased to 78.3° after 30% cheilectomy. The increase in dorsiflexion was significantly greater in the two specimens with hallux rigidus (33%) than in the other specimens (12.1%). After both levels of cheilectomy, the proximal phalanx demonstrated pivoting at the resection site on the metatarsal head. This pivoting resulted in abnormal motion patterns across the MTP joint. Normal sliding motion predominated in early dorsiflexion, with compression peaking at the end stage of dorsiflexion, producing jamming of the articular surfaces. Cheilectomy significantly increased dorsiflexion of the MTP joint, but resulted in abnormal motion patterns. The increase in dorsiflexion resulted from pivoting of the proximal phalanx on the metatarsal head, resulting in anomalous velocity vectors and compression across the MTP joint.

Cartiva Hemiarthroplasty for the Treatment of Hallux Rigidus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00257 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0025

Author(s):

Tyler Hoskins ◽

Jay Patel ◽

David Goyette ◽

Christopher Mazzei ◽

Arianna L. Gianakos ◽

...

Keyword(s):

Controlled Trial ◽

Proximal Phalanx ◽

Retrospective Chart Review ◽

Hallux Rigidus ◽

P Value ◽

Surgical Interventions ◽

Phone Calls ◽

Surgical Methods

Category: Lesser Toes; Arthroscopy; Other Introduction/Purpose: Hallux rigidus, degenerative arthritis of the first metatarsophalangeal (MTP) joint, is the most common type of arthritis of the foot, affecting nearly 2.5% of the population over the age of 50. The standard of treatment is non-operative in nature followed by surgical intervention if pain is not alleviated. Currently, first metatarsal dorsal cheilectomy and proximal phalanx osteotomy remain the two most common surgical interventions. Recently, first metartasophalangeal hemiartshroplasty with synthetic cartilage implant has become more popular. This procedure involves the implantation of synthetic cartilage in order to preserve motion and maintain joint space of the first metatarsophalangeal joint. Due to the scarce amount of literature reported on this technique, the goal of this study was to examine its efficacy in patients treated for hallux rigidus. Methods: From 2017 to 2019 twenty patients underwent a synthetic cartilage implant hemiarthroplasty for the treatment of hallux rigidus. Functional outcome scores were assessed using the American Orthopaedic Foot & Ankle scoring system (AOFAS) and the Foot and Ankle Outcome Score Survey (FAOS). Outcomes, complications, and any reoperations were recorded through retrospective chart review, direct patient examination, and phone calls to patients and their families. A statistical analysis was performed using Fischer’s Exact Test. Results were deemed statistically significant if the calculated p-value was less than 0.05. Results: The mean follow up for our patient cohort was 17.16 months (range, 12 to 26). The average age was 55.61 years (range, 47 to 73). Mean pre-op AOFAS and FAOS were 56.37 and 55 respectively, compared to 91.89 and 88.84 after surgery (p-value <0.05). There were no significant complications or reoperations reported in any of the patients at the time of publication. Conclusion: The pre-op and post-op AOFAS and FAOS scores were deemed statistically significant. Synthetic cartilage implant hemiarthroplasty, although new, offers promising results and remains a viable treatment option to decrease pain, improve function, and maintain motion for advanced hallux rigidus. However, a prospective randomized controlled trial comparing the efficacy of this procedure to other surgical methods would be necessary to further evaluate and validate our findings.

Kinematics of the First Metatarsophalangeal Joint in Intact and Surgically Altered Cadavers

Foot & Ankle International ◽

10.1177/107110079701800304 ◽

1997 ◽

Vol 18 (3) ◽

pp. 132-137 ◽

Cited By ~ 3

Author(s):

Craig Nevin

Keyword(s):

Hallux Valgus ◽

Soft Tissues ◽

Proximal Phalanx ◽

Hallux Rigidus ◽

First Metatarsal ◽

Silicone Prosthesis

The kinematics of the first metatarsophalangeal joint were investigated in five embalmed cadaver feet (three normal, one hallux valgus, one hallux rigidus). Sagittal displacements of the first metatarsal relative to the proximal phalanx were measured during first metatarsophalangeal joint dorsiplantarflexion; first in intact cadavers, then with an intact capsule sans extracapsular soft tissues (hallux amputated at the first metatarsal cuneiform joint), and finally with a double-stem silicone prosthesis inserted. In the intact cadaver, the base of the metatarsal is raised by FMTP dorsiflexion in a manner similar to a cam. However, this effect ceased when the extracapsular soft tissues were removed. Silicone arthroplasty did not restore cam function.

Percutaneous First Metatarsophalangeal Joint Fusion

The Open Orthopaedics Journal ◽

10.2174/1874325001711010724 ◽

2017 ◽

Vol 11 (1) ◽

pp. 724-731 ◽

Cited By ~ 3

Author(s):

Thomas Bauer

Keyword(s):

Simple Procedure ◽

Weight Bearing ◽

Hallux Rigidus ◽

Full Weight Bearing ◽

Normal Walking ◽

Joint Fusion ◽

Forefoot Surgery ◽

First Ray

The first metatarsophalangeal (MTP1) joint fusion is a very useful procedure in forefoot surgery and is still the gold standard for the treatment of severe and painful hallux rigidus. Normal walking and running are possible after MTP1 fusion, the first ray mobility being essentially in the interphalangeal (IP) joint with a compensatory hypermobility in dorsal flexion. Percutaneous MTP1 fusion is a simple procedure providing comparable results to fusions performed with open techniques. Postoperative cares are simplified with an immediate full weight bearing on rigid flat shoes and quick return to normal walking. Bone preparation is an important step and requires an experience in percutaneous forefoot surgery. Arthrodesis positioning and fixation with this percutaneous procedure are simple with possibility of clinical and radiological control. The indications for percutaneous MTP1 fusion are very large and only severe bone loss or osteoporosis represent the limits for this technique.

Effect of Functional Foot Orthoses on First Metatarsophalangeal Joint Dorsiflexion in Stance and Gait

Journal of the American Podiatric Medical Association ◽

10.7547/0960474 ◽

2006 ◽

Vol 96 (6) ◽

pp. 474-481 ◽

Cited By ~ 22

Author(s):

Paul R. Scherer ◽

Jennifer Sanders ◽

Denten E. Eldredge ◽

Susan J. Duffy ◽

Ryan Y. Lee

Keyword(s):

Hallux Valgus ◽

Maximum Degree ◽

Hallux Rigidus ◽

Foot Orthoses ◽

First Ray ◽

And Gender ◽

Midtarsal Joint ◽

The Relationship

Reduction in first metatarsophalangeal joint maximum degree of dorsiflexion with dorsiflexion of the first ray has been proposed to be the predominant cause of hallux abducto valgus and hallux rigidus. We sought to determine whether orthoses made from a cast with the first ray plantarflexed and a 4-mm medial skive could increase the maximum degree of dorsiflexion in patients with functional hallux limitus in stance and gait. Forty-eight feet of 27 subjects were casted for orthoses with the first ray plantarflexed and in the customary neutral rearfoot position with locked midtarsal joint. First metatarsophalangeal joint maximum dorsiflexion was measured with and without orthoses in stance, and subhallux pressure was measured with and without orthoses at heel-off. Changes in mean maximum dorsiflexion in stance and in mean maximum subhallux pressure in gait with orthoses were significant. We investigated the relationship between this increase in dorsiflexion and gender, shoe size, resting calcaneal stance position, and change in resting calcaneal stance position with the use of orthoses. These correlations were not statistically significant. The biomechanical implication of increasing limited first metatarsophalangeal joint dorsiflexion with orthoses is discussed and related to the clinical treatment of deformities, including hallux valgus and hallux rigidus. The use of orthoses to decrease subhallux pressure is also discussed. (J Am Podiatr Med Assoc 96(6): 474–481, 2006)

Comparing First Metatarsophalangeal Joint Flexibility in Hallux Rigidus Patients Pre- and Postcheilectomy Using a Novel Flexibility Device

Foot & Ankle Orthopaedics ◽

10.1177/2473011420930000 ◽

2020 ◽

Vol 5 (2) ◽

pp. 247301142093000 ◽

Cited By ~ 1

Author(s):

Jensen K. Henry ◽

Andrew Kraszewski ◽

Lauren Volpert ◽

Elizabeth Cody ◽

Howard Hillstrom ◽

...

Keyword(s):

Proximal Phalanx ◽

Clinical Results ◽

Hallux Rigidus ◽

Wedge Osteotomy ◽

Level Of Evidence ◽

Radiographic Findings ◽

Pain Symptoms ◽

Flexibility Parameters

Background: Hallux rigidus (HR) is a common pathology of the first metatarsophalangeal (MTP) joint causing pain and stiffness. However, severity of symptoms and radiographic findings are not always concordant. A novel flexibility device, which measures the mobility of the MTP joint through its arc of motion, has been validated. This study compares flexibility in patients before and after cheilectomy (with or without proximal phalanx osteotomy) for HR. Methods: This is a single-center study of adult patients with HR who were indicated for cheilectomy or cheilectomy and Moberg (dorsiflexion closing wedge) osteotomy of the proximal phalanx based on symptoms and radiographs from 2013 to 2015. Pre- and postoperatively, patients underwent testing with a validated flexibility protocol to generate flexibility curves. Parameters included early and late flexibility, laxity torque, and laxity angle. Patients completed Foot and Ankle Outcomes Scores (FAOS) pre- and postoperatively. Twelve operative patients underwent preoperative testing, with 9 completing postoperative testing (mean age, 53.0 years; 67% female; mean 2.8-year follow-up). Results: Patients had significant improvements in early sitting and standing flexibility, sitting and standing laxity angles, standing laxity torque, and both sitting and standing maximum dorsiflexion after surgery (all P < .05). While preoperative early flexibility, laxity angle, and maximum dorsiflexion all differed significantly between patients and controls ( P < .015), postoperative early flexibility was similar to controls ( P > .279). FAOS scores for pain, symptoms, sport, and quality improved significantly after surgery. Conclusion: Surgical treatment with cheilectomy was associated with significant improvements in nearly all flexibility parameters for sitting and standing positions. However, most postoperative flexibility parameters did not improve to the level of normal controls. Regardless, patients still experienced significant improvements in outcomes. This study demonstrated that surgical correction is associated with significant biomechanical and clinical results. The flexibility device can be used in further studies to assess outcomes after other HR procedures. Level of Evidence: Level II, prospective comparative study.

Kinematics and Contact Characteristics of the First Metatarsophalangeal Joint

Foot & Ankle International ◽

10.1177/107110079701800310 ◽

1997 ◽

Vol 18 (3) ◽

pp. 170-174 ◽

Cited By ~ 24

Author(s):

Tae-Kun Ahn ◽

Harold B. Kitaoka ◽

Zong-Ping Luo ◽

Kai-Nan An

Keyword(s):

Articular Surface ◽

Tracking System ◽

Proximal Phalanx ◽

Three Dimensional ◽

Hallux Rigidus ◽

Neutral Position ◽

Full Extension ◽

Contact Distribution

We studied six fresh frozen cadaver feet to define the three-dimensional motion of the hallux proximal phalanx in relation to the first metatarsal and to describe the contact features of the first metatarsophalangeal joint. Six tendons to the hallux were loaded to simulate dynamic loading of the hallux. A magnetic tracking system was used to monitor the three-dimensional movement of the proximal phalanx while the toe position was changed from a neutral position to full extension by adjusting the tendon loads. The average surface area was 0.38 ± 0.08 cm2 in the neutral position; it decreased with toe extension and was the lowest (0.04 ± 0.03 cm2) at the full extension position. Contact distribution of the proximal phalanx did not change substantially throughout the arc of motion. However, for the metatarsal articular surface, the contact distribution shifted dorsally with increasing degrees of extension. These data are consistent with the observation that chondral erosions associated with hallux rigidus and degenerative arthritis initially affect the dorsal articular surface of the metatarsal, and implant arthroplasty often fails from component loading dorsally. The current technique of determining joint contact characteristics is applicable not only for the first metatarsophalangeal joint but also other joints that have not been studied because of shortcomings with more conventional methods.