Biomechanical Risk Factors Associated with Neuropathic Ulceration of the Hallux in People with Diabetes Mellitus

2006 ◽  
Vol 96 (3) ◽  
pp. 189-197 ◽  
Author(s):  
Vanessa L. Nubé ◽  
Lynda Molyneaux ◽  
Dennis K. Yue
Keyword(s):  
Diabetes Mellitus ◽  
Subtalar Joint ◽  
Normal Values ◽  
Metatarsophalangeal Joint ◽  
First Metatarsophalangeal Joint ◽  
Factors Associated ◽  
Joint Range Of Motion ◽  
Foot Posture ◽  
History Of ◽  
Joint Range

In this study of people with diabetes mellitus and peripheral neuropathy, it was found that the feet of patients with a history of hallux ulceration were more pronated and less able to complete a single-leg heel rise compared with the feet of patients with a history of ulceration elsewhere on the foot. The range of active first metatarsophalangeal joint dorsiflexion was found to be significantly lower in the affected foot. Ankle dorsiflexion, subtalar joint range of motion, and angle of gait differed from normal values but were similar to those found in other studies involving diabetic subjects and were not important factors in the occurrence of hallux ulceration. These data indicate that a more pronated foot type is associated with hallux ulceration in diabetic feet. Further studies are required to evaluate the efficacy of footwear and orthoses in altering foot posture to manage hallux ulceration. (J Am Podiatr Med Assoc 96(3): 189–197, 2006)

Effect of the Low-Dye Strap on Pronation-Sensitive Mechanical Attributes of the Foot

2003 ◽  
Vol 93 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Jeffrey M. Whitaker ◽  
Kazuto Augustus ◽  
Suzanne Ishii
Keyword(s):  
Range Of Motion ◽  
Metatarsophalangeal Joint ◽  
Medial Longitudinal Arch ◽  
Arch Height ◽  
First Metatarsophalangeal Joint ◽  
Joint Range Of Motion ◽  
Longitudinal Arch ◽  
Before And After ◽  
Joint Range ◽  
State 1

The low-Dye strap is used routinely to temporarily control pronation of the foot and, thereby, to diagnose and treat pronatory sequelae. However, the exact biomechanical effects of this strapping technique on the foot are not well documented. The main purpose of this study was to establish the specific mechanical effects of the low-Dye strap on the pronatory foot. Within this context, the specific aim was to assess the effect of the low-Dye strap on three distinct pronation-sensitive mechanical attributes of the foot in the weightbearing state: 1) calcaneal eversion, 2) first metatarsophalangeal joint range of motion, and 3) medial longitudinal arch height. Weightbearing measurements of these three attributes were made before and after application of a low-Dye strap, and statistical comparisons were made. The results of this study indicate that the low-Dye strap is effective in reducing calcaneal eversion, increasing first metatarsophalangeal joint range of motion, and increasing medial longitudinal arch height in the weightbearing state. Knowledge of the exact mechanisms of action of the low-Dye strap will provide practitioners with greater confidence in the use of this modality. (J Am Podiatr Med Assoc 93(2): 118-123, 2003)

scholarly journals First metatarsophalangeal joint range of motion is associated with lower limb kinematics in individuals with first metatarsophalangeal joint osteoarthritis

2020 ◽  
Author(s):  
Jamie J Allan ◽  
Jodie A McClelland ◽  
Shannon E Munteanu ◽  
Andrew K Buldt ◽  
Karl B Landorf ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Sagittal Plane ◽  
Metatarsophalangeal Joint ◽  
Hip Joints ◽  
First Metatarsophalangeal Joint ◽  
Clinical Measurement ◽  
Joint Range Of Motion ◽  
Level Walking ◽  
Dynamic Function ◽  
Joint Range

Abstract Background Osteoarthritis of the first metatarsophalangeal joint (1st MTP joint OA) is a common and disabling condition that results in pain and limited joint range of motion. There is inconsistent evidence regarding the relationship between clinical measurement of 1st MTP joint maximum dorsiflexion and dynamic function of the joint during level walking. Therefore, the aim of this study was to examine the association between passive non-weightbearing (NWB) 1st MTP joint maximum dorsiflexion and sagittal plane kinematics in individuals with radiographically confirmed 1st MTP joint OA. Methods Forty-eight individuals with radiographically confirmed 1st MTP joint OA (24 males and 24 females; mean age 57.8 years, standard deviation 10.5) underwent clinical measurement of passive NWB 1st MTP joint maximum dorsiflexion and gait analysis during level walking using a 10-camera infrared Vicon motion analysis system. Sagittal plane kinematics of the 1st MTP, ankle, knee, and hip joints were calculated. Associations between passive NWB 1st MTP joint maximum dorsiflexion and kinematic variables were explored using Pearson’s r correlation coefficients. Results Passive NWB 1st MTP joint maximum dorsiflexion was significantly associated with maximum 1st MTPJ dorsiflexion (r=0.486, p<0.001), ankle joint maximum plantarflexion (r=0.383, p=0.007), and ankle joint excursion (r=0.399, p=0.005) during gait. There were no significant associations between passive NWB 1st MTP joint maximum dorsiflexion and sagittal plane kinematics of the knee or hip joints. Conclusions Passive NWB 1st MTP joint maximum dorsiflexion is associated with sagittal plane kinematics of the 1st MTP and ankle joints during level walking in individuals with 1st MTP joint OA. These findings suggest that clinical measurement of 1st MTP joint maximum dorsiflexion provides useful insights into the dynamic function of the foot and ankle during the propulsive phase of gait in this population.

scholarly journals First metatarsophalangeal joint range of motion is associated with lower limb kinematics in individuals with first metatarsophalangeal joint osteoarthritis

2020 ◽  
Author(s):  
Jamie J Allan ◽  
Jodie A McClelland ◽  
Shannon E Munteanu ◽  
Andrew K Buldt ◽  
Karl B Landorf ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Ankle Joint ◽  
Sagittal Plane ◽  
Metatarsophalangeal Joint ◽  
Hip Joints ◽  
First Metatarsophalangeal Joint ◽  
Clinical Measurement ◽  
Joint Range Of Motion ◽  
Dynamic Function ◽  
Joint Range

Abstract Background Osteoarthritis of the first metatarsophalangeal joint (1st MTP joint OA) is a common and disabling condition that results in pain and limited joint range of motion. There is inconsistent evidence regarding the relationship between clinical measurement of 1st MTP joint maximum dorsiflexion and dynamic function of the joint during level walking. Therefore, the aim of this study was to examine the association between passive non-weightbearing (NWB) 1st MTP joint maximum dorsiflexion and sagittal plane kinematics in individuals with radiographically confirmed 1st MTP joint OA. Methods Forty-eight individuals with radiographically confirmed 1st MTP joint OA (24 males and 24 females; mean age 57.8 years, standard deviation 10.5) underwent clinical measurement of passive NWB 1st MTP joint maximum dorsiflexion and gait analysis during level walking using a 10-camera infrared Vicon motion analysis system. Sagittal plane kinematics of the 1st MTP, ankle, knee, and hip joints were calculated. Associations between passive NWB 1st MTP joint maximum dorsiflexion and kinematic variables were explored using Pearson’s r correlation coefficients. Results Passive NWB 1st MTP joint maximum dorsiflexion was significantly associated with maximum 1st MTPJ dorsiflexion (r=0.486, p<0.001), ankle joint maximum plantarflexion (r=0.383, p=0.007), and ankle joint excursion (r=0.399, p=0.005) during gait. There were no significant associations between passive NWB 1st MTP joint maximum dorsiflexion and sagittal plane kinematics of the knee or hip joints. Conclusions These findings suggest that clinical measurement of 1st MTP joint maximum dorsiflexion provides useful insights into the dynamic function of the foot and ankle during the propulsive phase of gait in this population.

Hallux Interphalangeal Joint Range of Motion in Feet with and Without Limited First Metatarsophalangeal Joint Dorsiflexion

2012 ◽  
Vol 102 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Pedro V. Munuera ◽  
Piedad Trujillo ◽  
Israel Güiza
Keyword(s):  
Metatarsophalangeal Joint ◽  
Inverse Correlation ◽  
Interphalangeal Joint ◽  
Regression Equation ◽  
Control Group ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
Joint Range Of Motion ◽  
Joint Range ◽  
Strong Inverse Correlation

Background: This work was designed to assess the degree of correlation between hallux interphalangeal joint and first metatarsophalangeal joint dorsiflexion and to compare the mobility of the hallux interphalangeal joint between participants with and without limited first metatarsophalangeal joint dorsiflexion (hallux limitus). Methods: Dorsiflexion of the hallux interphalangeal joint was measured in 60 normal feet and in 60 feet with hallux limitus to find correlations with first metatarsophalangeal joint dorsiflexion with the Spearman correlation coefficient and a simple linear regression equation. In addition, movement of the hallux interphalangeal joint was compared between normal and hallux limitus feet with the Mann-Whitney U test. Results: Significant differences were found between the groups in mean ± SD interphalangeal joint dorsiflexion (control group: 1.17° ± 2.50° ; hallux limitus group: 10.65° ± 8.24° ; P &lt; .001). A significant inverse correlation was found between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion (ρ = −0.766, P &lt; .001), and the regression equation from which predictions could be made is the following: hallux interphalangeal joint dorsiflexion = 27.17 − 0.381 × first metatarsophalangeal joint dorsiflexion. Conclusions: Hallux interphalangeal joint dorsiflexion was greater in feet with hallux limitus than in normal feet. There was a strong inverse correlation between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion. (J Am Podiatr Med Assoc 102(1): 47–53, 2012)

Postsurgical rehabilitation exercises for hallux abducto valgus repair

1990 ◽  
Vol 80 (8) ◽  
pp. 410-413 ◽  
Author(s):  
J Donnery ◽  
RD DiBacco
Keyword(s):  
Range Of Motion ◽  
Surgical Procedures ◽  
Surgical Repair ◽  
Exercise Program ◽  
Metatarsophalangeal Joint ◽  
Postoperative Management ◽  
First Metatarsophalangeal Joint ◽  
Joint Range Of Motion ◽  
Joint Range ◽  
Rehabilitation Exercises

The authors describe postsurgical exercises designed to maximize first metatarsophalangeal joint range of motion following the surgical correction of hallux abducto valgus deformities. Concerns regarding the healing of skin, tendon, and bone are discussed, and the need to individualize the exercise program based on the surgical procedures performed is emphasized. Use of these exercises in the postoperative management of hallux abducto valgus surgical repair is encouraged.

scholarly journals Beliefs and Use of Forefoot Lateral Wedging in Podiatric Practice: A Survey of Podiatrists in Aotearoa New Zealand

2021 ◽  
Author(s):  
Aaron Jackson ◽  
Kelly Sheerin ◽  
Duncan Reid ◽  
Matthew Carroll
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Range Of Motion ◽  
Metatarsophalangeal Joint ◽  
Ethylene Vinyl Acetate ◽  
First Metatarsophalangeal Joint ◽  
Joint Range Of Motion ◽  
Aotearoa New Zealand ◽  
Joint Range ◽  
Lateral Wedges

Abstract Background There is currently limited evidence exploring the beliefs and application of forefoot lateral wedges in clinical practice by podiatrists. The study aimed to understand rationale and beliefs that guided the use of forefoot lateral wedges amongst Aotearoa New Zealand podiatrists. Methods A cross-sectional study of Aotearoa New Zealand podiatrists was conducted between 31st May 2021 and 26th July 2021. Data were collected anonymously using a web-based survey platform. The 30-item survey included questions to elicit participant characteristics, why and when podiatrists used orthotic modifications, what biomechanical assumptions influenced clinical decision making, and how podiatrists fabricated and placed forefoot lateral wedging. The survey findings were reported using descriptive statistics. Results Sixty-five podiatrists completed the survey. Most respondents were trained in Aotearoa New Zealand (91%), had over 10 years’ experience (70%), and worked with a mixed case load (60%). Seventy-seven percent (77%) prescribed 0 to 10 pairs of foot orthoses per week, with forefoot lateral wedges used in 44% of prescriptions. Forefoot lateral wedges were likely to be used in the treatment of peroneal tendon injuries (70%) and chronic ankle instability (64%). The most common belief being that forefoot lateral wedges increase first metatarsophalangeal joint range of motion (86%). Forefoot lateral wedges were regularly manufactured from 3mm (74%), medium density ethylene vinyl acetate (91%) and positioned from the calcaneo-cuboid joint (53%) to the sulcus (77%). Conclusion New Zealand podiatrists frequently use forefoot lateral wedges in clinical practice. Respondents were predominately guided by the underpinning belief that forefoot lateral wedging reduces tissue stress and have their greatest functional impact on first metatarsophalangeal joint range of motion. Forefoot lateral wedges are commonly manufactured from 3mm ethylene vinyl acetate, although it is important to be aware that this will translate to differing angles, dependant on width. Further research should be undertaken to explore the influence of forefoot lateral wedges on forefoot function and the effect of wedge length.

Lateral Column Lengthening with Calcaneocuboid Fusion: Range of Motion in the Triple Joint Complex

1995 ◽  
Vol 16 (11) ◽  
pp. 729-733 ◽  
Author(s):  
Jonathan T. Deland ◽  
James C. Otis ◽  
Kyung-Tai Lee ◽  
Sharon M. Kenneally
Keyword(s):  
Range Of Motion ◽  
Subtalar Joint ◽  
Clinical Investigation ◽  
Three Dimensions ◽  
Lateral Column ◽  
Joint Range Of Motion ◽  
Lateral Column Lengthening ◽  
Joint Range

Lengthening the lateral column of the foot has been shown to correct flatfoot deformity. In adults, however, lengthening leads to calcaneocuboid arthritis. Lateral column lengthening with calcaneocuboid fusion, which lengthens the lateral column of the foot and prevents calcaneocuboid arthritis, was investigated in a cadaver model to determine the remaining range of motion in the talonavicular and subtalar joints. Inversion/eversion motion was produced by tendon pulls and the range of motion was measured in three dimensions using a magnetic space tracker. After lateral column lengthening with calcaneocuboid fusion, 48% of talonavicular and 70% of subtalar joint range of motion were preserved. Analysis of the inversion and eversion ranges of motion suggests that the lengthening fusion limits eversion more than inversion. These findings demonstrate the need for clinical investigation of this procedure, which could preserve motion in the talonavicular and subtalar joints, correct deformity, and obviate calcaneocuboid arthritis.

scholarly journals Factors associated with undertriage in patients classified by the need to visit a hospital by telephone triage: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryota Inokuchi ◽  
Xueying Jin ◽  
Masao Iwagami ◽  
Toshikazu Abe ◽  
Masatoshi Ishikawa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cerebral Infarction ◽  
Clinic Visit ◽  
Telephone Triage ◽  
Hospital Visit ◽  
Over The Counter ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
History Of ◽  
House Call

Abstract Background Prehospital telephone triage stratifies patients into five categories, “need immediate hospital visit by ambulance,” “need to visit a hospital within 1 hour,” “need to visit a hospital within 6 hours,” “need to visit a hospital within 24 hours,” and “do not need a hospital visit” in Japan. However, studies on whether present and past histories cause undertriage are limited in patients triaged as need an early hospital visit. We investigated factors associated with undertriage by comparing patient assessed to be appropriately triaged with those assessed undertriaged. Methods We included all patients classified by telephone triage as need to visit a hospital within 1 h and 6 h who used a single after-hours house call (AHHC) medical service in Tokyo, Japan, between November 1, 2019, and November 31, 2020. After home consultation, AHHC doctors classified patients as grade 1 (treatable with over-the-counter medications), 2 (requires hospital or clinic visit), or 3 (requires ambulance transportation). Patients classified as grade 2 and 3 were defined as appropriately triaged and undertriaged, respectively. Results We identified 10,742 eligible patients triaged as need to visit a hospital within 1 h and 6 h, including 10,479 (97.6%) appropriately triaged and 263 (2.4%) undertriaged patients. Multivariable logistic regression analyses revealed patients aged 16–64, 65–74, and ≥ 75 years (adjusted odds ratio [OR], 2.40 [95% confidence interval {CI} 1.71–3.36], 8.57 [95% CI 4.83–15.2], and 14.9 [95% CI 9.65–23.0], respectively; reference patients aged < 15 years); those with diabetes mellitus (2.31 [95% CI 1.25–4.26]); those with dementia (2.32 [95% CI 1.05–5.10]); and those with a history of cerebral infarction (1.98 [95% CI 1.01–3.87]) as more likely to be undertriaged. Conclusions We found that older adults and patients with diabetes mellitus, dementia, or a history of cerebral infarction were at risk of undertriage in patients triaged as need to visit a hospital within 1 h and 6 h, but further studies are needed to validate these findings.

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