Effects of Rearfoot-Controlling Orthotic Treatment on Dorsiflexion of the Hallux in Feet with Abnormal Subtalar Pronation

2006 ◽  
Vol 96 (4) ◽  
pp. 283-289 ◽  
Author(s):  
Pedro V. Munuera ◽  
Gabriel Domínguez ◽  
Inmaculada C. Palomo ◽  
Guillermo Lafuente
Keyword(s):  
Metatarsophalangeal Joint ◽  
Foot Orthoses ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
Orthotic Treatment

The aim of this study was to determine whether the treatment of abnormal subtalar pronation restores functional (as opposed to structural) limited dorsiflexion of the first metatarsophalangeal joint (functional hallux limitus). We studied 16 feet of eight individuals with abnormal subtalar pronation. Orthoses were made for all of the feet, and hallux dorsiflexion was measured during weightbearing. Each patient was unshod without the orthosis, unshod with the orthosis fitted on the same day, and unshod with the orthosis fitted approximately 5 months later. The results suggest that in functional hallux limitus caused by abnormal subtalar pronation, hallux dorsiflexion will gradually be restored by the use of foot orthoses to control the abnormal subtalar pronation. (J Am Podiatr Med Assoc 96(4): 283–289, 2006)

Reliability Study of Diagnostic Tests for Functional Hallux Limitus

2020 ◽  
Vol 41 (4) ◽  
pp. 457-462 ◽  
Author(s):  
Rubén Sánchez-Gómez ◽  
Ricardo Becerro-de-Bengoa-Vallejo ◽  
Marta Elena Losa-Iglesias ◽  
César Calvo-Lobo ◽  
Emmanuel Navarro-Flores ◽  
...  
Keyword(s):  
High Reliability ◽  
Intraclass Correlation ◽  
Metatarsophalangeal Joint ◽  
Signs And Symptoms ◽  
Metatarsal Head ◽  
Reliability Study ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Limited Mobility ◽  
Hallux Limitus

Background: Functional hallux limitus (FHL) refers to dorsiflexion hallux mobility limitation when the first metatarsal head is under loading conditions but not in the unloaded state. The goal of the study was to evaluate 3 common manual tests (Buell, Dananberg, and Jack tests) for assessing first metatarsophalangeal joint (MPJ) mobility and determining the normal values needed to detect FHL, and clarify the signs and symptoms associated with this pathology. Methods: Forty-four subjects were included in this reliability study. Subjects were divided into healthy control (non-FHL) and FHL groups according to the Buell first MPJ limitation values in addition to signs and symptoms derived from the literature. In both groups, we measured the mobility in the Buell, Dananberg, and Jack tests using a goniometer; their intraclass correlation coefficients (ICCs), sensitivities, and specificity indexes were also calculated. Results: All techniques showed high reliability across measurement trials with ICCs ranging from 0.928 to 0.999. The optimal mobility grades for predicting FHL were 68.6 ± 3.7 degrees, 21 ± 5.9 degrees, and 25.5 ± 6.5 degrees (mean±SD) ( P < .05) for the Buell, Dananberg, and Jack tests, respectively. Conclusion: Normal and limited mobility values were established for assessing FHL using each technique. The sensitivity and specificity data were perfect for the Dananberg and Jack tests, thus identifying these tests as specific and valid tools for use in FHL diagnosis. Pinch callus was the sign most associated with FHL. Level of Evidence: Level II, comparative series.

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)

The Association of Hallux Limitus with the Accessory Navicular

2002 ◽  
Vol 92 (6) ◽  
pp. 359-365 ◽  
Author(s):  
R. D. Lee Evans ◽  
Ryan Averett ◽  
Stephanie Sanders
Keyword(s):  
Surgical Treatment ◽  
Causal Relationship ◽  
Metatarsophalangeal Joint ◽  
Pes Planus ◽  
First Metatarsophalangeal Joint ◽  
Radiographic Findings ◽  
Hallux Limitus ◽  
Accessory Navicular ◽  
Clinical Cases

Hallux limitus is one of the most prevalent, debilitating disorders of the first metatarsophalangeal joint, and it has many proposed etiologies. This article reviews these etiologies, focusing primarily on the pes planus foot. The pes planus foot type is often associated with symptomatic hallux limitus and the accessory navicular. This article discusses this correlation, although a causal relationship has not been proven. The prevalence and classification of the accessory navicular are also discussed. Clinical cases involving symptomatic hallux limitus occurring concomitantly with an accessory navicular are reviewed, including radiographic findings, symptoms, and surgical treatment. (J Am Podiatr Med Assoc 92(6): 359-365, 2002)

scholarly journals Foot osteoarthritis: latest evidence and developments

2018 ◽  
Vol 10 (4) ◽  
pp. 91-103 ◽  
Author(s):  
Edward Roddy ◽  
Hylton B. Menz
Keyword(s):  
Older Adults ◽  
Risk Factor ◽  
Randomized Trials ◽  
Metatarsophalangeal Joint ◽  
Epidemiological Studies ◽  
Controlled Trials ◽  
Foot Orthoses ◽  
First Metatarsophalangeal Joint ◽  
Surgical Interventions ◽  
Randomized Controlled

Foot osteoarthritis (OA) is a common problem in older adults yet is under-researched compared to knee or hand OA. Most existing studies focus on the first metatarsophalangeal joint, with evidence relating to midfoot OA being particularly sparse. Symptomatic radiographic foot OA affects 17% of adults aged 50 years and over. The first metatarsophalangeal joint is most commonly affected, followed by the second cuneometatarsal and talonavicular joints. Epidemiological studies suggest the existence of distinct first metatarsophalangeal joint and polyarticular phenotypes, which have differing clinical and risk factor profiles. There are few randomized controlled trials in foot OA. Existing trials provide some evidence of the effectiveness for pain relief of physical therapy, rocker-sole shoes, foot orthoses and surgical interventions in first metatarsophalangeal joint OA and prefabricated orthoses in midfoot OA. Prospective epidemiological studies and randomized trials are needed to establish the incidence, progression and prognosis of foot OA and determine the effectiveness of both commonly used and more novel interventions.

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.

Analysis of Dynamic Angle of Gait and Radiographic Features in Subjects with Hallux Abducto Valgus and Hallux Limitus

2007 ◽  
Vol 97 (3) ◽  
pp. 175-188 ◽  
Author(s):  
Julie Taranto ◽  
Michael J. Taranto ◽  
Alan R. Bryant ◽  
Kevin P. Singer
Keyword(s):  
Metatarsophalangeal Joint ◽  
Transverse Plane ◽  
Foot Deformities ◽  
Compensatory Mechanisms ◽  
Convenience Sample ◽  
Large Variability ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
And Function

Background: Hallux abducto valgus and hallux limitus are two commonly encountered foot deformities causing altered structure and function of the first metatarsophalangeal joint and subsequent compensatory mechanisms. This study was undertaken to determine the relationships between these two deformities and transverse plane position of the foot, or angle of gait, and several radiographic angular and linear parameters with established reliability. Methods: A convenience sample of 23 subjects with hallux abducto valgus, 22 subjects with hallux limitus, and 20 control subjects was used. Radiographic parameters were standardized weightbearing views and included lateral stressed dorsiflexion of the first metatarsophalangeal joint, composite, dorsoplantar, and lateral views. Angle of gait was obtained from powdered footprints recorded on paper. Two left and two right footprints identified on each trial were used to calculate angle of gait. Results: The findings of the study suggest that an association between angle of gait and the presence of hallux abducto valgus or hallux limitus does not exist. Possible explanations may relate to the large variability of normal angle of gait, the need to identify factors extrinsic to the foot capable of affecting transverse plane orientation of the foot, and the addition of information relating to symptoms. Conclusions: In this study, the presence of hallux abducto valgus or hallux limitus did not correspond to an association with a particular angle of gait. Length and elevation of the first metatarsal were associated in subjects with hallux abducto valgus and hallux limitus. (J Am Podiatr Med Assoc 97(3): 175–188, 2007)

Gait style as an etiology to chronic postural pain. Part I. Functional hallux limitus

1993 ◽  
Vol 83 (8) ◽  
pp. 433-441 ◽  
Author(s):  
HJ Dananberg
Keyword(s):  
Treatment Plan ◽  
Metatarsophalangeal Joint ◽  
Daily Basis ◽  
Entire Body ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
Lower Back ◽  
Previous Therapy ◽  
Pain Patients

A common, but locally asymptomatic and therefore rarely recognized functional inability of the first metatarsophalangeal joint to dorsiflex strictly during gait is described. Normal motion is present in this joint during nonweight-bearing examination; therefore this is referred to as functional hallux limitus. Since this joint forms the pivot about which the entire body advances during each step, this disturbance in function, when repeated thousands of times on a daily basis, can alter foot and postural biomechanics. It can cause and perpetuate many chronic postural ailments, including lower back pain. When functional hallux limitus is specifically addressed in an orthotic treatment plan, 77% of long-term chronic postural pain patients exhibit 50% to 100% improvement in their overall condition, in spite of failing previous therapy on their specific site of pain and never exhibiting any foot symptomatology.

scholarly journals Nonoperative Management of Functional Hallux Limitus in a Patient With Rheumatoid Arthritis

2003 ◽  
Vol 83 (9) ◽  
pp. 831-843 ◽  
Author(s):  
Joseph A Shrader ◽  
Karen Lohmann Siegel
Keyword(s):  
Rheumatoid Arthritis ◽  
Patient Education ◽  
Social Life ◽  
Complete Relief ◽  
Foot Orthoses ◽  
Foot Pain ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
Plantar Pressures ◽  
Patient Reported

Background and Purpose. Functional hallux limitus (FHL) is a condition that affects motion at the first metatarsophalangeal joint and may lead to abnormal forefoot plantar pressures, pain, and difficulty with ambulation. The purpose of this case report is to describe a patient with rheumatoid arthritis (RA) and FHL who was managed with foot orthoses, footwear, shoe modifications, and patient education. Case Description. The patient was a 55-year-old woman diagnosed with seropositive RA 10 years previously. Her chief complaint was bilateral foot pain, particularly under the left great toe. Her foot pain had been present for several years, but during the past 5 months it had intensified and interfered with her work performance, activities of daily living, and social life. Outcomes. Following 4 sessions of physical therapy over a 6-week time period, the patient reported complete relief of forefoot pain despite no change in medication use or RA disease pathophysiology. She was able to continuously walk for up to 4 hours. Left hallux peak plantar pressures were reduced from 43 N/cm2 to 18 N/cm2 with the foot orthoses. Discussion. Patients with RA who develop FHL may benefit from physical therapist management using semirigid foot orthoses, footwear, shoe modifications, and patient education.

The Anatomical Location of the Flexor Hallucis Brevis as It Pertains to Implant Arthroplasty

2012 ◽  
Vol 102 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Matthew DeMore ◽  
Erigena Baze ◽  
Anthony LaLama ◽  
Patrick Branagan ◽  
Michael Bowen ◽  
...  
Keyword(s):  
Articular Surface ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Anatomical Location ◽  
Foot And Ankle ◽  
Insertion Point ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
Fresh Frozen ◽  
The Mean

Background: Hallux limitus/rigidus is a painful arthritic condition affecting the first metatarsophalangeal joint that can be treated by implant arthroplasty, which, ultimately, may cause loss of the anatomical insertion points of the flexor hallucis brevis muscle. Preparation of the base involves resection of bone, thus compromising the insertion of the flexor hallucis brevis muscle. Methods: We dissected 54 fresh-frozen cadaveric specimens and quantitatively measured the distalmost insertion point of the medial and lateral heads of the flexor hallucis brevis muscle. These measurements were performed for both heads. The measurements were performed three times by three separate examiners. In addition, taking into consideration the anatomical construct of the articular surface of the base of the proximal phalanx of the hallux, another measurement was performed to note the concavity using 44 of the specimens. Again, these measurements were performed three times by three separate investigators. Results: The mean length from the base of the proximal phalanx to the distalmost insertion of the medial and lateral heads of the flexor hallucis brevis muscle was found to be 7 mm. Conclusions: This study provides precise anatomical data that can be used by foot and ankle surgeons when considering the use of implant arthroplasty for the treatment of hallux limitus/rigidus and the ability to maintain the insertion point of the flexor hallucis brevis muscle. (J Am Podiatr Med Assoc 102 (1):1-4, 2012)

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