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

2006 ◽  
Vol 96 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Paul R. Scherer ◽  
Jennifer Sanders ◽  
Denten E. Eldredge ◽  
Susan J. Duffy ◽  
Ryan Y. Lee
Keyword(s):  
Hallux Valgus ◽  
Maximum Degree ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Foot Orthoses ◽  
First Metatarsophalangeal Joint ◽  
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)

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.

Clinical, Quantitative Assessment of First Tarsometatarsal Mobility in the Sagittal Plane and Its Relation to Hallux Valgus Deformity

1994 ◽  
Vol 15 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Kaj Klaue ◽  
Sigvard T. Hansen ◽  
Alain C. Masquelet
Keyword(s):  
Hallux Valgus ◽  
Sagittal Plane ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Main Concern ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
First Ray

Today, bunion surgery is still controversial. Considering that a bunion deformity in fact may be a result of multiple causes, the rationale of the currently applied techniques of surgical treatment has not been conclusively demonstrated. In view of the known hypermobility syndrome of the first ray that results in insufficient weightbearing beneath the first metatarsal head, the relationship between this syndrome and hallux valgus deformity has been investigated. The results suggest a direct relationship between painful hallux valgus deformity and hypermobility in extension of the first tarsometatarsal joint. A pathological mechanism of symptomatic hallux valgus is proposed that relates this pathology with primary weightbearing disturbances in the forefoot where angulation of the first metatarsophalangeal joint is one of the consequences. The alignment of the metatarsal heads within the sagittal plane seems to be a main concern in many hallux valgus deformities. As a consequence, treatment includes reestablishing stable sagittal alignment in addition to the horizontal reposition of the metatarsal over the sesamoid complex. As an example, first tarsometatarsal reorientation arthrodesis regulates the elasticity of the multiarticular first ray within the sagittal plane and may be the treatment of choice in many hallux valgus deformities.

Silastic Ball Spacer Arthroplasty in the Management of Hallux Valgus and Hallux Rigidus

Foot & Ankle ◽  
1989 ◽  
Vol 10 (2) ◽  
pp. 61-64 ◽  
Author(s):  
N. S. Broughton ◽  
A. Doran ◽  
B. F. Meggitt
Keyword(s):  
Hallux Valgus ◽  
Young Patients ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
New Bone Formation ◽  
Great Toe ◽  
First Metatarsophalangeal Joint ◽  
Proximal Migration ◽  
Original Concept

Sixty-two feet in 39 patients who were treated by insertion of a silastic ball spacer prosthesis into the first metatarsophalangeal joint for hallux valgus or hallux rigidus have been reviewed with a follow-up time of between 2 and 6 years. Twenty-one results (34%) were excellent, 27 (43%) were fair, 13 (21%) were poor, and one was revised. Seventeen feet (27%) had some metatarsalgia at followup. Results were disappointing in the young patients; in 19 cases of hallux valgus under the age of 45, 8 were either poor or had been revised. The original concept of the silastic ball spacer was to maintain great toe length and prevent proximal migration of the sesamoids. However 60% of these feet showed settling of the prosthesis or new bone formation around the prosthesis and 54% had more than 2 mm proximal migration of the sesamoid bones. The symptomatic results in these patients were similar to those in whom great toe length had been successfully maintained. The silastic ball spacer infrequently achieves its aims, however maintenance of hallux length does not seem to be important in the symptomatic result.

scholarly journals The correlation between body mass index and the type of foot arches with the risk of hallux valgus in children aged 13–14 years old

2021 ◽  
Vol 9 (3) ◽  
pp. 680
Author(s):  
Govinda Vittala ◽  
Luh Putu Ratna Sundari ◽  
I Putu Radhe Bhakti Krisnanda ◽  
Ni Komang Dewi Semariasih
Keyword(s):  
Body Mass Index ◽  
Hallux Valgus ◽  
Body Mass ◽  
Random Sampling ◽  
Metatarsophalangeal Joint ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
Cross Sectional ◽  
First Metatarsophalangeal Joint ◽  
The Relationship

Background: Hallux valgus is a deformity characterized by a change in the shape of the thumb with symptoms of swelling, redness and pain. Hallux valgus is progressive where there is a lump at the base of the thumb which can occur due to the weakness of the muscles and ligaments around the first metatarsophalangeal joint. The purpose of this study was to determine the relationship between body mass index and the type of foot arches on the risk of hallux valgus in children aged 13–14 years.  Methods: This research is a cross sectional analytic study with simple random sampling technique. The number of samples are 99 children (39 males, 60 females) aged 13–14 years. The variables measured were body mass index using body weight scales and a stature meter, the type of foot arches using a wet footprint test, and hallux valgus with a goniometer.Results: Our study shows that there is no significant correlation between body mass index and hallux valgus at the level of 0.157. However, there is a significant correlation between the type of foot arches and hallux valgus at the 0.003 level. In addition, there is a significant correlation between body mass index and foot arches.  Conclusions: There was a significant relationship between body mass index and foot arches and foot arches with the risk of hallux valgus. However, body mass index is not directly related to hallux valgus condition.   

scholarly journals The Influence of Patient Factors on the Outcome of Synthetic Cartilage Implant Hemiarthroplasty versus First Metatarsophalangeal Joint Arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Andrew Goldberg ◽  
Mark Glazebrook ◽  
Timothy Daniels ◽  
Gwyneth de Vries ◽  
M. Elizabeth Pedersen ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Clinical Success ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Success Rates ◽  
Preoperative Pain ◽  
Duration Of Symptoms ◽  
First Metatarsophalangeal Joint ◽  
Valgus Angle ◽  
The Impact

Category: Midfoot/Forefoot Introduction/Purpose: Many studies have compared the outcomes of MTPJ1 hemiarthroplasty and arthrodesis, but there is a paucity of data on the influence of patient factors on clinical outcomes. A prior prospective, randomized, clinical trial compared the efficacy and safety of first metatarsophalangeal joint (MTPJ1) hemiarthroplasty with a synthetic polyvinyl alcohol hydrogel implant (Cartiva®) and MTPJ1 arthrodesis for moderate to severe hallux rigidus. The current study evaluated the data from this clinical trial to determine the impact of numerous patient variables, including osteoarthritis grade, hallux valgus angle, preoperative range of motion (ROM), gender, body mass index (BMI), preoperative duration of symptoms, and preoperative pain level, on the success or failure of MTPJ1 hemiarthroplasty and arthrodesis. Methods: Patients =18 years diagnosed with hallux rigidus grade 2, 3, or 4 were randomized and treated with synthetic cartilage implant MTPJ1 hemiarthroplasty (n=129) or arthrodesis (n=47). Outcome measures included a pain visual analogue scale (VAS), Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) scores, and Short Form-36 Physical Functioning (SF-36 PF) subscore, obtained preoperatively and at 2, 6, 12, 24, 52 and 104 weeks postoperatively. Great toe active dorsiflexion motion, secondary procedures, radiographs and safety parameters were evaluated. A patient’s outcome was deemed successful if composite primary endpoint criteria for clinical success (pain, function and safety) were met at 24 months. Predictor variables included: osteoarthritis grade; hallux valgus angle; preoperative ROM; gender; body mass index (BMI); preoperative symptom duration; prior surgery; and preoperative pain level. Two-sided Fisher’s Exact test was used to assess the impact of these variables on success of surgery (p<0.05). Results: Standard patient demographics and baseline outcome measures were similar for both groups; both procedures demonstrated equivalent pain relief and functional outcomes.1 There was no significant difference (p>0.05) in success rates (i.e., VAS pain reduction ≥ 30%, maintenance/improvement in function, freedom from radiographic complications, and no secondary surgical intervention) between synthetic cartilage implant MTPJ1 hemiarthroplasty and arthrodesis when stratified by osteoarthritis grade, degree of preoperative hallux valgus, extent of preoperative ROM, gender, BMI, duration of symptoms, prior MTPJ1 surgery status, and preoperative pain VAS score (Table 1). Notably, patients with minimal ROM and mild hallux valgus had equivalent success rates for both procedures. Males tended to have greater clinical success with implant hemiarthroplasty versus arthrodesis, but this difference was not statistically significant. 1Baumhauer et al., FAI, 2016;37(5):457-69. Conclusion: Synthetic cartilage implant hemiarthroplasty is an appropriate treatment for patients with hallux rigidus of Coughlin grade 2, 3 or 4. Its results in those with associated mild hallux valgus (<20 degrees) and in those with a high degree of preoperative stiffness are equivalent to MTPJ1 fusion, irrespective of gender, BMI, osteoarthritis grade, or preoperative pain or duration of symptoms, in contrast to what might have been expected.

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

1997 ◽  
Vol 18 (3) ◽  
pp. 132-137 ◽  
Author(s):  
Craig Nevin
Keyword(s):  
Hallux Valgus ◽  
Soft Tissues ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
First Metatarsophalangeal Joint ◽  
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.

scholarly journals Intermetatarsal Angle and Hallux Abductus Angle Reduction After First Metatarsophalangeal Joint Arthrodesis in Mild, Moderate, and Severe Hallux Valgus

2021 ◽  
Vol 111 (2) ◽  
Author(s):  
Kimberly S. Cravey ◽  
Ian M. Barron ◽  
Said A. Atway ◽  
Michael L. Anthony ◽  
Erik K. Monson
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
First Ray ◽  
Severe Hallux Valgus ◽  
Preoperative Deformity

Background First metatarsophalangeal joint fusion is a commonly used procedure for treating many pathologic disorders of the first ray. Historically, hallux valgus deformity with severely increased intermetatarsal angle or metatarsus primus adductus indicated need for a proximal metatarsal procedure. However, the effectiveness and reliability of first metatarsophalangeal joint arthrodesis in reducing the intermetatarsal angle has been increasingly described in the literature. We compared findings at our institution with current literature for further validation of this well-accepted procedure in correcting hallux valgus deformity with high intermetatarsal angle. Methods Weightbearing preoperative and postoperative radiographs of 43 patients, 31 women and 12 men, meeting the inclusion and exclusion criteria were identified. Two independent investigators measured the hallux abductus and intermetatarsal angles. Preoperative and postoperative measurements for each angle were compared and average reduction calculated. The data were further analyzed by grouping deformities as mild, moderate, and severe. Mean follow-up was 10 months. Results The overall mean preoperative intermetatarsal and hallux abductus angles decreased significantly (from 13.09° to 9.33° and from 23.72° to 12.19°, respectively; both P &lt; .01). When grouping deformities as mild, moderate, and severe, all of the categories maintained reduction of intermetatarsal and hallux abductus angles (P &lt; .01). Furthermore, the mean reduction of the intermetatarsal and hallux abductus angles seemed to correlate with preoperative deformity severity. Conclusions In patients undergoing correction of hallux valgus deformity, first metatarsophalangeal joint arthrodesis produced consistent reductions in the intermetatarsal and hallux abductus angles. Furthermore, these findings are consistent with those reported by other institutions.

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