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)

Clinical improvement in functional hallux limitus using a cut-out orthosis

2014 ◽  
Vol 40 (2) ◽  
pp. 215-223 ◽  
Author(s):  
Ricardo Becerro de Bengoa Vallejo ◽  
Rubén Sanchez Gómez ◽  
Marta Elena Losa Iglesias
Keyword(s):  
Beneficial Effect ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Bone ◽  
Transverse Plane ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
Declination Angle

Background: Functional hallux limitus (FHL) has been implicated in the development of metatarsophalangeal joint osteoarthritis. Objectives: To determine whether cut-out orthosis treatment increases plantarflexion of the first metatarsal by increasing its declination angle. Study design: Cross-sectional study. Methods: A total of 46 female volunteers with an average age of 25.66 ± 5.70 years (range: 19–42 years) and FHL participated in the study. We assessed the degrees of movement of the first metatarsal and proximal phalanx bones at the first metatarsophalangeal joint without and while wearing the cut-out orthosis using the 3Space Fastrak® via sensors. Results: The movement of the plantarflexión declination angle of the first metatarsal bone was higher using the orthosis 29.84° ± 5.98° versus without orthosis 27.69° ± 5.91° (p < 0.031°). Use of sandals may have minimized the magnitude of movement changes associated with orthosis versus non-orthosis use. Conclusion: The cut-out orthosis demonstrated a beneficial effect on non-fixed first metatarsophalangeal and metatarsal cuneiform joints affected by FHL, significantly increasing the declination of the metatarsal angle. Furthermore, use of the cut-out orthosis significantly reduced adduction movement of the first metatarsal bone in the transverse plane. Clinical relevance The cut-out orthosis demonstrated a beneficial effect on non-fixed first metatarsophalangeal and metatarsal cuneiform joints affected by FHL, significantly increasing the declination of the metatarsal angle. Furthermore, use of the cut-out orthosis significantly reduced adduction movement of the first metatarsal bone in the transverse plane.

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)

Assessment of Partial First-Ray Resections and Their Tendency to Progress to Transmetatarsal Amputations

2012 ◽  
Vol 102 (5) ◽  
pp. 412-416 ◽  
Author(s):  
John Kadukammakal ◽  
Sydney Yau ◽  
William Urbas
Keyword(s):  
Surgical Intervention ◽  
Metatarsophalangeal Joint ◽  
Foot Deformities ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Diabetic Foot Infections ◽  
First Ray ◽  
Initial Procedure ◽  
Transmetatarsal Amputation ◽  
Mean Time

Background: Diabetic foot infections tend to lead to amputation. Partial first-ray resections are used to help salvage the foot and maintain bipedal ambulation. Losing the first metatarsophalangeal joint has biomechanical consequences that lead to further foot deformities and result in more proximal amputations of the ipsilateral limb, such as a transmetatarsal amputation. Methods: We reviewed 48 patients (32 male and 16 female; mean age = 62.44) who underwent 50 partial first-ray resections between April 1, 2003, and July 31, 2009. These partial first-ray resections were done at various levels of the first metatarsal. We hypothesize that partial first-ray resections that require further bone resection will lead to poor biomechanics that can result in further amputation. Results: We found that out of 50 partial first-ray resections, 24 cases required further surgical intervention, 12 of which were a transmetatarsal amputation (TMA) (mean time between partial first-ray resection and TMA = 282.08 days). Forty-eight percent of patients did not require further surgical intervention and were considered a success. Conclusions: Partial first-ray resections are not highly successful. Our study found a higher success rate compared to a previous study done by Cohen et al in 1991. Partial first-ray amputations can be a good initial procedure to salvage the foot and prolong a patient’s bipedal ambulatory status, thereby lowering the patient’s morbidity and mortality. (J Am Podiatr Med Assoc 102(5): 412–416, 2012)

scholarly journals Concept, etiology, and pathomechanics of hallux rigidus

2021 ◽  
Vol 15 (3) ◽  
pp. 193-197
Author(s):  
Manuel Monteagudo de la Rosa ◽  
Ramón Viladot-Pericé
Keyword(s):  
Positive Impact ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Compensatory Mechanisms ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Functional Changes ◽  
Hallux Limitus ◽  
Sliding Mechanism ◽  
Movement Mechanism

There is a continuous anatomical, functional and pathomechanical roadmap from functional hallux limitus to hallux rigidus. Although many etiologies for hallux rigidus have been studied it is very probable that it has a primary origin with less-than-ideal movement when we are born. Upon a restricted range of motion, symptoms may arise depending on the amount of work and how compensatory mechanisms work around the first metatarsophalangeal joint. Changes occurring at the joint that allow the transition from a sliding movement mechanism (physiological) to a rolling mechanism (pathological) may trigger anatomical and functional changes resulting in pain and dysfunction. Any surgical technique that is able to restore the sliding mechanism to the first metatarsophalangeal joint will have a positive impact on pain and function in a patient with a symptomatic functional hallux limitus/rigidus. Level of Evidence V; Therapeutic Study; Expert opinion.

Plantar Pressure and Joint Motion After the Youngswick Procedure for Hallux Limitus

2004 ◽  
Vol 94 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Alan R. Bryant ◽  
Paul Tinley ◽  
Joan H. Cole
Keyword(s):  
Pressure Distribution ◽  
Peak Pressure ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Joint Motion ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Second Metatarsal

The effects of the Youngswick osteotomy on plantar peak pressure distribution in the forefoot are presented for 17 patients (23 feet) with mild-to-moderate hallux limitus deformity and 23 control subjects (23 feet). During 2 years of follow-up, the operation produced a significant increase in the range of dorsiflexion of the first metatarsophalangeal joint in these patients, reaching near-normal values. Preoperative and postoperative measurements, using a pressure-distribution measurement system, show that peak pressure beneath the hallux and the first metatarsal head remained unchanged. However, peak pressure was significantly increased beneath the second metatarsal head and decreased beneath the fifth metatarsal head. These findings suggest that the foot functioned in a less inverted manner postoperatively. Compared with normal feet, hallux limitus feet demonstrated significantly higher peak pressure beneath the fourth metatarsal head preoperatively and postoperatively. (J Am Podiatr Med Assoc 94(1): 22-30, 2004)

Effects of Hallux Limitus on Plantar Foot Pressure and Foot Kinematics During Walking

2006 ◽  
Vol 96 (5) ◽  
pp. 428-436 ◽  
Author(s):  
Bart Van Gheluwe ◽  
Howard J. Dananberg ◽  
Friso Hagman ◽  
Kerstin Vanstaen
Keyword(s):  
Three Dimensional ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Limited Attention ◽  
Foot Pressure ◽  
Foot Kinematics ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Peak Plantar Pressure

The effects of hallux limitus on plantar foot pressure and foot kinematics have received limited attention in the literature. Therefore, a study was conducted to assess the effects of limited first metatarsophalangeal joint mobility on plantar foot pressure. It was equally important to identify detection criteria based on plantar pressures and metatarsophalangeal joint kinematics, enabling differentiation between subjects affected by hallux limitus and people with normal hallux function. To further our understanding of the relation between midtarsal collapse and hallux limitus, kinematic variables relating to midtarsal pronation were also included in the study. Two populations of 19 subjects each, one with hallux limitus and the other free of functional abnormalities, were asked to walk at their preferred speed while plantar foot pressures were recorded along with three-dimensional foot kinematics. The presence of hallux limitus, structural or functional, caused peak plantar pressure under the hallux to build up significantly more and at a faster rate than under the first metatarsal head. Additional discriminators for hallux limitus were peak dorsiflexion of the first metatarsophalangeal joint, time to this peak value, peak pressure ratios of the first metatarsal head and the more lateral metatarsal heads, and time to maximal pressure under the fourth and fifth metatarsal heads. Finally, in approximately 20% of the subjects, with and without hallux limitus, midtarsal pronation occurred after heel lift, validating the claim that retrograde midtarsal pronation does occur. (J Am Podiatr Med Assoc 96(5): 428–436, 2006)

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 Is Fibular Sesamoidectomy a Viable Option for Sesamoiditis? A Retrospective Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0031
Author(s):  
Leonardo V. M. Moraes ◽  
Jeffrey Pearson ◽  
Kyle Paul ◽  
Jianguang Peng ◽  
Karthikeyan Chinnakkannu ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Retrospective Chart Review ◽  
Extended Period ◽  
Varus Deformity ◽  
Operative Management ◽  
Superficial Infection ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Varus

Category: Midfoot/Forefoot Introduction/Purpose: Although the first metatarsophalangeal joint sesamoids have biomechanical value in the foot, pathologic conditions of these sesamoids are a source of disabling pain for patients, particularly during toe-off. Underlying causes include acute fracture, acute separation of bipartite sesamoids, sesamoiditis caused by repetitive trauma, infection, chondromalacia, osteochondritis dissecans, and osteoarthritis. Nonoperative treatment is the initial standard of care and has satisfactory outcomes overall, but operative management may be indicated in cases of pain refractory to conservative management. Surgical management includes tendo-Achilles or gastrocnemius lengthening, dorsiflexion osteotomy at the base of first metatarsal, corrective osteotomies, fusions for fixed pes cavus foot. Sesamoidectomy is a relatively uncommon procedure but should be considered if 6- 12 months of conservative managements fail or if the patient experiences ongoing debilitating symptoms. Methods: A retrospective chart review was conducted at our institution from 2009-2018. Twelve patients diagnosed with fibular sesamoiditis were treated with sesamoidectomy. Baseline patient demographics as well as postoperative outcomes were recorded. All patients were initially treated for an extended period conservatively with orthotics, anti-inflammatory medications, physical therapy, limitation of activity and a trial of non-weight bearing. Despite these measures, symptoms persisted for these twelve patients - all of who then underwent fibular sesamoidectomy for their symptoms. The fibular sesamoidectomy was performed by one of the three fellowship trained foot and ankle surgeons. All surgeons used plantar approach with a longitudinal incision on the lateral edge of the first metatarsal fat pad. Postoperatively, patients were kept non–weight bearing for 2 weeks and in a post-op walking shoe for 6 weeks. Results: Average age of the patients was 38 years. Ten of twelve patients (83%) were female. Majority of the patients (10) had no history of trauma, only two referred forefoot injury in the past. Average follow-up was 35 months. Two patients had both hallux valgus and hallux rigidus. One had preexisting rheumatoid arthritis with involvement of the first MTP. MRI showed 5 of 12 (42%) of patients had avascular necrosis of the sesamoid based on magnetic resonance imaging. None of the patients developed cock-up deformity of the lesser toes or hallux varus deformity, clinically or radiologically. Two patients experienced transient neuritis, one developed a superficial infection, and one had painful postoperative scarring. Hallux varus deformity was not observed in any patients. None underwent reoperation. Conclusion: Our study contradicts earlier studies which associate sesamoidectomy with high incidence of complications, particularly hallux varus. But, most of these earlier reports focus on combinations of medial, lateral, and paired excision, rather than lateral excision alone, unlike our study. Hence, fibular sesamoidectomy can be a safe, viable procedure for patients who fail conservative measures for sesamoiditis. The plantar lateral approach allows for adequate exposure of the fibular sesamoid, repair of the plantar plate, and preservation of flexor hallucis brevis, and is beneficial in preventing the occurrence of hallux varus deformity.

The Simple Bunion: Anatomy at the Metatarsophalangeal Joint of the Great Toe

Foot & Ankle ◽  
1984 ◽  
Vol 4 (5) ◽  
pp. 229-240 ◽  
Author(s):  
Richard Alvarez ◽  
Ray J. Haddad ◽  
Nathaniel Gould ◽  
Saul Trevino
Keyword(s):  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Great Toe ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Sesamoid Bones ◽  
Proper Interpretation

The pathomechanics for the development of the hallux valgus deformity takes place at the first metatarsophalangeal joint-the sesamoid complex. The sesamoid complex consists of seven muscles, eight ligaments, and two sesamoid bones. When the first metatarsal escapes the complex and drifts medially, the sesamoids remain twisted in situ, several of the ligaments “fail,” and others contract. The authors propose reduction of the metatarsus primus varus by first metatarsal osteotomy and appropriate ligament releases and plications to restore alignment. A detailed understanding of the pathomechanics is essential for proper interpretation of the problems and anticipated lasting surgeries.

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.

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