Length of the Sesamoids and Their Distance From the Metatarsophalangeal Joint Space in Feet With Incipient Hallux Limitus

2008 ◽  
Vol 98 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Pedro V. Munuera ◽  
Gabriel Domínguez ◽  
Guillermo Lafuente
Keyword(s):  
Metatarsophalangeal Joint ◽  
Inverse Correlation ◽  
Metatarsal Head ◽  
Joint Space ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Significant Difference ◽  
Distal Edge ◽  
The Relationship ◽  
Moderate Inverse Correlation

Background: We designed this study to verify whether the sesamoids of the first metatarsal head are longer than normal in feet with incipient hallux limitus, and whether feet with incipient hallux limitus are in a more proximal than normal sesamoid position. Methods: In a sample of 183 dorsoplantar radiographs under weightbearing conditions (115 of normal feet and 68 of feet with slightly stiff hallux), measurements were made of the length of both the medial and the lateral sesamoids and of the distance between these bones to the distal edge of the first metatarsal head. These variables were compared between the normal and the hallux limitus feet. The relationship between these variables and the hallux dorsiflexion was also studied. Results: We found significant differences between the two types of foot in the medial and lateral sesamoid lengths, but no significant difference in the distance between the sesamoids to the distal edge of the first metatarsal. A poor-to-moderate inverse correlation was found between hallux dorsiflexion and medial sesamoid length and between hallux dorsiflexion and lateral sesamoid length. Conclusions: The length of the sesamoid bones of the first metatarsal head could be implicated in the development of the hallux limitus deformity. (J Am Podiatr Med Assoc 98(2): 123–129, 2008)

Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus

2016 ◽  
Vol 106 (3) ◽  
pp. 172-181
Author(s):  
Andrew F. Knox ◽  
Alan R. Bryant
Keyword(s):  
Metatarsal Head ◽  
Radiographic Evaluation ◽  
Head Shape ◽  
Intrinsic Factors ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Radiographic Measurements ◽  
Angle Data ◽  
Significant Difference ◽  
First Ray

Background: Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. Methods: Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. Results: Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ2 tests: P > .05). Conclusions: No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

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 The relationship between CD204 M2-polarized tumour-associated macrophages (TAMs), tumour-infiltrating lymphocytes (TILs), and microglial activation in glioblastoma microenvironment: a novel immune checkpoint receptor target

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Maher Kurdi ◽  
Badrah Alghamdi ◽  
Nadeem Shafique Butt ◽  
Saleh Baeesa
Keyword(s):  
Microglial Activation ◽  
Inverse Correlation ◽  
Idh1 Mutation ◽  
High Expression ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Tumour Infiltrating Lymphocytes ◽  
Infiltrating Lymphocytes ◽  
The Relationship ◽  
Low Expression

Abstract Background Tumour associated macrophages (TAMs) and tumour infiltrating lymphocytes (TILs) are considered dominant cells in glioblastoma microenvironment. Aim The purpose of this study was to assess the expression of CD204+ M2-polarized TAMs in glioblastomas and their relationship with CD4+TILs, Iba+microglia, and IDH1 mutation. We also exploreed the prognostic value of these markers on the recurrence-free interval (RFI). Methods The expressions of CD204+TAMs, CD4+TILs, and Iba1+microglia were quantitively assessed in 45 glioblastomas using immunohistochemistry. Kaplan–Meier analysis and Cox hazards were used to examine the relationship between these factors. Results CD204+TAMs were highly expressed in 32 tumours (71%) and the remaining 13 tumours (29%) had reduced expression. CD4+TILs were highly expressed in 10 cases (22%) and 35 cases (77.8%) had low expression. There was an inverse correlation between CD204+TAMs and CD4+TILs, in which 85% of tumours had a high expression of CD204+TAMs and a low expression of CD4+TILs. Nevertheless, there was no significant difference in IDH1 mutation status between the two groups (p = 0.779). There was a significant difference in Iba1+microglial activation between IDH1mutant and IDH1wildtype groups (p = 0.031). For cases with a high expression of CD204+TAMs and a low expression of CD4+TILs, there was a significant difference in RFI after treatment with chemoradiotherapy or radiotherapy (p = 0.030). Conclusion Glioblastoma with a dense CD204+TAMs and few CD4+TILs is associated with IDH1wildtype. These findings suggest that TAMs masks tumour cell and suppress T-cell tumoricidal functions via immunomodulatory mechanisms. Blockade of the CD204-TAM receptor may prevent this mechanism and allow the evolution of TILs.

scholarly journals A Novel Radiographic Measurement Method for the Evaluation of Metatarsophalangeal Joint Dislocation of the Lesser Toe in Patients with Rheumatoid Arthritis

2021 ◽  
Vol 18 (14) ◽  
pp. 7520
Author(s):  
Hideki Ohashi ◽  
Keiichiro Nishida ◽  
Yoshihisa Nasu ◽  
Kenta Saiga ◽  
Ryuichi Nakahara ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Roc Analysis ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Radiographic Measurement ◽  
Joint Dislocation ◽  
Severity Grading ◽  
Grade 3 ◽  
The Relationship ◽  
Mtp Joints

Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (−0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.

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.

First Metatarsal Head and Medial Eminence Widths with and Without Hallux Valgus

2016 ◽  
Vol 106 (5) ◽  
pp. 323-327 ◽  
Author(s):  
Robin C. Lenz ◽  
Darshan Nagesh ◽  
Hannah K. Park ◽  
John Grady
Keyword(s):  
Hallux Valgus ◽  
Frontal Plane ◽  
Metatarsal Head ◽  
Head Width ◽  
Plane Rotation ◽  
First Metatarsal ◽  
Significant Difference ◽  
Medial Eminence ◽  
And Control

Background: Resection of the medial eminence in hallux valgus surgery is common. True hypertrophy of the medial eminence in hallux valgus is debated. No studies have compared metatarsal head width in patients with hallux valgus and control patients. Methods: We reviewed 43 radiographs with hallux valgus and 27 without hallux valgus. We measured medial eminence width, first metatarsal head width, and first metatarsal shaft width in patients with and without radiographic hallux valgus. Results: Medial eminence width was 1.12 mm larger in patients with hallux valgus (P &lt; .0001). Metatarsal head width was 2.81 mm larger in patients with hallux valgus (P &lt; .001). Metatarsal shaft width showed no significant difference (P = .63). Conclusions: Metatarsal head width and medial eminence width are significantly larger on anteroposterior weightbearing radiographs in patients with hallux valgus. However, frontal plane rotation of the first metatarsal likely accounts for this difference.

scholarly journals Assessment of New Measurements to Assess First Metatarsal Elevation in Hallux Rigidus Compared to Controls

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Mackenzie Jones ◽  
Austin Sanders ◽  
Rachael Da Cunha ◽  
Elizabeth Cody ◽  
Carolyn Sofka ◽  
...  
Keyword(s):  
Proximal Phalanx ◽  
Elevation Angle ◽  
Hallux Rigidus ◽  
Intrarater Reliability ◽  
First Metatarsal ◽  
Radiographic Measurements ◽  
Significant Difference ◽  
And Control ◽  
The Relationship ◽  
Research Assistants

Category: Midfoot/Forefoot Introduction/Purpose: While Metatarsus Primus Elevatus (MPE) has been implicated in the development of hallux rigidus, previous studies have presented conflicting findings regarding the relationship between an elevated first metatarsal and arthritis. This may be due to the variety of definitions for MPE and the radiographic measurement techniques that are used to assess it. The aim of this study was to examine the reliability of new radiographic measurements that take into account the elevation of the first metatarsal in relation to the proximal phalanx, rather than in relation to the second metatarsal as previously described, to assess for MPE. In addition, we aimed to determine whether the elevation of the first metatarsal was significantly different in hallux rigidus patients than in a control population. Methods: A retrospective chart review was conducted from prospectively collected registry data at the investigators’ institution to identify patients with hallux rigidus (n=65). A size matched control cohort of patients without evidence for first metatarsophalangeal (MTP) joint arthritis were identified (n=65). Patients with a previous history of foot surgery, rheumatoid arthritis, or hallux valgus were excluded. Five blinded raters of varying levels of training, including two research assistants, a senior orthopedic resident, a foot & ankle fellow, and an attending radiologist, evaluated seven radiographic measurements for their reliability in assessing for MPE in hallux rigidus and control groups. Four of the seven measurements were newly designed taking into account the relationship of the first MTP joint. Inter- and intrarater reliability were calculated using Intraclass Correlation Coefficients (ICC) and categorized by Landis and Koch reliability thresholds. The measurements between the hallux rigidus and control populations were compared using an independent t-test. Results: Six of the seven radiographic measurements were found to have substantial to almost perfect interrater reliability (ICC=0.800 to 0.953) between all levels of training, except for the Proximal Phalanx-First Metatarsal Angle which showed moderate reliability (ICC=0.527) (Table). Substantial to almost perfect intrarater reliability (ICC=0.710-0.980) was demonstrated by the research assistants. Six of the seven measurements taken by the attending radiologist demonstrated significant differences in first metatarsal elevation between the hallux rigidus and control populations with the hallux rigidus group showing increased elevation (p=0.000-0.020). Only the First Metatarsal Elevation Angle failed to show a significant difference between the populations (p=0.368). However, the First Metatarsal Elevation Angle measurements of the research assistant and the senior orthopedic resident did show a significant difference between the two populations (p<0.050). Conclusion: This study confirmed the reliability of seven radiographic measurements used to assess for MPE, including three previously established and four newly described measurements. Observers across all levels of training were able to demonstrate reliable measurements. In addition, the measurements were used to show that hallux rigidus patients are more likely to have an elevated first metatarsal compared to patients without radiographic evidence for first MTP arthritis. These measurements could be used in future work to examine how the presence of MPE relates to the etiology and progression of hallux rigidus, and how it affects the results of operative treatment.

Functional Hallux Limitus

2009 ◽  
Vol 99 (3) ◽  
pp. 236-243 ◽  
Author(s):  
Beverley Durrant ◽  
Nachiappan Chockalingam
Keyword(s):  
Sagittal Plane ◽  
Proximal Phalanx ◽  
Metatarsal Head ◽  
The Body ◽  
Evidence Based ◽  
Joint Motion ◽  
Detailed Review ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Gait Characteristics

Functional hallux limitus is defined as a functional inability of the proximal phalanx of the hallux to extend on the first metatarsal head during gait. The theory concerning this anomaly and the altered gait characteristics that may result appears to have influenced the understanding of sagittal plane podiatric biomechanics. Although there is an increase in the body of evidence to support the proposed gait alterations, a detailed review suggests the need for further work. The aim of this article is to review the functional hallux limitus literature and its reported effects on gait. Furthermore, we explore some of the key and inherent problems with obtaining accurate data for joint motion measurement in the foot. With evidence-based practice now at the forefront of both clinical and academic practice, it is imperative to review the literature that underpins a particular commonly held or historical belief, in order to substantiate and validate subsequent diagnoses and treatments provided in light of this information. This is also true to advance the understanding of a particular anomaly or pathology and to inform so as to facilitate the provision of better care to patients. (J Am Podiatr Med Assoc 99(3): 236–243, 2009)

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.

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