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)

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)

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.

Radiographic Study of the Size of the First Metatarso-Digital Segment in Feet with Incipient Hallux Limitus

2007 ◽  
Vol 97 (6) ◽  
pp. 460-468 ◽  
Author(s):  
Pedro V. Munuera ◽  
Gabriel Domínguez ◽  
Jose M. Castillo
Keyword(s):  
Proximal Phalanx ◽  
Distal Phalanx ◽  
Radiographic Study ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Total Length ◽  
The Absolute

Background: The aim of this study is to confirm whether the absolute and relative lengths of the first metatarso-digital segment is greater than normal in incipient hallux limitus deformity. Methods: In a sample of 144 dorsoplantar radiographs under weightbearing conditions (94 of normal feet and 50 of feet with a slightly stiff hallux), measurements were made of the relative first metatarsal protrusion, the length and width of the first metatarsal and of the proximal phalanx of the hallux, the length of the distal phalanx of the hallux, and the total length of the hallux. Results: There were significant differences between the two types of feet in the relative first metatarsal protrusion, the width of the first metatarsal, the length and width of the proximal phalanx of the hallux, the length of the distal phalanx, and the total length of the hallux. Conclusion: The size of the first metatarso-digital segment could be implicated in the development of hallux limitus deformity. (J Am Podiatr Med Assoc 97(6): 460–468, 2007)

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.

The Plantar Plate of the First Metatarsophalangeal Joint

2014 ◽  
Vol 7 (2) ◽  
pp. 108-112 ◽  
Author(s):  
Douglas E. Lucas ◽  
Terrence Philbin ◽  
Safet Hatic
Keyword(s):  
Sagittal Plane ◽  
Average Distance ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Cadaver Study ◽  
Joint Line ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Plantar Plate

The plantar plate of the first metatarsophalangeal (MP) joint is a critical structure of the forefoot that has been identified as a major stabilizer within the capsuloligamentous complex. Many studies have clarified and documented the anatomy of the lesser toe MP plantar plates, but few have looked closely at the anatomy of the first MP joint. Ten cadaveric specimens were examined to identify and document the objective anatomic relationship of the plantar plate, tibial sesamoid, and surrounding osseus structures. The average distance of the plantar plate distal insertion from the joint line into the proximal phalanx was 0.33 mm. The plantar plate was inserted into the metatarsal head on average 17.29 mm proximal from the joint line. The proximal aspect of the sesamoid was 18.55 mm proximal to the distal attachment of the plantar plate to the phalanx. The distal aspect of the sesamoid averaged 4.69 mm away from the distal attachment into the proximal phalanx. The footprint of the distal plate insertion was on average 6.33 mm in length in the sagittal plane. The authors hope that these objective data measures can aid in the understanding and subsequent surgical repair of this important forefoot structure. Level of Evidence: Level V: Cadaver study

Osteochondral Fresh Allograft Transfer to Address Osteochondral Defect of the First Metatarsal Head in Early Hallux Limitus

2021 ◽  
Vol 60 (1) ◽  
pp. 157-162
Author(s):  
Shane Hollawell ◽  
Ruth Moen ◽  
Meagan Coleman ◽  
Michael Carson
Keyword(s):  
Osteochondral Defect ◽  
Metatarsal Head ◽  
Hallux Limitus ◽  
First Metatarsal

scholarly journals Analysis and planning of correction of midfoot deformity located in sagittal plane of X-ray

2017 ◽  
Vol 176 (5) ◽  
pp. 59-63
Author(s):  
L. N. Solomin ◽  
K. A. Ukhanov ◽  
A. V. Boichenko ◽  
D. .. Khertsenberg
Keyword(s):  
Sagittal Plane ◽  
Articular Surface ◽  
Metatarsal Head ◽  
Segment Length ◽  
X Ray ◽  
First Metatarsal ◽  
Distal Edge ◽  
Hindfoot Deformity ◽  
Method Of Assessment ◽  
Foot Position

OBJECTIVE. The authors developed a new method of assessment and planning of correction of sagittal midfoot deformity, which is based on original reference lines and angles. MATERIAL AND METHODS. X-ray lateral foot projections without deformities were analyzed in 64 adult volunteers. There was determined the angle between articular line of talus trochlea joint and the first metatarsal mechanical axis. It was estimated the ratio of segment length which was limited by distal point of the head of first metatarsal bone and distal edge of articular surface of talus trochlea joint (AC) to segment length, which was limited by edge of articular line of talus trochlea joint (AB). RESULTS. The target angle was 23,6 ± 3,2. The ratio coefficient of segment length AC to AB consisted of 4,3 ± 0,9. The method of planned foot correction was based on data obtained. It allowed doctors to determine the deformity apex and normal position of the first metatarsal head. CONCLUSIONS. The developed method facilitates to plan surgical correction of midfoot deformity in sagittal plane. It gives an opportunity to assess correction results independently from presence of equinus foot position in ankle joint and (or) hindfoot deformity.

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)

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.

The Radiographic Morphology of Foot Deformities in Patients with Fibrodysplasia Ossificans Progressiva

2005 ◽  
Vol 26 (11) ◽  
pp. 937-941 ◽  
Author(s):  
Richard J. Harrison ◽  
J. David Pitcher ◽  
Mark S. Mizel ◽  
H. Thomas Temple ◽  
Sean P. Scully
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Metatarsal Head ◽  
Length Ratio ◽  
Fibrodysplasia Ossificans Progressiva ◽  
Foot Deformities ◽  
First Metatarsal ◽  
First Ray ◽  
The Mean ◽  
And Gender

Background: The most consistent deformities that allow early diagnosis of fibrodysplasia ossificans progressiva are the presence of bilateral short first rays and hallux valgus. The purpose of this study was to describe the radiographic features observed in the feet of patients with fibrodysplasia ossificans progressiva. Methods: The radiographs of 26 feet (15 patients with fibrodysplasia ossificans progressiva) were reviewed to evaluate the radiographic changes that occur in the first ray. Variables analyzed were the hallux valgus (HV) angle, the distal metatarsal articular (DMA) angle, the proximal phalangeal articular (PPA) angle, the intermetatarsal (IM) angle, ratio of the lengths of the first and second metatarsal lengths (MT1:MT2), and the first and second ray length ratio. The length ratios were then subtracted from similar ratios in radiographs of age- and gender-matched normal patients previously reported. Results: The proximal phalanx was consistently shortened but morphologically dissimilar from subject to subject. Asymmetry was noted in some patients with bilateral radiographs. The mean HV angle was 28 degrees, and the mean IM angle was 10 degrees. The mean DMA angle was 33 degrees, and the mean PPA angle was 14 degrees. The MT1:MT2 ratio was 0.89, and the mean first ray to second ray length ratio was 0.87. The mean of the differences in the MT1:MT2 and first and second ray length ratios in patients with fibrodysplasia ossificans progressiva compared to the normal controls were 0.05 and 0.01, respectively. Fusion occurred between the abnormal tibial epiphysis of the proximal phalanx and metatarsal head with advancing age, and 68% of the metatarsal heads were fused with the abnormal proximal phalangeal epiphysis. Conclusions: Foot pathology in patients with fibrodysplasia ossificans progressiva is variable but consistently involves an abnormality of the tibial aspect of the proximal phalangeal epiphysis of the hallux. This results in the clinical observation of hallux valgus in these patients. The first metatarsal is consistently shortened, and fusion between the epiphysis of the abnormal proximal phalanx and the shortened first metatarsal head occurs with advancing age.

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