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)

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)

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.

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)

Management of Hallux Limitus with Distraction of the First Metatarsophalangeal Joint

2005 ◽  
Vol 95 (2) ◽  
pp. 121-129 ◽  
Author(s):  
Leonard M. Talarico ◽  
George R. Vito ◽  
Larry Goldstein ◽  
Adam D. Perler
Keyword(s):  
External Fixator ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Long Term Results ◽  
Joint Function ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus

This article describes a joint-preserving and joint-restoring procedure for the management of hallux limitus and hallux rigidus. The procedure uses a minirail external fixator to obtain distraction with or without arthrotomy of the first metatarsophalangeal joint. This procedure aims to restore joint function through elimination of the pathologic forces involved in hallux limitus and hallux rigidus. Both intrinsic and extrinsic muscular imbalances are reduced. Follow-up of 133 patients treated in this manner since 1997 demonstrates excellent long-term results. (J Am Podiatr Med Assoc 95(2): 121–129, 2005)

Lapidus Arthrodesis Plus Osteochondral Autograft Transplantation in the Management of Hallux Rigidus With an Elevated First Ray

2013 ◽  
Vol 7 (2) ◽  
pp. 135-139
Author(s):  
Kajetan Klos ◽  
Paul Simons
Keyword(s):  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Joint Function ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Osteochondral Autograft ◽  
Osteochondral Autograft Transplantation ◽  
First Ray ◽  
Transplantation Technique ◽  
Novel Method

The range of joint-sparing treatments for advanced hallux rigidus is still very limited. The authors describe an osteochondral autograft transplantation technique combined with Lapidus arthrodesis as a novel method of obtaining a relatively symptom-free first metatarsophalangeal joint function in patients with hallux rigidus and first-ray elevation. Level of Evidence: Level V

Follow-up of the Isolated Medial Approach to Hallux Abducto Valgus Correction Without Interspace Release

2002 ◽  
Vol 92 (10) ◽  
pp. 555-562 ◽  
Author(s):  
Jeffrey S. Boberg ◽  
Molly S. Judge
Keyword(s):  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Study Group ◽  
Entire Study ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Medial Approach ◽  
Average Decrease ◽  
First Ray

A retrospective radiographic review was performed of 29 patients (37 feet) who underwent an isolated medial approach for correction of hallux abducto valgus deformity from March 1993 to November 1998. Only those patients who had a traditional Austin-type osteotomy with a reducible first metatarsophalangeal joint and flexible first ray were included in the study. The average follow-up period for the entire study group was 18.4 months, with 13 patients (44.83%; 17 feet) having a follow-up period of longer than 2 years. The average decrease in the intermetatarsal angle was 9.89°, and the average decrease in the hallux abductus angle was 14.0°, results that correlated well with those of other studies on correction of hallux abducto valgus. No clinical or radiographic recurrence of hallux abducto valgus was noted throughout the follow-up period. The authors believe that an isolated medial approach to hallux abducto valgus correction without a lateral interspace release yields predictable results when performed in appropriately selected patients. (J Am Podiatr Med Assoc 92(10): 555-562, 2002)

Forefoot Surgery in Rheumatoid Arthritis: Subjective Assessment of Outcome

Foot & Ankle ◽  
1987 ◽  
Vol 8 (3) ◽  
pp. 148-151 ◽  
Author(s):  
Lael G. Hasselo ◽  
Robert F. Willkens ◽  
Hugh E. Toomey ◽  
David E. Karges ◽  
Sigvard T. Hansen
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Severity ◽  
Metatarsophalangeal Joint ◽  
Severity Index ◽  
Subjective Assessment ◽  
Subjective Data ◽  
First Metatarsophalangeal Joint ◽  
Forefoot Surgery ◽  
First Ray ◽  
Better Than

Forefoot surgical outcomes were evaluated in 26 patients with rheumatoid arthritis. A total of 45 procedures were reviewed with emphasis on first ray intervention. Disease duration and aggressiveness of preceding medical therapy were combined to establish a disease severity index. Patients operated were predominantly in the midrange of disease severity. Subjective data on the relief of pain, callus, and deformity were favorable but this benefit was not long lasting inasmuch as patients were most satisfied in the period immediately following surgery and less so as time elapsed from intervention. Fusion of the first metatarsophalangeal joint seemed better than resection alone, indicating that stability should be the primary goal for surgical intervention of the rheumatoid forefoot.

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.

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.

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)

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