Eighty-six mucous cysts in 79 patients were surgically excised. Follow-up was carried out at an average of 2.6 years. Fifteen digits (17%) had a residual loss of extension of 5 to 20 degrees at the IP or DIP joints. One patient developed a superficial infection and two developed a DIP pyarthrosis, which eventually required DIP arthrodesis. Nail deformities were present in 25 of 86 digits preoperatively (29%), 15 of which resolved after surgery (60%). Four of 61 digits developed a nail deformity which was not present preoperatively (7%). Three of 86 digits (3%) developed recurrence. Other complications included persistent swelling, pain, numbness, stiffness, and radial or ulnar deviation at the DIP joint. We recommend that patients be informed preoperatively of the potential risks of decreased range of motion, persistent swelling and pain, infection, recurrence, and persistent or postoperatively acquired nail deformity.

Hypermobility of the first metatarsal cuneiform joint has been implicated as a cause of the hallux valgus deformity. The objective definition of hypermobility at this joint, however, has not been clearly defined. We used a modified Coleman block test to accentuate motion at the first metatarsal cuneiform joint in order to measure physiologic limits of motion in vivo. This motion was compared with radiographic analysis of the feet, which included the hallux valgus angle, intermetatarsal angle, and medial cortical thickening at the midshaft of the second metatarsal. This assessment was performed on 100 feet (50 right feet and 50 left feet in 50 patients). The average intermetatarsal angle was 8.7 degrees (range, 4-14 degrees), the average hallux valgus angle was 11 degrees (range, 4 degrees of varus to 30 degrees of valgus), and the average midshaft medial cortical thickness was 3.2 mm (range, 2.0-5.5 mm). Pearson's correlation coefficient was calculated to compare these factors. The relationship between variables was found to be small (r < or = 0.2). Motion was noted to occur in the normal foot at this joint and a range of normal values for medial cortical thickness was identified.

Fifty volunteers with 100 asymptomatic feet were evaluated by physical examination, radiographic analysis, and questionnaire. This investigation was used to evaluate first metatarsocuneiform motion and establish normal values at this joint. Normal first ray sagittal range of motion was 4.37 degrees (SD, +/- 3.4 degrees). The shape of the distal cuneiform was then categorized by three classification methods. Multiple independent variables were cross-referenced to determine their relationship with motion and shape at the distal cuneiform. Hyperflexibility of the thumb correlated with first ray hypermobility. No correlation was found between first ray motion and sex, age, intermetatarsal angle, side, skin stretch, hyperextension of the knee, hyperextension of the elbow, or shape of the distal cuneiform.

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