Investigation of first ray mobility during gait by kinematic fluoroscopic imaging-a novel method

Abstract

BackgroundIt is often suggested that sagittal instability at the first tarso-metatarsal joint level is a primary factor for hallux valgus and that sagittal instability increases with the progression of the deformity. The assessment of the degree of vertical instability is usually made by clinical evaluation while any measurements mostly refer to a static assessment of medial ray mobility (i.e. the plantar/dorsal flexion in the sagittal plane). Testing methods currently available cannot attribute the degree of mobility to the corresponding anatomical joints making up the medial column of the foot. The aim of this study was to develop a technique which allows for a quantification of the in-vivo sagittal mobility of the joints of the medial foot column during the roll-over process under full weight bearing.MethodsMobility of first ray bones was investigated by dynamic distortion-free fluoroscopy (25 frames/s) of 14 healthy volunteers and 8 patients with manifested clinical instability of the first ray. A CAD-based evaluation method allowed the determination of mobility and relative displacements and rotations of the first ray bones within the sagittal plane during the stance phase of gait.ResultsTotal flexion of the first ray was found to be 13.63 (SD 6.14) mm with the healthy volunteers and 13.06 (SD 8.01) mm with the patients (resolution: 0.245 mm/pixel). The dorsiflexion angle was 5.27 (SD 2.34) degrees in the healthy volunteers and increased to 5.56 (SD 3.37) degrees in the patients. Maximum rotations were found at the naviculo-cuneiform joints and least at the first tarso-metatarsal joint level in both groups.ConclusionsDynamic fluoroscopic assessment has been shown to be a valuable tool for characterisation of the kinematics of the joints of the medial foot column during gait.A significant difference in first ray flexion and angular rotation between the patients and healthy volunteers however could not be found.

Changes in length of the plantar aponeurosis during the stance phase of gait – An in vivo dynamic fluoroscopic study

“…From the original larger number of samples (Martin et al, 2012) some measurements had to be excluded for the present study, since the experimental setup did not always allow relevant anatomical details to be clearly imaged. Experimental data on the tensile mechanical properties of the PA is extremely scarce, as documented in the introduction.…”

“…Changes in PA length, MP angle and total ground force during the stance phase of gait Dynamic fluoroscopic imaging of the foot during normal gait had been performed at the University of Rostock, originally to observe the movement in the 1st tarsometatarsal joint in normal gait by means of fluoroscopic sequences at a rate of 25 frames/s (Martin et al, 2012). The same fluoroscopic records proved to be well suited for the purpose of the present investigation.…”

First Ray Kinematics in Women With Rheumatoid Arthritis and Bunion Deformity: A Gait Simulation Imaging Study

“…To overcome the problems of skin motion and rigid‐modeling error assumptions, alternative methods have been devised. Innovations include the surgical fixation of motion sensors (), videofluoroscopy (), and imaging (). Of these newer methods, only magnetic resonance imaging (MRI) uses nonionizing energy and allows for weight‐bearing position simulation.…”

“…The study identified the calcaneus more everted ( P < 0.05), the first ray more adducted ( P < 0.001), and the first ray axis inclined toward vertical by an average of 18° more in the group with bunion compared to controls. Methods defined movement of the first metatarsal cuneiform arch segment as the first ray (), located the first ray axis as passing through the navicular and across the midfoot (), and modeled the axis as a helical axis vector (). When synthesizing the results, Glasoe et al () identified linkage between eversion of the calcaneus and adduction of the first ray.…”

Prediction of the First Ray Axis from Clinical Measurements: Implications for the Treatment of Bunion

“…Acting as a load-bearing strut [7,8], the first ray rotates about a single axis [9]. The locus of the axis passes from the navicular across the midfoot horizontal [3].…”