Mobility of the First Tarsometatarsal Joint in Hallux Valgus Patients: A Radiographic Analysis

Abstract

Hypermobility of the first tarsometatarsal (TMT 1) joint in the sagittal plane plays a role in the etiology and treatment of the hallux valgus complex. However, objective quantification of this mobility is still a problem. We performed a radiographic analysis of TMT 1 mobility in the sagittal plane in 94 hallux valgus patients aged 15 to 65 years. We examined 94 feet with symptomatic hallux valgus deformity requiring operative correction. Excluded were patients with osteoarthritis, inflammatory diseases or previous operations on the foot. The TMT 1 mobility was tested with a clinical test and by radiographic measurement using the modified Coleman block test. The mean mobility of the TMT 1 joint in the sagittal plane in the patient group was 12.9 degrees (SD 4.80). In addition, there was a statistically significant difference between two subgroups: patients with and without clinical TMT 1 hypermobility. No correlation of TMT 1 (hyper)mobility and radiographic second ray hypertrophy was found. This simple method can produce additional information to the clinical TMT 1 hypermobility test in the sagittal plane.

Comparison of dorsal and dorsomedial displacement in evaluation of first ray hypermobility in feet with and without hallux valgus

“…Klaue et al introduced a device that measures dorsal first metatarsal displacement with a numeric value [9]. The validity and reliability of the ''Klaue Device'' has been demonstrated in many studies and has been compared with others methods or radiological investigations [10][11][12][13][14][15][16][17]. Several authors quantify a pathological dorsal hypermobility as a displacement, regardless of the test used, of more than 10 mm [3,9,18,19].…”

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

“…However, for the determination of instabilities and their specific anatomical localization occurring during the gait cycle, a more detailed analysis seems to be necessary in view of the fact that clinicians claim that instability in hallux valgus is mostly confined within the first tarso-metatarsal joint which indicates surgery in the form of an arthrodesis of this joint [4-6]. …”

“…The relevance of instability of the first ray in hallux vagus deformity has been a matter of discussion for decades. The particular pathogenesis of hallux valgus formation and deformity progression has been attributed to first ray instability with variable percentage [4-6,9,11]. …”

“…Hypermobility of the first ray, mainly due to plantar arch and Lisfranc joint ligaments laxity, is assumed to predispose for hallux valgus in a certain subset of patients [1,2]. The fraction of these patients with manifested instability of the first ray has been reported to range between 10% [3] and 94% [4] of all patients with symptomatic hallux valgus deformity. With increasing degree of hallux valgus deformity and adduction of the first metatarsal, the first ray may become hypermobile and symptomatic [5,6].…”

Diagnosis and Management of the Painful Ankle/Foot. Part 2: Examination, Interpretation, and Management

“…Passive testing of the first tarsometatarsal (TMT) and metatarsal phylangeal joint (MTP) is important, since it can have a profound impact on TCJ and STJ performance during gait. The first TMT joint is typically involved with hallux valgus deformities, due to hypermobility of the first TMT joint 32–34 . In the literature, testing of the first TMT is performed by stabilizing the second through fifth metatarsals while moving the first metatarsal on the first cuneiform.…”