Role of Metatarsus Primus Elevatus in the Pathogenesis of Hallux Rigidus

Horton, Greg A.; Park, Yong-Wook; Myerson, Mark S.

doi:10.1177/107110079902001204

Cited by 113 publications

(87 citation statements)

References 9 publications

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“…The variability in individual subject responses to orthotic use is not unique to our investigation 2,5,15,22,34,36,42,49 and there are excellent review papers that have summarized the wide-ranging effects of orthotic intervention. 1,24,41 To further investigate individual subject responses, we used the smallest real difference (SRD) to indicate the magnitude of change for an individual across conditions that is beyond the expected trial-to-trial variability.…”

Section: Discussionmentioning

confidence: 99%

“…This angle reflects the anterior component of the arch height measurement, such that an increase in the metatarsal declination angle corresponds to an elevation of the anterior portion of the medial longitudinal arch. 6,22,26 An increase in the metatarsal declination angle also places the first metatarsal in a position of relative plantar flexion, which is considered favorable for the propulsive phase of gait. 43,44,47 We selected the metatarsal declination angle to assess whether a change, if it did occur with orthotic use during relaxed standing, would parallel the direction of change in first MTP joint dorsiflexion during gait.…”

Section: Discussionmentioning

confidence: 99%

“…The dependent variables were peak first MTP joint dorsiflexion during gait and metatarsal declination angle during relaxed stance. The metatarsal declination angle was defined as the magnitude of x-axis rotation of the first metatarsal relative to the floor 22 (or global coordinate system) and represents the anterior component of the medial longitudinal arch. In addition to changes in arch height, this angle also provides an indication of the relative amount of metatarsal plantar flexion with respect to the floor.…”

Section: Methodsmentioning

confidence: 99%

“…21,39,43 Failure of the fibularis longus to stabilize the first metatarsal may result in a dorsal translation or elevation of this structure, particularly during the later part of the stance phase of gait. Further, in static analysis investigations, an elevated first metatarsal has been shown to result in a significant decrease in hallux or first metatarsophalangeal (MTP) joint dorsiflexion 22,44 ( Figure 1). Restrictions of first MTP joint dorsiflexion may lead to abnormal compression of the dorsal surfaces of the metatarsal and proximal phalanx, resulting in proliferative and degenerative changes of the articular cartilage.…”

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confidence: 99%

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The Effect of Forefoot and Arch Posting Orthotic Designs on First Metatarsophalangeal Joint Kinematics During Gait

Nawoczenski¹,

Ludewig²

2004

J Orthop Sports Phys Ther

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Study Design: Repeated-measures analysis of variance. Objective: To examine the effect of 2 different orthotic posting designs on first metatarsophalangeal (first MTP) joint kinematics during gait. Background: Common orthotic designs used to control abnormal pronation incorporate the use of a medial post in the forefoot and/or rearfoot locations. Although this design may favorably alter rearfoot and lower-limb kinematics, the incorporation of a forefoot post has been theorized to negatively impact first MTP joint function by limiting hallux dorsiflexion during push off. An alternative design that has been proposed to be more favorable for function of the hallux and first metatarsal is the medial arch support. Methods and Measures: Eighteen subjects with a mean age of 28.2 years (SD, 8.3 years) completed the study. All subjects were judged to have excessive pronation based on a clinical orthopaedic examination. Two different pairs of orthoses were custom molded for each subject. One design incorporated an extrinsic rearfoot and forefoot post and the second design had a high medial longitudinal arch in combination with an extrinsic rearfoot post. The ''Flock of Birds'' electromagnetic tracking device was used to collect 3-dimensional position and orientation data of 3 body segments (hallux, first metatarsal, and calcaneus) during the stance phase of walking for 3 conditions (no orthosis and each of the 2 different orthotic designs). A repeated-measures analysis of variance was used to assess differences in first MTP joint dorsiflexion at midstance and during the push-off period of gait, as well as metatarsal declination angle changes during relaxed stance. An exploratory regression analysis was used to investigate factors that related to the change in peak dorsiflexion for the orthotic conditions. Results: Peak first MTP joint dorsiflexion averaged between 38°and 40°across all conditions. Although slight increases in first MTP joint dorsiflexion values were noted with both types of orthotic designs, these differences were not significant at either phase of the stance cycle (P = .50). The metatarsal declination angle in relaxed stance significantly increased (P = .001) under both orthotic conditions. Considerable individual variability was present. For the rearfoot-forefoot posted orthosis, a change in the declination angle of the first metatarsal during relaxed stance with the orthosis was a significant nonlinear predictor of change in peak dorsiflexion during push off. Deborah A. Nawoczenski, Professor, Ithaca College, University of Rochester Campus, 300 East River Road 1-102, Rochester, NY 14623. E-mail: dnawoczenski@ithaca.edu Conclusions: Foot orthoses that incorporate a medial forefoot post do not have a consistent negative effect of reducing first MTP joint dorsiflexion during walking.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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The Effect of Forefoot and Arch Posting Orthotic Designs on First Metatarsophalangeal Joint Kinematics During Gait

Nawoczenski¹,

Ludewig²

2004

J Orthop Sports Phys Ther

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“…Several of the included studies failed to clearly describe the distributions of principal confounders in each of the participant groups. The study by Zgonis et al 48 was the only one to adequately identify the population from which the study participants were derived; no studies adequately determined whether study participants were Description of Studies Included in the Review Horton et al (1999) Clinical and radiographic evidence of hallux limitus. Joint degeneration radiographically graded 1 to 3 in accordance to Hattrup representative of the source population from which they were recruited; no studies adjusted for confounding variables in their statistical analysis; and no studies specifically reported matching case and control participants for age and sex ( ).…”

mentioning

confidence: 99%