Orthotic effect on metatarsophalangeal joint extension. A preliminary study

Effect by custom-made foot orthoses with added support under the first metatarso-phalangeal joint in hallux limitus patients: Improving on first metatarso-phalangeal joint extension

BACKGROUND

Hallux limitus is one of the most common disorders affecting foot biomechanics. Custom-made foot orthoses can improve the function of the first metatarso-phalangeal joint.

OBJECTIVES

The objective underlying this study was to test whether custom-made foot orthoses increased the range of mobility of metatarso-phalangeal joint in patients with hallux limitus.

STUDY DESIGN

Randomized, double-blinded, and clinical trial.

METHODS

The study consisted of 20 participants (40 feet) diagnosed with hallux limitus. A control group and an experimental group both wore the same custom-made foot orthoses and, in the experimental group, a support element under the first metatarso-phalangeal joint was added to the orthoses. Two measurements were made with both groups: the relaxed position of the first metatarso-phalangeal joint and the maximum extension of the hallux. These measurements were made before first placing the foot orthoses and 6 months after application of the treatment.

RESULTS

In the experimental group, the results showed an improvement of 4.5° in the relaxed position and 22.2° in the maximum extension being statistically significant (p < 0.001) for both measurements.

CONCLUSION

Custom-made foot orthoses with added support under the first metatarso-phalangeal joint were proved to be an effective treatment to restore functionality of this joint in hallux limitus patients.

CLINICAL RELEVANCE

Limitation of hallux movement in the joints propulsive phase of gait negatively affects the biomechanics of the lower extremity, causing changes in the rest of the joins. The use of foot orthoses designed in this study restores range of motion of the first metatarso-phalangeal joint.

Joint-preserving procedure for moderate hallux rigidus

Hallux rigidus is a complex disorder, and numerous surgical procedures have been described for its management. Although the optimal technique has yet to be defined, it is important to individualize the degree of arthritis as well as other clinical features (metatarsal index, pain characteristics, and so forth) of each patient to achieve optimal results. The authors firmly believe that for patients with only dorsal pain, a cheilectomy is the ideal choice because good and reliable results can be achieved. When pain is also present around the joint or is combined, which is the most common scenario, their main choice now is to perform a decompressive osteotomy. The biomechanics of the joint are more adequately restored, soft tissues are relaxed, and remodeling of the contracted tissues is allowed. More investigation has still to be performed to elucidate the origin of this abnormality.

The relationship between hallux dorsiflexion and ankle joint complex frontal plane kinematics: a preliminary study

BACKGROUND

It has been suggested that the function of the first metatarsophalangeal joint may be related to the motion of the ankle joint complex.

OBJECTIVE

This study explored the relationship between ankle joint complex and first metatarsophalangeal joint motion during gait in a group of 14 who demonstrated clinically limited passive hallux dorsiflexion in quiet standing (cases), and 15 matched controls.

METHOD

An electromagnetic tracking system was used to measure the ankle joint complex frontal plane motion and first metatarsophalangeal joint sagittal plane motion during gait, in both cases and controls. The case group was then evaluated further to investigate the effect of an orthosis on first metatarsophalangeal joint motion.

FINDINGS

The correlation between maximum ankle joint complex eversion and maximum first metatarsophalangeal joint dorsiflexion during gait was r=0.471. Within the case group, maximum rearfoot eversion was reduced following the application of the orthoses, but there was no change in sagittal first metatarsophalangeal joint rotations.

INTERPRETATION

The relationship between maximum ankle joint complex eversion and first metatarsophalangeal joint dorsiflexion kinematics found in this study was moderate, and decreasing maximum ankle joint complex eversion with an orthosis did not result in any increase in first metatarsophalangeal joint dorsiflexion during gait in patients with functional first metatarsophalangeal joint limitation. These results do not support the assumption that ankle joint complex eversion influences first metatarsophalangeal joint motion substantially.

Distal oblique osteotomy of the first metatarsal for the correction of hallux limitus and rigidus deformity

The purpose of this study was to evaluate the effectiveness of the distal oblique osteotomy of the first metatarsal (a triplanar shortening decompression osteotomy) to correct stage I and II hallux rigidus. The osteotomy cut is performed from dorsal-distal to plantar-proximal with an angle ranging from 35 degrees to 45 degrees in the sagittal plane. The capital fragment is then displaced plantarly and proximally and fixed with two screws and the metatarsal head is remodeled. From January 1993 through December 1995, a total of 26 patients (21 females and 5 males) underwent 30 distal oblique osteotomies of the first metatarsal (22 unilateral and 4 bilateral). The mean age of the patients was 54 years and the mean follow-up was 21 months. Patient satisfaction and objective clinical and radiographic measurements were evaluated. Patients' satisfaction was measured postoperatively with a modification of the University of Maryland 100-Point Painful Foot Center Scoring System. The results were: 84% good to excellent; 7% fair; and 9% poor. Radiographic measurements included: intermetatarsal angle mean: preop = 12.2 degrees, postop = 8.6 degrees; proximal articular set angle mean: preop = 11.8 degrees; postop = 10.3 degrees. There was no evidence of avascular necrosis in any of the cases. Clinical findings were: dorsiflexion of the first metatarsophalangeal joint: preop = 22 degrees, postop = 45 degrees; plantarflexion of the first metatarsophalangeal joint: preop = 15 degrees, postop = 18 degrees; hallux purchase power: preop = 2.5, postop = 2.3; pain on the second and third metatarsophalangeal joints, associated with excessive pressure on the central metatarsal heads: preop--present in 10 patients, postop--present in 12 patients; forefoot supination angle: preop = 13 degrees, postop = 7 degrees.