Plantar pressure distribution in older people with osteoarthritis of the first metatarsophalangeal joint (hallux limitus/rigidus)

The purpose of this study was to evaluate differences in dynamic plantar pressure distribution between older people with and without radiographically confirmed osteoarthritis (OA) of the first metatarsophalangeal joint (first MPJ) of the foot. Dynamic plantar pressure recordings using the TekScan MatScan® system were obtained during barefoot level walking in 40 older participants; 20 with radiographically confirmed OA of the first MPJ displaying less than 55 degrees of passive dorsiflexion, and 20 with no evidence of OA in the first MPJ displaying greater than 55 degrees of passive dorsiflexion. Group comparisons between the variables maximum force and peak pressure were made for seven different regions underneath the right foot (heel, midfoot, first MPJ, second MPJ, third to fifth MPJs, hallux, and lesser toes). Compared to the control group, participants with OA of the first MPJ exhibited 34% greater maximum force (7.9 ± 2.5 vs. 5.9 ± 1.7 kg, p = 0.005) and 23% higher peak pressure (1.6 ± 0.3 vs. 1.3 ± 0.3 kg/cm², p = 0.001) under the hallux. Similar results were also found under the lesser toes with 43% greater maximum force (5.0 ± 1.9 vs. 3.5 ± 1.4 kg; p = 0.006) and 29% higher peak pressure (0.9 ± 0.2 vs. 0.7 ± 0.2 kg/cm², p = 0.018). No significant differences were found to exist between groups for any other plantar region. These findings indicate that OA of the first MPJ is associated with significant changes in load‐bearing function of the foot, which may contribute to the development of secondary pathological changes associated with the condition, such as plantar callus formation and hyperextension of the hallux interphalangeal joint. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res     

Arthrodesis for degenerative disease of the hallux metatarsophalangeal and interphalangeal joints

Arthrodesis of the hallux metatarsophalangeal (MTP) or interphalangeal (IP) joint is a sound surgical solution to degenerative disease of these joints. Where conservative measures have failed, MTP or IP arthrodesis can alleviate pain and normalize gait. Preoperative planning should include evaluation of the skin, bone quality, and range of motion of the involved and adjacent joints. The technique of joint preparation described allows for easily individualized fusion position and maintenance of length. In patients with adequate bone stock, the fixation techniques described provide for compression and obviate the need for removal for most patients. Where bone stock is questionable, plate fixation can provide stability, improving results. With careful patient selection, preoperative planning, and conservative postoperative care, predictable results can be obtained with these techniques.     

Sesamoid disorders of the first metatarsophalangeal joint

The sesamoid complex is located centrally and plantar to the first metatarsal head, where they are imbedded within the plantar plate, which transmits 50% of body weight and more than 300% during push-off, is susceptible to numerous pathologies. These pathologies include sesamoiditis, stress fracture, avascular necrosis, osteochondral fractures, and chondromalacia, and are secondary to these large weight-bearing loads. This article discusses sesamoid conditions and their relationship with hallux limitus, and reviews the conditions that predispose the first metatarsophalangeal joint to osteoarthritic changes.     

Beware the hallucal interphalangeal joint sesamoid in first metatarsophalangeal joint arthrodesis

Background

We describe a previously unreported presentation of the hallucal interphalangeal joint sesamoid (HIPJS) following arthrodesis of the first metatarsophalangeal joint (MTP1).

选择性跖骨远端截骨治疗中重度(足母)外翻

[目的]探讨选择性跖骨远端截骨治疗(足母)外翻的手术适应证、手术方法及疗效.[方法]对2007年3月～2011年1月本院60例(101足)中度及重度(足母)外翻进行回顾性分析.双足41例,单足19例.其中女性57例,男性3例;年龄23～81岁,平均62.6岁.[结果]本组60例(101足)均获随访,随访时间6～48个月,平均22个月.参照美国足踝外科协会Maryland(足母)跖趾关节百分评分系统,90～ 100分40例(66足);80～89分16例(30足);70～79分4例(5足);优良率95％.术前HVA 30°～44°,平均36°;术后10.5°～21°,平均15.3°.IMA 13°～18°,平均16°;术后6°～10°,平均8.5°.第1跖趾关节活动度术前0°～30°,平均16°;术后为25°～50°,平均35°.第1跖骨长度较术前减少3 ～6 mm,平均4.2mm.[结论]本术式为软组织合并骨性手术,手术方法简单,创伤较小,跖骨头成形充分,术后不需要辅助内固定等优点,是一种值得推广的术式.     

Neglected dorsolateral dislocation of the first metatarsophalangeal joint: A case report

IntroductionAlthough the first metatarsophalangeal (MTP) joint is frequently injured, Complete dislocation of the first MTP joint represents a relatively rare traumatic injury.Presentation of caseA 46-year-old gentleman presented with a traumatic first MTP joint dislocation resulting from an automobile accident. Due to coronavirus outbreak in the hospital at that time, patient was referred to another hospital. Six months later, reduction was achieved surgically and fixation of the MTP with K-wires was done.DiscussionOnly few case reports have described the injury, and the ideal treatment along with the long-term result of the injury has yet to be further studied because reports are rare in this regard.ConclusionFunctional range of motion may result even after 6 months of delayed treatment with ORIF and osteopenia may result.     

Etiology, pathophysiology, and staging of hallux rigidus

The condition of hallux limitus is well understood and agreed on as visualized histologically and radiographically. But the historically described pathophysiology and anatomy that predisposes to hallux limitus has been challenged. Numerous investigators have proposed anatomic abnormalities of the foot as a primary cause of this condition, but perhaps trauma is the only unanimously agreed on cause. However, this accounts for only a small percentage of cases. To strive for better treatment outcomes, understanding the pathophysiology, assessing patient risk factors, and recognizing causative agents can better equip the foot and ankle surgeon in managing this condition.     

Arthrodesis of the first metatarsophalangeal joint: The “when and how”

Arthrodesis of the first metatarsophalangeal (MTP) joint has been established as the “gold standard” for the treatment of several first ray disorders, due to its perceived efficacy and the consistently reported good results in the literature. Arthrodesis is a commonly performed procedure for the treatment of end stage arthritis, rheumatoid arthritis with severe deformity, selected cases of severe hallux valgus (with or without signs of degenerative joint disease), as well as a salvage procedure after failed previous operation of the first ray. The goals of a successful 1^st MTP arthrodesis are pain alleviation and deformity correction in order to restore a comfortable gait pattern and to improve shoe wear. Several techniques have been reported with several proposals regarding the preparation of the articular surfaces and the method of definitive fixation. As with any given surgical procedure, various complications may occur after arthrodesis of the 1^st MTP joint, namely delayed union, nonunion, malunion, irritating hardware, etc.      

A Retrospective Analysis of Joint Salvage Procedures for Grades III and IV Hallux Rigidus

The purpose of this study was to evaluate the outcome of the use of a decompression osteotomy for the treatment of end-stage hallux rigidus. We conducted a retrospective analysis of 28 feet (23 patients) with grades III and IV hallux rigidus that underwent a first metatarsal head decompression osteotomy with preservation of the articular surfaces of the first metatarsophalangeal joint. We also devised a 9-item questionnaire to explore the patients' perceptions of preoperative and postoperative pain, limitations of activity, influence on shoe wear, and the total range of motion of the first metatarsophalangeal joint. Furthermore, we used a modified version of the AOFAS forefoot scoring system to compare the patients' foot-related health status in relative to the operative repair of hallux rigidus. Comparisons of the pre- and postoperative results revealed statistically significant improvements in pain (P< .001), functional limitation (P< .001), shoe restrictions (P= .0072), total range of motion (P= .0449), and the AOFAS forefoot score (P< .001). Overall patient satisfaction with the results of the surgery was more than 85%, and the patients' chief complaint was alleviated in more than 75% of the participants. The results of this investigation demonstrated that a decompression first metatarsal osteotomy is an acceptable alternative to joint destructive procedures for the treatment of end-stage hallux rigidus. LEVEL OF CLINICAL EVIDENCE: 4.     

Arthroscopic accessibility of the first metatarsophalangeal joint for osteochondral defects of the metatarsal head by two-portal technique - comparing joint distraction and plantarflexion

BackgroundSeveral techniques and approaches for first metatarsophalangeal (MTP1) joint arthroscopy have been reported, where joint accessibility plays a key role. This study aimed to evaluate differences in arthroscopic accessibility of the first metatarsal head (MTH1) comparing non-invasive distraction and maximum plantarflexion in a two-portal approach.MethodsForty fresh-frozen lower leg specimens were included and divided into a distraction group (D-group) and a plantarflexion group (PF-group). A two-portal technique (1.9 mm-30°-scope) was used for arthroscopy, maximum reach at the MTH1 was marked. Following arthroscopy, specimens were dissected and examined for iatrogenic injuries. The reached area at the chondral surface was pinned and accessibility calculated.ResultsAccessibility of the MTH1 was 58.03 % ± 13.64 (D-group) and 55.93 % ± 10.30 (PF-group, p = 0.51). The dorsomedial hallucal nerve was injured in one specimen (2.5 %).ConclusionMaximum plantarflexion showed no difference in arthroscopic MTP1 joint accessibility compared to non-invasive distraction in a two-portal approach. During dorsomedial portal placement, the dorsomedial hallucal nerve is at risk for iatrogenic injury.     

The first metatarsophalangeal joint meniscus and its relation to hallux valgus deformity—An anatomical and clinical study

Background

This study describes the anatomy and incidence of the metatarsophalangeal (MTP) joint meniscus, a structure not mentioned before in literature.

Methods

An anatomical cadaver study on 102 feet was performed with special attention to the first MTP joint anatomy. These results were compared with the per-operative findings in a clinical prospective study on 100 consecutive hallux valgus surgeries.

Results

On cadavers this meniscus is more common in patients with hallux valgus. Clinically, in patients with a mild hallux valgus the meniscus is found in more than half of cases during surgery, while it is seldom found in patients with moderate or severe deformities.

Conclusions

The presence of this structure seems to stabilize the MTP joint preventing progression of the hallux valgus deformity and may explain the pain, which is often seen in mild bunions in younger, patients. Once the rotational deformity increases the meniscus tears and slips into the joint. In the more advanced hallux valgus deformity this meniscus plays little function and seems to disappear, leading to arthrosis.     

Prosthetic replacement arthroplasty as a salvage operation for failed procedures of the first metatarsophalangeal joint: A small series and literature review

BackgroundA number of complications have been associated with Keller resection arthroplasty and arthrodesis of the first metatarsophalangeal joint for hallux rigidus. Salvage may be by arthrodesis (conversion to or revision). However, the optimal alignment is technically difficult to achieve and even if the fusion is successful, the procedure may still result in transfer metatarsalgia.ObjectiveTo assess the viability of prosthetic replacement arthroplasty as a salvage procedure for the first metatarsophalangeal joint.MethodsFour patients were identified who had undergone prosthetic replacement arthroplasty (one titanium hemiarthroplasty and three Moje prostheses) as a salvage procedure for failed surgery to the first metatarsophalangeal joint. Mean follow-up was 29.3 months (range 15–46). Patients were assessed with the American Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal–Interphalangeal Score, subjective patient satisfaction and current radiographs.ResultsAll patients who had a Moje press-fit ceramic arthroplasty reported subjective improvement of pain and function and achieved arcs of movement of between 20° and 50°. Mean AOFAS score was 63 (range 57–73). Radiographs revealed lucency around the prostheses in some patients.ConclusionsWe feel that the Moje arthroplasty as a salvage procedure is a viable alternative to that of arthrodesis, especially if preservation of movement is desired.     

Arthritis of the first metatarsophalangeal joint is not always gout: A prospective cohort study in primary care patients

ObjectivesArthritis of the first metatarsophalangeal joint has been considered pathognomonic for gout, but it is unknown how frequently other forms of arthritis occur in this joint. The aims were to determine the validity of the general practitioner's clinical diagnosis using joint fluid analysis as the reference test, the prevalence of other diagnoses than gout, and the signs and symptoms that discriminate between gout and non-gout patients.MethodsThis prospective cohort study comprised primary care patients with monoarthritis of the first metatarsophalangeal joint. After patient recruitment by general practitioners, patients’ characteristics were collected by a rheumatologist. Joint fluid was analyzed for the presence of monosodium urate-crystals. If crystals were absent, patients entered a follow-up period of 6 years, or until a definite diagnosis. If during follow-up crystals were identified, the patient was classified as already having gout at baseline assessment.ResultsOne hundred and fifty-nine primary care patients were included. At baseline the clinical diagnosis was gout in 98%. The positive and negative predictive values of the diagnosis of gout were 0.79 and 0.75, respectively. After follow-up 77% had gout, 8% had another rheumatic disease, and 15% had a transient unspecified monoarthritis. Gout patients had discriminating signs and symptoms from non-gout patients.ConclusionsGout is an important but certainly not an exclusive cause of arthritis of the first metatarsophalangeal joint.     

参与第1跖趾关节的籽骨软骨软化症

目的　探讨籽骨软骨软化症的病因、病理。方法　对经病理学明确诊断的４ 例籽骨退行性改变患者进行回顾性分析, 结合足部解剖及生物力学特点探讨病因及病理。结果　４ 例均因长期穿尖头高跟鞋,产生强制性拇外翻及跖趾关节过度背伸,这种不正常的力学载荷最终导致籽骨软骨软化。结论　籽骨软骨软化症主要病因可能来源于两种效应即“弓弦效应”和“高弓效应”。     

Minimally invasive arthrodesis of the first metatarsophalangeal joint: A systematic literature review

AimCurrently, cohort studies reported the use of minimally invasive arthrodesis of the first metatarsophalangeal joint (MTP I). The aim of this systematic literature review was to analyse clinical, radiological outcome and complications with this technique.MethodsA systemic literature search of the databases Google Scholar, PubMed, Scopus, EMBASE and Cochrane to identify studies reporting on clinical, radiological outcome or complications of minimally invasive MTP I arthrodesis was conducted.ResultsA total of 6 studies (1 Level V, 5 Level IV) reporting on 109 minimally invasive MTP arthrodesis in 105 patients were included. Validated scores were reported in 103 cases. Clinical outcome improved in 57 cases from a mean of 36.9 to 82.6 points American Orthopedic Foot and Ankle Score (AOFAS) and in 46 cases from 38.7 to 18.4 points Manchester Oxford Foot Questionnaire (MOXFQ). Radiological fusion rate was 87% (n = 94 out of 109) achieved after 6–12 weeks.Overall complication rate was 11.9% (13 cases) leading to revision surgeries in 5.5% (6 cases). Most common complications Most common complications were symptomatic non-union (n = 6, 5.5%), asymptomatic non-union (n = 2, 1.8%) and subsequent interphalangeal joint arthritis (n = 2, 1.8%).ConclusionMinimally invasive MTP I arthrodesis is a promising technique with comparable clinical, radiological outcome and complication rates to open surgery in hallux rigidus and rigido-valgus. Future studies are needed providing higher level of evidence to prove the potential benefit of minimally invasive compared to open MTP I arthrodesis.     

Nonimplant Arthroplasty for the Treatment of End-Stage Hallux Rigidus

Surgical management of end-stage hallux rigidus involves joint-sparing techniques, including cheilectomy and decompression osteotomies, and joint-destructive procedures, including arthroplasty (resection, interpositional, implant, Valenti) and arthrodesis. Joint-destructive procedures have traditionally been reserved for the end stages of hallux rigidus involving grade 3 and 4. We present a modification of the previously reported Valenti arthroplasty with short-term patient outcomes. We performed a retrospective review of the medical records of 96 patients who had undergone the nonimplant arthroplasty procedure for treatment of end-stage hallux rigidus with a minimum follow-up period of 6 months. The preoperative and postoperative dorsiflexion of the first metatarsophalangeal joints and visual analog scale (VAS) scores were compared. Of the 96 medical records, 27 (28%) met the inclusion criteria. The mean patient age was 60.2 (range 48 to 73) years, and the mean follow-up period was 12 (range 6 to 23) months. The mean preoperative range of motion for first metatarsophalangeal joint dorsiflexion was 4.69° (range ?3° to 10°), and the mean postoperative dorsiflexion was 48.23° (range 30° to 65°), with a mean difference of 43.54° (range 25° to 60°). The preoperative VAS score averaged 6.46° (range 4° to 10°), and the postoperative VAS score averaged 0.69° (range 0° to 3°). Nonimplant arthroplasty was found to increase first metatarsophalangeal joint dorsiflexion and significantly decrease patient pain. Thus, it is a viable option for the treatment of end-stage hallux rigidus.