Evaluation of Gait Parameters on Subjects with Hallux Limitus Using an Optogait Sensor System: A Case-Control Study.

Background and Objetives: The foot is a part of the body's kinetic chain and needs to be efficient during the entire gait cycle. Electronic Sensor Gait analysis is useful and an important tool within the area of podiatry to assess the physical state of patients that helps the comprehensive intervention in situations where the daily activity is limited. The aim of this research is to evaluate if the presence of a hallux limitus (HL) can alter gait space-time parameters and consequently can affect the take-off phase of the gait and the limitation of the range of motion (ROM) of the hallux. Materials and Methods: A case-control study was designed to verify whether there are alterations in the spatiotemporal parameters of the gait cycle between subjects with structural HL compared to the group of subjects with a normal hallux range. A total of n = 138 participants, cases (68 HL subjects) and healthy controls (70 subjects) were studied using an OptoGait LED sensor system to identify gait imbalances using OptoGait photocell gait analysis sensors. Results: Significant differences were found between the two groups with respect to stride length, gait cycle duration in seconds (for both feet) and for total stride and load response (p < 0.05). Conclusions: The limitation of the Hallux ROM may alter the normal gait patterns measured with an Optogait system. The early identification and treatment of gait disturbances due to HL are important to achieve normal gait physical activity to maintain a healthy lifestyle.

Osteochondral Allograft Transplant for Degenerative Joint Disease of the First Metatarsophalangeal Joint: A Case Report.

The first metatarsophalangeal joint is the most common location for arthritis in the foot. Pain and limited mobility associated with arthritis of the first metatarsophalangeal joint are the hallmarks of this disease. Treatments include shoe modification, orthotic devices, nonsteroidal anti-inflammatory drugs, injections, physical therapy, and surgery. Surgery has been the most perplexing, with surgical treatments ranging from simple ostectomies to fusion of the first metatarsophalangeal joint. Implant arthroplasty, with its various designs and techniques, has yet to be proven as the definitive solution for first metatarsophalangeal joint arthritis or hallux limitus (unlike the knee and hip). Interpositional arthroplasty and tissue-engineered cartilage grafts also have limitations when dealing with osteoarthritis and hallux limitus of the first metatarsophalangeal joint. In this case report, we present a 45-year-old woman with arthritis of the left first metatarsophalangeal joint who underwent surgical intervention by means of a frozen osteochondral allograft transplant to the first metatarsal head.

Cheilectomy With Decompression Osteotomy for Treatment of Hallux Limitus and Rigidus: A Retrospective Study With 5-Year Outcomes.

We examined outcomes following metatarsophalangeal joint cheilectomy with decompression osteotomy to evaluate the efficacy of this technique for treatment of hallux limitus/rigidus. At a minimum follow-up of 5 years, we identified 94 patients who fit the inclusion criteria. Chart review was performed to obtain range of motion (ROM) of the first metatarsophalangeal joint (MTPJ) preoperatively and at 6 weeks, 6 months, and 5 years postoperatively. Additionally, time to traditional shoe gear return, need for revision arthrodesis, radiographic findings, and postoperative visual analog scale (VAS) pain scores were reviewed. Statistical analysis was conducted by 1-way analysis of variance with post-hoc analysis and independent sample t-test. At an average follow-up of 6.3 ± 0.9 years, 42.3% (33/78) of females and 25.0% (4/16) of males reported limited ROM of the first MTPJ with 5 patients requiring first MTPJ arthrodesis. MTPJ ROM improved on average from 11.0° to 36.3° by 5-year minimum follow-up after surgery (p < .001). Analysis of variance revealed a significant difference of the preoperative ROM when compared to all postoperative time points (F[3,368] = 69.4, p < .001). Mean postoperative VAS pain scores after decompression osteotomy of the 5 patients who required MTPJ fusion were higher when compared to the rest of the patient cohort at final follow-up (7.4 ± 0.6 vs 1.5 ± 1.3; p < .001). Cheilectomy with decompression osteotomy for treatment of hallux limitus/rigidus leads to satisfactory long-term outcomes.

The Cotton Osteotomy as an Adjunct Procedure in Hallux Valgus and Hallux Limitus Surgery.

The Cotton osteotomy, as described in 1936 by Frederic Cotton, consisted of a medial cuneiform opening base wedge osteotomy. This Cotton osteotomy served to restore the "triangle of support" of the foot. In his address to the New England Surgical Society, he described this osteotomy as being multipurpose; it can be used for plantarflexion in hallux valgus surgery and has use in hallux rigidus conditions. Since its inception, the procedure has become a popular adjunct to aid in the restoration of the medial column deformity present in pes planus. Recently, there has been renewed interest in the use of the procedure to aid in the correction of deformities involving metatarsus primus elevatus, specifically, hallux valgus and hallux limitus. The advantage of the use of this procedure as opposed to others is that it allows for the preservation and/or restoration of first ray length and the preservation of motion at the medial column. In retrospective review, the authors evaluated seven cases with a 1-year follow-up. In this series of cases, the Cotton osteotomy was performed as an adjunct to common hallux valgus procedures or hallux limitus corrections. Radiographic review was also performed evaluating for initial evidence of radiographic bone-graft healing and patient weightbearing. Although not without its own limitations, the Cotton osteotomy offers several advantages with minimal complications, proving to be a valuable underused resource in the foot and ankle surgeon's toolkit.

Diagnosis, imaging, and potential morbidities of the hallux interphalangeal joint os interphalangeus.

Hallux pain is a common entity with a differential diagnoses including hallux valgus, hallux limitus/rigidus, and gout and specifically at the interphalangeal joint (IPJ), flexor hallucis longus (FHL) tenosynovitis, and joint arthrosis. An under-recognized source of pain is the os interphalangeus, an ossicle typically located at the plantar aspect of the hallucal interphalangeal joint. This ossicle is radiographically visible in its ossified form in 2-13% of individuals, but can also be present as an ossified or non-ossified nodule in patients. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone in the FHL tendon, it is an ossicle located in the joint capsule of the IPJ and separated from the tendon by a bursa. When the ossicle is absent, the bursa is also absent and the tendon is attached to the joint capsule. Infrequently, the os may be located eccentrically under the first IPJ and reflect persistence of one of the distal phalanx. Rarely, the os interphalangeus may be dorsal to the IPJ. The os interphalangeus is best evaluated on radiographs, ultrasound, and MRI. Pain is a result of altered mechanics with arthrosis or frictional effects with bursitis, tenosynovitis, or intractable plantar keratosis (IPK). The ossicle may also displace into a dislocated IPJ, preventing reduction. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone. This has been found within the plantar joint capsule of the distal hallucal interphalangeal joint and separated from the tendon by a bursa. Uncommonly, the location may be plantar eccentric and reflect persistence of one of the ossification centers of the distal phalanx. Although the ossicle can be imaged with standard AP and lateral radiographs in many cases, in those cases of unexplained pain with no radiographically visible ossicle, and the presence of friction blisters, intractable plantar keratosis (IPK), hyper-extension of the IPJ, hallux limitus/rigidus, or metatarsophalangeal joint (MTPJ) arthrodesis, an MRI or CT should be considered to identify a non-ossified fibrocartilaginous node. This is of particular concern in a patient with a history of underling diabetes mellitus or other metabolic disorders associated with diminished pedal sensation where neurotrophic changes place them most at risk for complications associated with excessive plantar pressure. Pain is a result of altered biomechanics with arthrosis, or frictional effects causing bursitis, tenosynovitis, or IPK. The ossicle may also displace into a dislocated IPJ, preventing reduction. In this article, we will describe the anatomy and imaging appearance of the common os interphalangeus variants and associated complications including frictional effects, arthrosis, and IPK and discuss conservative and surgical management of a symptomatic ossicle.

[Distal osteotomy of the first metatarsal bone with plantarization for the treatment of hallux limitus due to metatarsus primus elevatus]. / Distale plantarisierende Osteotomie des Os metatarsale I zur Behandlung des Hallux limitus bei Metatarsus primus elevatus.

OBJECTIVE: Joint-preserving procedure with plantarization of the 1st metatarsal and improvement of range of motion. INDICATIONS: Mild and moderate arthrosis of the 1st metatarsophalangeal joint with pain and shoe discomfort due to elevation of 1st ray and failed conservative treatment. CONTRAINDICATIONS: Severe degenerative conditions 1st metatarsophalangeal joint with significant loss of range of motion preoperatively. General contraindications for surgical treatment/anesthesia. SURGICAL TECHNIQUE: Dorsomedial approach to 1st metatarsophalangeal joint, mild cheilectomy and arthrolysis, v­shaped osteotomy of metatarsal 1 from dorsal with plantarization of the metatarsal head, screw fixation from proximal dorsal to distal plantar. POSTOPERATIVE MANAGEMENT: Full weightbearing in rocker bottom shoe for 6 weeks. RESULTS: Improvement of range of motion from 35° dorsal extension to 50° in all cases after 6 months. Reduction of painful movement from VAS 6-7 to VAS 2-3 in 80% of patients.

Osteochondral Fresh Allograft Transfer to Address Osteochondral Defect of the First Metatarsal Head in Early Hallux Limitus.

Osteochondral fresh allograft transfer of the first metatarsal can be an accepted surgical management option for early stages of hallux limitus. This study consisted of evaluating clinical outcomes with patients who underwent this procedure. Thirteen (N=13) patients were included in this study, 10 (76.9%) were female and 3 (23.1%) were male. The mean age was 52.2 (range, 27-61) years and the mean body mass index was 25.3 (range, 33.8-19.4) kg/m2. Intraoperative evaluation of osteochondral defects of the first metatarsal demonstrated a mean diameter size of 8.2 mm. Ten (76.9%) patients had a concomitant cheilectomy procedure performed. The mean follow-up was 41.0 (range, 3.5-89.1) months. American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire and patient satisfaction survey were completed. The mean AOFAS Hallux Metatarsophalangeal-Interphalangeal score, which was determined postoperatively, was 71.2 (range, 55-85) of 100. Four (30.8%) patients with overall scores below 60 (range, 55-59) reported moderate daily pain at the first metatarsophalangeal joint. Mean AOFAS pain score was 26.9 (range, 20-30) of 40. Mean AOFAS function score was 30.8 (range, 24-35) of 45. Mean AOFAS alignment score was 13.4 (range, 8-15) of 15. There was statistical significance in mean AOFAS total score when comparing hallux limitus grade 1 versus grade 2, as well as when comparing grade 1 versus grade 3, p < .05. There was no significance in mean AOFAS total score when comparing number of plugs used, body mass index, and size of defect. However, an overall improvement in preoperative symptoms and patient satisfaction was documented and therefore osteochondral fresh allograft transfer can be considered a reasonable option in treating defects found at the first metatarsal head.

Nonoperative Management of Hallux Limitus Using a Novel Forefoot Orthosis.

Hallux limitus is among the most common arthritides of the foot and ankle, with increasing incidence in the aging population. Despite its prevalence and disease burden, treatment of the condition remains poorly understood. Many patients will fail initial conservative management, whereas controversy exists surrounding indications for and outcomes of surgery. The present study sought to examine the impact of a novel forefoot orthosis on foot function, pain, and plantar pressure distributions in patients with symptomatic hallux limitus. Nineteen adult patients completed a questionnaire consisting of the 23-item Foot Function Index and a 10-point visual analogue scale measuring pain. Standing pedobarographic maps were generated using a foot scanning system. Participants were instructed to wear the orthosis in athletic shoes for 4 weeks. Eighteen participants (94.7%) experienced improvements in foot function and pain, with 12 (63.2%) reporting complete resolution of pain at the end of the 4-week trial. Mean Foot Function Index scores improved significantly from 43.0% at baseline to 11.0% with the orthosis (p < .001). Similarly, mean visual analogue scale pain scores decreased significantly from 4.87 to 1.18 (p < .001). Pedobarographic analysis while wearing the orthosis demonstrated increased ability of participants to bear weight on the arthritic hallux metatarsophalangeal joint and restoration of physiologic stance. Compared to existing products, the device was well tolerated and did not require footwear modifications or impede normal gait. Overall, the orthosis offers an appealing solution to patients dissatisfied with existing treatment options as well as those who may be averse to or ineligible for surgery.

Reliability Study of Diagnostic Tests for Functional Hallux Limitus.

BACKGROUND: Functional hallux limitus (FHL) refers to dorsiflexion hallux mobility limitation when the first metatarsal head is under loading conditions but not in the unloaded state. The goal of the study was to evaluate 3 common manual tests (Buell, Dananberg, and Jack tests) for assessing first metatarsophalangeal joint (MPJ) mobility and determining the normal values needed to detect FHL, and clarify the signs and symptoms associated with this pathology. METHODS: Forty-four subjects were included in this reliability study. Subjects were divided into healthy control (non-FHL) and FHL groups according to the Buell first MPJ limitation values in addition to signs and symptoms derived from the literature. In both groups, we measured the mobility in the Buell, Dananberg, and Jack tests using a goniometer; their intraclass correlation coefficients (ICCs), sensitivities, and specificity indexes were also calculated. RESULTS: All techniques showed high reliability across measurement trials with ICCs ranging from 0.928 to 0.999. The optimal mobility grades for predicting FHL were 68.6 ± 3.7 degrees, 21 ± 5.9 degrees, and 25.5 ± 6.5 degrees (mean±SD) (P < .05) for the Buell, Dananberg, and Jack tests, respectively. CONCLUSION: Normal and limited mobility values were established for assessing FHL using each technique. The sensitivity and specificity data were perfect for the Dananberg and Jack tests, thus identifying these tests as specific and valid tools for use in FHL diagnosis. Pinch callus was the sign most associated with FHL. LEVEL OF EVIDENCE: Level II, comparative series.

The Role of Plantar Fascia Tightness in Hallux Limitus: A Biomechanical Analysis.

Restriction of greater toe dorsiflexion without degeneration of the first metatarsophalangeal joint is defined as hallux limitus. We assume that in hallux limitus the limitation of greater toe dorsiflexion takes place in the terminal stance phase because of massive tightening of the calf and plantar structures. The current study investigated the role of a tight plantar fascial structure in impairing dorsiflexion of the greater toe. For the purpose of the study, 7 lower limbs from Thiel-fixated human cadavers were evaluated. To simulate double-limb standing stance, the tibia and fibula were mounted on a materials testing machine and constantly loaded with 350N. Additionally, the tendons of the specimens were loaded using a custom-made system. The plantar fascia was fixed to a clamp and tensioned using a threaded bar. Four different tensile forces were then applied to the plantar fascia (approximately 100, 200, 300, and 350 N) and the extension of the first toe was measured. The results show a significant positive correlation between the decrease in extension of the hallux and the tension applied to the plantar fascia reaching a maximum mean decrease of 4.2° (117% compared with the untightened situation) for an applied tension of 364N.

Modified Valenti Arthroplasty in Running and Jumping Athletes With Hallux Limitus/Rigidus: Analysis of One Hundred Procedures.

Despite hallux limitus/rigidus being a common condition, results of surgical procedures specifically pertaining to athletes are scarce. The results of 100 modified Valenti procedures, prospectively studied from January 2000 to June 2016 with an average 49.17 months of follow-up, are presented evaluating demographics, sport, time and ability to return to activity (RTA), decreased desired activity level, and need for additional surgery. Inclusion criteria included athletes who have exhausted conservative care without relief of daily pain, dorsiflexion <20°, and grade ≥2. Seventeen had grade 2, 79 had grade 3, and 4 had grade 4 disease. RTA for the 89 procedures where exact time could be determined was 9.25 weeks; however, 100% were confirmed to RTA to some degree. The RTA of dancers and runners (the largest portion of the cohort at 76) was around 8 weeks, whereas soccer players were the slowest at >16 weeks, which was significant. There was no other significant difference in RTA between sport, sex, or grade of hallux limitus/rigidus except for between runners and soccer players. Six patients (6%) stated a decreased desire to activity, although this was not a significant finding. The modified Valenti procedure is a safe and highly effective treatment for running and jumping athletes limited by hallux limitus/rigidus because 94% of patients were able to return to their desired level of activity.

Metatarsus Primus Elevatus Resolution After First Metatarsophalangeal Joint Arthroplasty.

BACKGROUND: Hallux limitus (HL) is the second-most common pathology associated with the first metatarsophalangeal joint. A common etiology believed to be associated with HL is metatarsus primus elevatus (MPE), although causation has been unsubstantiated by evidence. Historically, correction of MPE is surgically addressed with an osteotomy. However, some believe MPE is a secondary manifestation of HL due to retrograde pressure and lack of dorsiflexion at the first metatarsophalangeal joint. This study sought to determine whether MPE resolves spontaneously after first metatarsophalangeal joint arthroplasty and reinstitution of normal joint dorsiflexion. METHODS: Twenty-seven weightbearing lateral radiographs from patients with HL were reviewed before and after nonimplant first metatarsophalangeal joint arthroplasty. Radiographs were taken preoperatively and at postoperative visits 1 (mean, 2 weeks) and 2 (mean, 10 weeks). Measurements included first to second metatarsal elevation, Seiberg Index, first to fifth metatarsal distance, sagittal plane first to second metatarsal angle, Meary's angle, metatarsal declination angle, and hallux equinus angle. RESULTS: Statistically significant improvement was seen at both postoperative visits in all of the previously mentioned measurements except first to fifth metatarsal distance, which was reduced but was not statistically significant. CONCLUSIONS: Metatarsus primus elevatus was reduced significantly after first metatarsophalangeal joint arthroplasty. Resolution occurred rapidly and was maintained at the final postoperative visit. This could be due to MPE being a manifestation of HL and not a cause. Based on the results of this study, osteotomies may be unnecessary to surgically address MPE because it can spontaneously correct after reinstitution of first metatarsophalangeal joint motion.

Complications Following Allograft and Xenograft Resurfacing of the First Metatarsal Head: A Case Series.

Ten cases using decellularized allografts and xenografts for the purpose of resurfacing the first metatarsal head are reviewed in this article. Although most of the cases were performed without any postoperative complications, the focus of this series is on 2 of the 3 cases in which destruction of the first metatarsal head was observed postoperatively due to a foreign body reaction and severe degeneration within the metatarsal head. A salvage procedure using a silicone total joint to replace the damaged surface is shown. The role of cystic changes present preoperatively, and its role in subsequent failure is examined.

A new surgical procedure for hallux limitus treatment: Double-V osteotomy on the base of the proximal phalanx of the hallux.

The purpose of this study was to evaluate the effectiveness of the new Double-V osteotomy of the first metatarsophalangeal joint (1MPJ) in patients with hallux limitus (HL).A study of 66 patients was performed, 33 patients were treated Cheilectomy and 33 were treated Double-V. All patients underwent an assessment of the passive mobility of the 1MPJ before the procedure, reevaluated 12 months later evaluating dorsiflexion, plantarflexion, and patients status using both the American Orthopaedic Foot and Ankle Society (AOFAS) for Hallux Metatarsophalangeal-Interphalangeal Scale.In comparing the improvement achieved regarding the increase of mobility obtained with surgical treatment, the feet operated with procedure Double-V gained significant degrees of movement increased in all analyzed parameters (P < .05). We achieved 13.33° more than average in dorsiflexion motion and 2.12° more than average in plantarflexion with regard to the feet that were operated with Cheilectomy procedure. Double-V scores on the AOFAS scale improved significantly (P = .000) 91.48 points postoperative, while with the following Cheilectomy only 79.30 points.This new surgical technique, easy to perform and with low complexity in surgical execution and a minimum of complications, produces better clinical and functional results that Cheilectomy alone.

Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus A Case-Control Pilot Study.

BACKGROUND: Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. METHODS: Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. RESULTS: Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ(2) tests: P > .05). CONCLUSIONS: No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

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.

Clinical improvement in functional hallux limitus using a cut-out orthosis.

BACKGROUND: Functional hallux limitus (FHL) has been implicated in the development of metatarsophalangeal joint osteoarthritis. OBJECTIVES: To determine whether cut-out orthosis treatment increases plantarflexion of the first metatarsal by increasing its declination angle. STUDY DESIGN: Cross-sectional study. METHODS: A total of 46 female volunteers with an average age of 25.66 ± 5.70 years (range: 19-42 years) and FHL participated in the study. We assessed the degrees of movement of the first metatarsal and proximal phalanx bones at the first metatarsophalangeal joint without and while wearing the cut-out orthosis using the 3Space Fastrak® via sensors. RESULTS: The movement of the plantarflexión declination angle of the first metatarsal bone was higher using the orthosis 29.84° ± 5.98° versus without orthosis 27.69° ± 5.91° (p < 0.031°). Use of sandals may have minimized the magnitude of movement changes associated with orthosis versus non-orthosis use. CONCLUSION: The cut-out orthosis demonstrated a beneficial effect on non-fixed first metatarsophalangeal and metatarsal cuneiform joints affected by FHL, significantly increasing the declination of the metatarsal angle. Furthermore, use of the cut-out orthosis significantly reduced adduction movement of the first metatarsal bone in the transverse plane. CLINICAL RELEVANCE: The cut-out orthosis demonstrated a beneficial effect on non-fixed first metatarsophalangeal and metatarsal cuneiform joints affected by FHL, significantly increasing the declination of the metatarsal angle. Furthermore, use of the cut-out orthosis significantly reduced adduction movement of the first metatarsal bone in the transverse plane.

Lateral Stress Dorsiflexion View: A Case Series Demonstrating Clinical Utility in Midterm Hallux Limitus.

The lateral hallux stress dorsiflexion view is part of our standard workup for midterm hallux limitus (HL)/hallux rigidus (HR). It provides a functional radiographic examination of the first metatarsal phalangeal joint. Midterm HL primarily involves degenerative changes in the upper one third of the metatarsal phalangeal joint involving formation of bone spurs, dorsal bone impingement, joint space narrowing with cartilage degeneration, and fragmentation of the bone spurs. The lateral hallux stress dorsiflexion view provides diagnostic information not visible on a standard weightbearing lateral view in patients with midterm HL/HR, including joint space narrowing on the dorsal third of the joint despite intact cartilage through the center one third of the joint, the extent of maximum first metatarsal phalangeal joint dorsiflexion, and direct visualization of dorsal bone spur impingement. This functional radiographic examination also appears to provide improved patient understanding regarding why their joint is stiff and painful. Improved patient understanding of their condition positively influences the shared decision making regarding the treatment objectives and options. The cases of 5 patients with stage II or III HL/HR are presented to depict the utility of this radiographic view, including objective measurement of maximum first metatarsal phalangeal joint dorsiflexion, confirmation of a bony block at the end range of dorsiflexion, the presence or absence of joint space narrowing at the dorsal third of the joint, evaluation of the excursion of the sesamoid apparatus, a tool to help the patient understand, an intraoperative assessment of procedure effectiveness, and a comparison of maximum dorsiflexion before and after surgery.

An assessment of hallux limitus in university basketball players compared with noncompetitive individuals.

BACKGROUND: Injuries of the first metatarsophalangeal joint have lately been receiving attention from researchers owing to the important functions of this joint. However, most of the studies of turf toe injuries have focused on sports played on artificial turf. METHODS: This study compared the range of motion of the first metatarsophalangeal joint in collegiate basketball players (n = 123) and noncompetitive individuals (n = 123). RESULTS: A statistically significant difference (P < .001) in range of motion was found between the two groups. The difference between the two sample means was 21.35°. CONCLUSIONS: With hallux rigidus being a potential sequela of repeated turf toe injuries, it seems likely that subacute turf toe injuries occur in basketball players, leading to degenerative changes that result in hallux limitus.

Plantar fasciitis and its relationship with hallux limitus.

BACKGROUND: We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. METHODS: The 100 study participants (34 men and 66 women) were divided into two groups: patients with plantar fasciitis and controls. The Foot Posture Index and dorsiflexion of the first metatarsophalangeal joint were compared between the two groups, and a correlation analysis was conducted to study their relationship. RESULTS: In the plantar fasciitis group there was a slight limitation of dorsiflexion of the hallux that was not present in the control group (P < .001). Hallux dorsiflexion and the Foot Posture Index were inversely correlated (Spearman correlation coefficient, -0.441; P < .01). CONCLUSIONS: Participants with plantar fasciitis presented less hallux dorsiflexion than those in the control group, and their most common foot type was the pronated foot.