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Background: The stiffness of the first metatarsophalangeal joint (MTPJ) is of interest in cases such as hallux rigidus and apropulsive gait. Subjective rating of joint mobility as 'hypermobile, normal, or stiff' is an unreliable method. Previous instruments for the assessment of first MTPJ stiffness can be too hard and uncomfortable for test subjects. Recently, a new device using a load cell and optical fiber with fiber Bragg grating (FBG) sensors was developed to provide a comfortable means of clinical foot assessment. This study aimed to evaluate the test-retest reliability of this FBG-load cell device in measuring the first MTPJ quasi-stiffness., Methods: The left foot of 13 female subjects were measured twice for their first MTPJ quasi-stiffness, approximately seven days apart. The FBG-load cell device measured the MTPJ range of motion from a resting position to maximum dorsiflexion and then returning to the resting start-position. The force applied by a clinician to displace the toe was simultaneously recorded using the load cell. The quasi-stiffness over the "working range" in loading and unloading directions were determined from the slope of the torque-angular displacement graph. The test-retest reliability of the MTPJ quasi-stiffness was evaluated using intra-class correlation coefficient [ICC (2,1)]., Results: The reliability was almost perfect for MTPJ quasi-stiffness over the loading phase (ICC = 0.814), moderate for MTPJ quasi-stiffness over the unloading phase (ICC = 0.477) and moderate for MTPJ maximum range (ICC = 0.486)., Conclusion: The foot assessment device comprising FBG and load cell was able to reliably measure the first MTPJ quasi-stiffness in a clinical setting. The measurement reliability was higher during the loading phase than the unloading phase., (Copyright © 2020. Published by Elsevier Ltd.)

Background: The aim of this study was to examine the biomechanical gait effects and range of motion following a proximal hemiarthroplasty with a HemiCap®., Methods: Forty-one HemiCAP-operated participants with a mean follow-up time of 5 years had plantar force variables (PFVs) examined and compared with their non-operated foot and a control group. PFVs were compared to the MTPJ1 range of motion (ROM), and pain measured by Visual Analog Scale (VAS)., Results: The HemiCAP participants' operated feet had higher PFVs laterally on the foot and lower PFVs under the hallux. Dorsal ROM of the operated feet was a median 45° (range 10-75) by goniometer and 41.5 (range 16-80) by X-ray. An increase in ROM decreased the forces under the hallux. Most participants were pain-free. No correlation between pain and PFVs was found., Conclusions: Increased dorsiflexion decreased the maximum force under the hallux. A mid-term HemiCAP maintains some motion. The decreased PFVs under the hallux may reflect a patient reluctance to load the first ray, although no correlation between plantar forces and pain was found., (Copyright © 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Arthrodesis is the gold standard procedure for advanced arthrosis of the first metatarsophalangeal joint. Having a strong construct is preferable for allowing immediate bearing of weight, which facilitates patient rehabilitation. Plate and screw fixation is currently in favor but can lead to prominent metalware necessitating removal. The aim of this study is to report the results of a series of 54 first metatarsophalangeal joint arthrodeses performed in 52 patients treated with an implant composed of an intraosseous post and lag screw. All of the patients had a minimum follow-up of 1 year, and the indication for the surgery was end-stage hallux rigidus in 44 (81.5%) feet, severe hallux valgus in 8 (14.8%) feet, and rheumatoid arthritis in 2 (3.7%) feet. Arthrodesis was achieved in 52 (96.3%) feet at a mean of 61 ± 16 (range 39 to 201) days with nonunion observed in 2 (3.7%) feet; neither of the 2 patients had known risk factors. Metalware impinging on soft tissues necessitating removal was observed in 3 (5.6%) feet, and there were no cases of loss of position or implant breakage. The mean Manchester-Oxford Foot Questionnaire score improved from 46.4 ± 13.3 to 18.4 ± 9.4 (p < .001) at latest follow-up. In conclusion, our results suggest the intraosseous post and lag screw device was safe and effective, and it can be considered an alternative method of stabilizing the first metatarsophalangeal joint when undertaking arthrodesis surgery., (Copyright © 2019 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: The flexibility of the first metatarsophalangeal (MTP) joint in patients with hallux rigidus (HR) has not been studied. Compared to measuring range of motion alone, measures of joint flexibility provide additional information that may prove useful in the assessment of HR. The purpose of this study was to assess the flexibility of the hallux MTP joint in patients with HR compared to controls using a novel flexibility device., Methods: Fifteen patients with Coughlin stage II or III HR and 20 healthy controls were recruited prospectively. Using a custom flexibility jig, each of 2 raters performed a series of seated and standing tests on each subject. Dorsiflexion angle and applied torque were plotted against each other to generate 5 different parameters of flexibility. Differences between (1) HR patients and controls and (2) the sitting and standing testing positions were assessed with t tests. Intrarater test-retest reliability, remove-replace reliability, and interrater reliability were assessed with intraclass correlation coefficients (ICCs)., Results: Patients in the HR group were older than patients in the control group ( P < .001) and had lower maximum dorsiflexion ( P < .001). HR patients were less flexible as measured by 3 of the 5 flexibility parameters: early flexibility (first 25% of motion; P = .027), laxity angle ( P < .001), and torque angle ( P = .002). After controlling for age, only laxity angle differed significantly between HR patients and controls ( P < .001). Generally, patients were more flexible when seated compared to standing, with this effect being more marked in HR patients. All parameters had good or excellent intra- and interrater reliability (ICC ≥ 0.60)., Conclusions: Hallux MTP joint flexibility was reliably assessed in HR patients using a flexibility device. Patients with HR had decreased flexibility of the hallux MTP joint compared to control patients., Level of Evidence: Level II, prospective comparative study.

Background: The reliability of range of motion (ROM) measurements has not been established for the hallux metatarsophalangeal (MTP) joint in patients with hallux rigidus. The aim of the present study was to prospectively assess the clinical versus radiographic difference in ROM of the arthritic hallux MTP joint., Method: One hundred consecutive patients who presented with any grade of hallux rigidus were included in this prospective study to determine the hallux MTP range of motion. Clinical range of motion using a goniometer and radiographic range of motion on dynamic x-rays was recorded., Results: The mean difference between clinical and radiographic dorsiflexion was 13 degrees (P < .001). For all measurements, clinical dorsiflexion was equal to or less than radiographically measured dorsiflexion. The difference was significantly greater in patients with a clinical dorsiflexion of less than 30 degrees than in patients with 30 degrees or more. Radiographic measurement of hallux dorsiflexion had an excellent intra- and interobserver reliability., Conclusion: We describe a reliable, reproducible, and straightforward method of measuring hallux MTP ROM that improved upon measuring clinical ROM., Level of Evidence: Level II, prospective comparative study., (© The Author(s) 2015.)

Surgical intervention for hallux rigidus could be necessitated when conservative attempts fail to alleviate pain and dysfunction. Controversy exists as to which procedure is ideal and will provide lasting relief of hallux rigidus pain. Many arguments have been made for and against hemi-implant arthroplasty. We advocate the use of a low-profile hemimetallic endoprosthesis (Metasurg(®)) and present our technique of using a reamer to sculpt the articular surface of the metatarsal head when necessary. We further advocate for minimal resection of the phalangeal base when using a low-profile device to maintain the soft tissue periarticular intrinsics. We present a 2- to 3-position reamer decompression of the metatarsal and discuss the benefits of maintaining range of motion at the first metatarsophalangeal joint., (Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Unlabelled: The purpose of this brief paper is to present the preliminary results of a modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus. In this procedure, the dorsal arm of the osteotomy is performed orthogonal to the horizontal plane of the first metatarsal, the main advantage being that this allows much easier and more accurate multiplanar correction of first metatarsal deformities. From 2010 to 2013, 184 consecutive patients with symptomatic hallux valgus and 48 patients with hallux rigidus without severe metatarsophalangeal joint degeneration underwent such modified chevron osteotomy. Mean patient age was 54.9 (range 21-70) years, and mean follow-up duration was 41.7 (range 24-56) months. Ninety-three percent of patients were satisfied with the surgery. Mean American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 56.6 preoperatively to 90.6 at last follow-up, and mean visual analog scale (VAS) pain score decreased from 5.7 preoperatively to 1.6 at final follow-up (p < 0.05). In patients treated for hallux valgus, mean hallux valgus angle decreased from 34.1° preoperatively to 6.2° at final follow-up, and mean intermetatarsal angle decreased from 18.5° preoperatively to 4.1° at final follow-up (p < 0.05). One patient developed postoperative transfer metatarsalgia, treated successfully with second-time percutaneous osteotomy of the minor metatarsals, whilst one patient had wound infection that resolved with systemic antibiotics., Level of Evidence: Level IV.

Background: This study aimed to analyze the functional results of cheilectomy in the surgical treatment of grade III hallux rigidus and to evaluate whether cheilectomy is a preferable first-line treatment over other surgical methods., Methods: Of 29 patients with moderate daily physical activity who underwent cheilectomy between 2009 and 2012 on being diagnosed as having grade III hallux rigidus according to the Coughlin-Shurnas grading system, 21 patients (14 women and 7 men; mean age, 59.2 years; age range, 52-67 years) (22 feet) with regular follow-up and complete medical records were included in the study. The patients were evaluated in the preoperative and postoperative periods using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society metatarsophalangeal assessment forms., Results: The preoperative mean American Orthopaedic Foot and Ankle Society score of 53 (range, 29-67) improved to 78 (range, 57-92) postoperatively (Wilcoxon test P = .001). The preoperative mean visual analog scale score of 89 (range, 60-100) improved to 29 (range, 0-70) in the postoperative period (Wilcoxon test P = .001)., Conclusions: As a simple and repeatable procedure that allows for further joint-sacrificing surgical procedures when required, cheilectomy is a preferable method to be applied as a first-line option for the surgical treatment of grade III hallux rigidus.

Hallux rigidus is a painful condition of the great toe characterized by restriction of the metatarsophalangeal joint arc of motion and progressive osteophyte formation. Precise cause of hallux rigidus remains under debate. Anatomic variations and historical, clinical, and radiographic findings have been implicated in the development and progression of hallux rigidus. Radiologic findings associated with hallux rigidus include metatarsal head osteochondral defects, altered metatarsal head morphology, and an elevated hallux interphalangeus angle measure. Associated historical findings include a positive family history and history of trauma to the joint. An understanding of relevant anatomy and pathophysiology is essential during the approach to hallux rigidus treatment., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The purpose of this study was to provide a quantitative analysis of the changes that occur in the foot and ankle during the gait of patients with hallux rigidus. Using a 15-camera Vicon Motion Analysis System, gait analysis was conducted on a population of 22 patients with hallux rigidus and compared to that of 25 healthy ambulators. Weight-bearing radiographs were measured to index marker positions to underlying bony anatomy. The Milwaukee Foot Model was used to perform three-dimensional analysis of dynamic foot and ankle motion, and temporal-spatial parameters were also calculated. Values were compared to controls using unpaired parametric methods (Student t-test, p < 0.002). The hallux rigidus population showed significant alterations in gait patterns as compared to controls in various planes in all segments (hallux, forefoot, hindfoot, and tibia) of the foot and ankle, particularly in the range of motion of the hallux and the forefoot. Prolonged stance phase was also observed. As reports regarding the quantitative study of the multisegment foot and ankle are limited, this study was useful in providing characterization of gait patterns in patients with hallux rigidus., ((c) 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.)