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Solomou G, Bilyy A, Tadikonda P, Gurdas B, Pasapula C. Diagnostic accuracy of clinical, radiological and device-driven tests for the detection of First Ray Instability: A systematic review. Foot (Edinb) 2024; 59:102080. [PMID: 38484413 DOI: 10.1016/j.foot.2024.102080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/08/2024] [Indexed: 06/17/2024]
Abstract
INTRODUCTION First Ray Instability (FRI) and especially hypermobility leads to the collapse of the medial longitudinal arch's structural framework, which reduces the foot's ability to become a rigid lever for propulsion, resulting in progressive foot deformities. Early detection of FRI with prompt intervention helps prevent degenerative foot deformities. Various manual, device-based and radiographic diagnostic tests for FRI quantification have been described in the literature. We aim to conduct an up-to-date, comprehensive, systematic review of the literature reporting on diagnostic tests to evaluate FRI. METHODOLOGY Electronic databases (Medline, Embase and PubMed) and bibliography lists were searched until May 2021 for studies evaluating diagnostic tests for FRI. MeSH terms were used to conduct the literature search. The authors screened all produced abstracts. Selected articles were further assessed in full based on inclusion and exclusion criteria. The relevant studies were qualitatively assessed and grouped into tables based on tests. RESULTS 18,176 studies were identified. Thirty-two full-text articles were included for assessment. Ten articles were excluded based on evaluation criteria. 18 studies were included for qualitative assessment: two studies describing manual diagnostic tests, three evaluating device-driven tests, six image-guided studies and seven comparison studies assessing a new test versus an established one. CONCLUSION Gold standard tests in defining FRI need to be improved. Manual tests exhibit significant subjective variability. Radiographic tests, while accurate, are complex and cumbersome to perform and, therefore, are not widely applied. Dorsal rulers have demonstrated mixed results and shown variability when compared to instruments. The focus has been on assessing FRI in hallux valgus (HV). More studies are needed to investigate FRI in the absence of HV.
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Affiliation(s)
- Georgios Solomou
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Andrey Bilyy
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
| | - Pranav Tadikonda
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
| | - Brian Gurdas
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
| | - Chandra Pasapula
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
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Effect of Spatiotemporal Parameters on the Gait of Children Aged from 6 to 12 Years in Podiatric Tests: A Cross Sectional Study. Healthcare (Basel) 2023; 11:healthcare11050708. [PMID: 36900713 PMCID: PMC10001326 DOI: 10.3390/healthcare11050708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
The use of lower limb tests in the paediatric population is of great importance for diagnostic evaluations. The aim of this study is to understand the relationship between the tests performed on the feet and ankles, covering all of its planes, and the spatiotemporal parameters of children's gait. METHODS It is a cross-sectional observational study. Children aged between 6 and 12 years participated. Measurements were carried out in 2022. An analysis of three tests used to assess the feet and ankles (FPI, the ankle lunge test, and the lunge test), as well as a kinematic analysis of gait using OptoGait as a measurement tool, was performed. RESULTS The spatiotemporal parameters show how Jack's Test is significant in the propulsion phase in its % parameter, with a p-value of 0.05 and a mean difference of 0.67%. Additionally, in the lunge test, we studied the % of midstance in the left foot, with a mean difference between the positive test and the 10 cm test of 10.76 (p value of 0.04). CONCLUSIONS The diagnostic analysis of the functional limitation of the first toe (Jack's test) is correlated with the spaciotemporal parameter of propulsion, as well as the lunge test, which is also correlated with the midstance phase of gait.
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Glasoe WM. An Operational Definition of First Ray Hypermobility. Foot Ankle Spec 2022; 15:494-496. [PMID: 35656787 DOI: 10.1177/19386400221093864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The first ray (metatarsocuneiform) behaves as a load-bearing strut in supporting weight. Due to its functional importance, stress-testing techniques are used to assess the stability of the first ray and objectify evidence of hypermobility. The test and measurement of first ray hypermobility (FRH) is of interest to clinicians and researchers. The condition itself, however, has proven elusive to diagnose. This article defines FRH for the purpose of improving the consistency by which the diagnosis is made. Currently, the lack of a consensus definition prevents research from determining the incidence rates and prevalence of FRH, a commonly reported medical condition. THE DEFINITION Symptomatic FRH presents as dorsal displacement that measures greater than 8 mm, accompanied with signs and symptoms consistent with loading insufficiency of the first ray. The operational definition is objective and if adopted across health care professions, the criterion could become the standard for identifying FRH in patients and research participants. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Ward M Glasoe
- Division in Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota (WMG)
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Li G, Shen J, Smith E, Patel C. Development of a Manual Measurement Device for Measuring Hallux Valgus Angle in Patients with Hallux Valgus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159108. [PMID: 35897475 PMCID: PMC9330551 DOI: 10.3390/ijerph19159108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023]
Abstract
Background: Hallux valgus (HV) is one of the most common forefoot deformities, and its prevalence increases with age. HV has been associated with poor foot function, difficulty in fitting footwear and poor health-related quality of life. The aims of this study were to design and develop an easy-to-use measurement device for measuring hallux valgus angle (HVA) in patients with HV and to assess the measurement reliability of the newly designed measurement device. Methods: A manual measurement device for measuring HVA was designed and developed to test on patients with HV. Two measuring methods, i.e., test–retest and intra-observer measurements, were used to evaluate the repeatability and reliability of the newly designed measurement device. In the test–retest measurements, a total of 42 feet from 26 patients with HV were repeatedly measured by the same researcher using the manual measurement device every 3 weeks over a period of 12 months. The measurement reliability of the newly designed measurement device was analysed based on the collected HVA data. In the intra-observer measurements, a total of 22 feet from the same group of HV patients were measured by the same researcher using the manual measurement device and by a consultant using X-ray measurement for comparison. The intraclass correlation coefficient (ICC) was used to determine the correlation of measurements between the manual measurement device and X-ray measurement. Results: The mean of the difference between the two repeat measurements of HVA using the newly designed manual device was 0.62°, and the average of ICC was 0.995, which indicates excellent reliability. The ICC between X-ray and the average of twice-repeated manual measurements was 0.868, with 95% CI (0.649, 0.947) (p = 0.000). When the relationship in HVA between X-ray measurement and manual measurement using the new device was regressed as a linear relationship, the regression equation was y = 1.13x − 4.76 (R2 = 0.70). Conclusions: The newly designed measurement device is easy to use, with low-cost and excellent reliability for HVA measurement, with the potential for use in clinical practice.
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Affiliation(s)
- Guoli Li
- School of Art and Design, Guangzhou Panyu Polytechnic, Guangzhou 511483, China
- Correspondence: (G.L.); (J.S.)
| | - Jinsong Shen
- Textile Engineering and Materials Research Group, School of Fashion and Textiles, De Montfort University, Leicester LE1 9BH, UK;
- Correspondence: (G.L.); (J.S.)
| | - Edward Smith
- Textile Engineering and Materials Research Group, School of Fashion and Textiles, De Montfort University, Leicester LE1 9BH, UK;
| | - Chetna Patel
- The Maths Learning Centre, De Montfort University, Leicester LE1 9BH, UK;
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Cobos-Moreno P, Astasio-Picado Á, Gómez-Martín B. Pathophysiological Behaviour of the Climber's Foot versus the General Population: A Prospective Observational Study. Healthcare (Basel) 2022; 10:868. [PMID: 35628005 PMCID: PMC9141719 DOI: 10.3390/healthcare10050868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Sport climbing is becoming increasingly popular, with people of all types and ages practising it. The feet suffer a lot of pressure with the sport climbing gesture, which in the long run can produce alterations in the first metatarsophalangeal joint or in the first radius of the foot. Objective: To observe and quantify the behaviour of the foot in climbing subjects compared to a group of non-climbing subjects, comparing the pressures, first metatarsophalangeal joint and first radius of the foot. Method: This is a non-experimental and observational, cross-sectional, descriptive and prospective research. The study sample consisted of 105 subjects (42 males and 63 females). The control group consisted of 52 subjects and the climbing group consisted of 53 subjects. Different exploratory tests were carried out on all the subjects, such as: mobility of the metatarsophalangeal joint and first radius of the foot and the study of plantar pressures in different areas of the study. Results: No significant difference was found between left and right foot measurements (p > 0.05). The pressures of the same foot are significant, both at static and dynamic stages for both groups. The maximum pressure in the climbing group was under the first metatarsal head, while in the control group it was under the second metatarsal head. There were significant differences in the mobility of the first metatarsal joint and the first radius between the two groups. Conclusion: It can be seen that the group of climbers has less plantar pressure than the control group. They also have altered mobility of the first radius and the first metatarsophalangeal joint.
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Affiliation(s)
- Paula Cobos-Moreno
- Nursing Department, University of Extremadura, 10600 Plasencia, Spain; (P.C.-M.); (B.G.-M.)
| | - Álvaro Astasio-Picado
- Nursing, Physiotherapy and Occupational Therapy Department, Faculty of Health Sciences, University of Castilla-La Mancha, Real Fábrica de Sedas, s/n, 45600 Talavera de la Reina, Spain
| | - Beatriz Gómez-Martín
- Nursing Department, University of Extremadura, 10600 Plasencia, Spain; (P.C.-M.); (B.G.-M.)
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Morgan OJ, Hillstrom R, Turner R, Day J, Thaqi I, Caolo K, Ellis S, Deland JT, Hillstrom HJ. Is the Planus Foot Type Associated With First Ray Hypermobility? FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221081545. [PMID: 35274071 PMCID: PMC8902198 DOI: 10.1177/24730114221081545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Many foot pathologies have been associated with foot type. However, the
association of first ray hypermobility remains enigmatic. The purpose of
this study was to investigate first ray hypermobility among participants
with planus and rectus foot types and its influence on static measures of
foot structure. Methods: Twenty asymptomatic participants with planus (n = 23 feet) and rectus (n = 17
feet) foot types were enrolled. Several parameters of static foot structure
(arch height index, arch height flexibility, first metatarsophalangeal joint
flexibility, and first ray mobility) were measured. Participants were
further stratified into groups with nonhypermobile (n = 26 feet) and
hypermobile (n = 14 feet) first rays. First ray mobility ≥8 mm
was used to define “first ray hypermobility”. Generalized estimating
equations, best-fit regression lines, and stepwise linear regression were
used to identify significant differences and predictors between the study
variables Results: Overall, 86% of subjects categorized with first ray hypermobility exhibited a
planus foot type. Arch height flexibility, weightbearing first ray mobility,
and first metatarsophalangeal joint flexibility showed no significant
between-group differences. However, weightbearing ray mobility and first
metatarsophalangeal joint laxity were associated with partial weightbearing
first ray mobility, accounting for 38% of the model variance. Conclusion: The planus foot type was found to be associated with first ray hypermobility.
Furthermore, weightbearing first ray mobility and first metatarsophalangeal
joint laxity were predictive of partial weightbearing first ray mobility,
demonstrating an interaction between the translation and rotational
mechanics of the first ray. Clinical Relevance: Association of first ray hypermobility with foot type and first
metatarsophalangeal joint flexibility may help understand the sequela to
symptomatic pathologies of the foot.
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Affiliation(s)
- Oliver J. Morgan
- Medical Engineering Research Group, Faculty of Science and Engineering, Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | - Rajshree Hillstrom
- Biomed Consulting, Inc, New York, NY, USA
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Robert Turner
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan Day
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ibadet Thaqi
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Kristin Caolo
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T. Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Howard J. Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
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Morgan OJ, Hillstrom R, Turner R, Day J, Thaqi I, Caolo K, Song J, Russell R, Ellis S, Deland JT, Hillstrom HJ. Comparative Reliability of a Novel Electromechanical Device and Handheld Ruler for Measuring First Ray Mobility. Foot Ankle Int 2021; 42:1613-1623. [PMID: 34112024 DOI: 10.1177/10711007211020345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Quantifying first ray mobility is crucial to understand aberrant foot biomechanics. A novel device (MAP1st) that can perform measurements of first ray mobility in different weightbearing conditions, foot alignments, and normalization was tested. The reliability of these measurement techniques was assessed in comparison to a handheld ruler considered representative of the common clinical examination. METHODS The study included 25 participants (50 feet). Two independent raters performed baseline, test-retest, and remove-replace measurements of first ray mobility with MAP1st and the handheld device. The effects of non-, partial, and full weightbearing in subtalar joint neutral and the resting calcaneal stance position were assessed. Measurement normalization relative to foot size was also investigated. Intra- and interclass correlation coefficients (ICCs) were calculated for each device between the 2 raters. In addition, Bland-Altman plots were constructed to determine if fixed biases or substantial outliers were present. RESULTS Similar intrarater ICC values were found for both devices (≥0.85). However, interrater ICC values were substantially improved by MAP1st compared with the handheld device (0.58 vs 0.06). Bland-Altman plots demonstrated biases of 1.27 mm for the handheld ruler, and 2.88 to 0.05 mm and -1.16 to 0.00 for linear and normalized MAP1st measurements, respectively. Improved reliability was achieved with MAP1st for normalized assessments of first ray mobility while the foot was placed in partial- and full-weightbearing resting calcaneal stance positions. CONCLUSION MAP1st provided reliable assessments of partial- and full-weightbearing first ray mobility. It should help investigators to explore the potential relationships between first ray function and aberrant foot biomechanics in future research. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Oliver J Morgan
- Medical Engineering Research Group, Faculty of Science and Engineering, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Rajshree Hillstrom
- Leon Root, MD, Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA.,Biomed Consulting, Inc. New York, New York, USA
| | - Robert Turner
- Leon Root, MD, Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan Day
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ibadet Thaqi
- Leon Root, MD, Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Kristin Caolo
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jinsup Song
- School of Podiatric Medicine, Temple University, Philadelphia, PA, USA
| | | | - Scott Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Howard J Hillstrom
- Leon Root, MD, Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
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Távara Vidalón P, Lafuente Sotillos G, Munuera-Martínez PV. Movimiento del primer dedo en sujetos con hallux limitus vs. sujetos con pies normales. REVISTA ESPAÑOLA DE PODOLOGÍA 2021. [DOI: 10.20986/revesppod.2021.1621/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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