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Hallux limitus

Troy J Boffeli, Katherine R Schnell
The Cotton osteotomy or opening wedge medial cuneiform osteotomy is a useful adjunctive flatfoot reconstructive procedure that is rarely performed in isolation. The Cotton procedure is relatively quick to perform and effectively corrects forefoot varus deformity after rearfoot fusion or osteotomy to achieve a rectus forefoot to rearfoot relationship. Proper patient selection is critical, because preoperative findings of medial column joint instability, concomitant hallux valgus deformity, or degenerative joint disease of the medial column might be better treated with arthrodesis of the naviculocuneiform or first tarsometatarsal joints...
July 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Benjamin Cullen, Alexandria Lila Stern, Glenn Weinraub
Two commonly used procedures for early stage hallux rigidus are cheilectomy and decompression metatarsal osteotomy. However, although both procedures were first described several decades ago, a deficit exists in the published data comparing their effectiveness. We performed a retrospective comparative study to examine the results of surgical treatment of early-stage hallux rigidus. A total of 423 subjects were included. Hallux limitus or rigidus had been diagnosed in all patients, who had undergone either cheilectomy or any variation of plantarflexion decompression metatarsal head osteotomy...
May 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Andrew F Knox, Alan R Bryant
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...
May 2016: Journal of the American Podiatric Medical Association
Luis María Gordillo-Fernández, Mercedes Ortiz-Romero, José Valero-Salas, José Luis Salcini-Macías, Salomon Benhamu-Benhamu, Raquel García-de-la-Peña, Jose Antonio Cervera-Marin
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...
December 2016: Prosthetics and Orthotics International
Troy J Boffeli, Shelby B Hyllengren
Diabetes-related neuropathic ulcers located at the plantar aspect of the hallux interphalangeal joint are often chronic or recurrent and frequently become complicated by osteomyelitis. Once infected, treatment will typically involve hallux amputation. Although intended as a definitive procedure, amputation of the first toe is not desirable from a cosmetic or functional standpoint and often leads to transfer ulcers at adjacent locations of the foot. Reconstructive wound surgery, combined with limited bone resection, is possible if the infection is caught early before the local tissue and bone have become necrotic...
November 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Jacques Vallotton
Functional Hallux limitus (Fhl) is still a misconceived and unappreciated clinical entity, being often diagnosed during a clinical examination or a podiatric assessment. In the presence of Fhl, the patient's gait necessitates the unwitting existence of complementary efforts on their part, thus resembling to the gait pattern of someone with elongated foot or feet. The consequences of this dysfunction affect all age groups and manifest themselves in the form of low back pain, impingement, sprain, joint incongruence, or overload tendon and fibro-osseous lesions...
December 3, 2014: Revue Médicale Suisse
Paul Trégouët
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 < ...
September 2014: Journal of the American Podiatric Medical Association
Ricardo Becerro de Bengoa Vallejo, Rubén Sanchez Gómez, Marta Elena Losa Iglesias
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...
April 2016: Prosthetics and Orthotics International
Troy J Boffeli, Rachel C Collier
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...
July 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Yolanda Aranda, Pedro V Munuera
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...
May 2014: Journal of the American Podiatric Medical Association
Jose M Castillo-Lopez, Javier Ramos-Ortega, Maria Reina-Bueno, Gabriel Domínguez-Maldonado, Inmaculada C Palomo-Toucedo, Pedro V Munuera
BACKGROUND: Excessive deviation of the distal phalanx in abduction frequently occurs in advanced stages of hallux rigidus but not in hallux valgus. Therefore, theoretically there should be no significant differences in the hallux interphalangeal angle (HIPA) between individuals with normal feet, those with hallux valgus, and those with mild hallux limitus. The objective of the present study was thus to determine if significant differences in HIPA exist in the early stages of hallux valgus or hallux limitus deformities...
March 2014: Journal of the American Podiatric Medical Association
M N Magin
OBJECTIVE: Correction of hallux valgus deformities without loss of toe length. Achievement of full weight-bearing. INDICATIONS: Hallux valgus with intermetatarsal angle of more than 20°. Hypermobility of the first metatarsal bone combined with instability. Recurrence of hallux valgus deformity. Hallux limitus combined with metatarsus primus elevatus. Painful arthrosis of the metatarsal-cuneiform-medial joint (TMT 1). CONTRAINDICATIONS: Arterial occlusive disease...
April 2014: Operative Orthopädie und Traumatologie
Alfred Gatt, Tiziana Mifsud, Nachiappan Chockalingam
BACKGROUND: Functional hallux limitus (FHL) is diagnosed with a static test known as the Hubscher Manoeuvre, the validity of which has been previously questioned. OBJECTIVES: To investigate the validity of this Manoeuvre and whether introducing severity of pronation as a second concurrent test would increase this validity. METHOD: 30 participants with a hallux dorsiflexion <12° were divided into 2 equal groups, depending on their severity of pronation according to the Foot Posture Index...
June 2014: Foot
Tun Hing Lui
Osteotomy of the first metatarsal in the sagittal plane is useful in correction of numerous deformity of the foot. Plantarflexion osteotomy of the first metatarsal can be used to treat hallux rigidus, hallux limitus, forefoot varus in flatfoot deformity and iatrogenic metatarsus primus elevates. Dorsiflexion osteotomy of the first metatarsal is an important component in surgical correction of pes cavus. It is also indicated in recalcitrant diabetic neuropathic ulcers at the first metatarsal head. We described a minimally invasive technique of sagittal plane corrective osteotomy of the first metatarsal, which can be either a plantarflexion or dorsiflexion one...
February 2014: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Cynthia Formosa, Alfred Gatt, Nachiappan Chockalingam
AIMS: The aim of the study was to assess foot morphology and document foot deformities and joint mobility in a cohort of subjects living with type-2 diabetes mellitus in Malta in a Primary Care setting. METHODS: A retrospective observational study was conducted on 243 subjects who participated in a local pilot diabetes foot screening project. Assessments included hammer/claw toes, hallux valgus, hallux limitus, prominent metatarsal heads, bony prominences, Charcot deformity, plantar callus, foot type and ankle and hallux mobility...
April 2013: Primary Care Diabetes
Belinda Ihaka, Angela Bayley, Keith Rome
AIM: The prevalence of diabetes and its associated manifestations is higher in New Zealand Maori than New Zealand Europeans. There is no current evidence regarding podiatric clinical characteristics of Maori with diabetes. The aim of this study was to determine the clinical and foot characteristics of Maori with diabetes using a podiatry-specific assessment tool. METHOD: This study used a cross-sectional design. Participants with diabetes were recruited from two Maori Primary Health Organisations...
August 24, 2012: New Zealand Medical Journal
Ricardo Becerro de Bengoa Vallejo, Marta Elena Losa Iglesias, Kevin T Jules
Hallux valgus, limitus, and rigidus are conditions affecting the first metatarsophalangeal joint that can be treated by arthroplasty. Excessive arthroplasty can compromise the insertion of the tendons at the base of the proximal phalanx of the hallux, leading to first metatarsophalangeal joint plantarflexion weakness, cock-up toe deformity, and altered forefoot loading. The present study investigated the anatomic length of insertion of the medial and lateral flexor hallucis brevis, extensor hallucis brevis, abductor hallucis, and adductor hallucis tendons into the base of the hallux proximal phalanx and the amount of bone that can be safely resected without compromising the insertional limits...
November 2012: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Robert M Rajczy, Patrick R McDonald, Howard S Shapiro, Steven F Boc
Arthrodesis of the first metatarsophalangeal joint (MTPJ) is used primarily for end-stage hallux rigidus whereby pain, crepitus, and limitation of motion is noted at the joint. Arthrodesis at the first MTPJ also has it uses as a primary procedure for rheumatoid arthritis when severe deformity is present, as well as for salvage procedures for failed joint arthroplasties with or without implant, fractures with intra-articular extension, avascular necrosis, and infection management. A first MTPJ arthrodesis should provide stable fixation, attain suitable positioning for a reasonable gait, maintain adequate length, and create a stable platform for a plantigrade foot type...
January 2012: Clinics in Podiatric Medicine and Surgery
Pedro V Munuera, Piedad Trujillo, Israel Güiza
BACKGROUND: This work was designed to assess the degree of correlation between hallux interphalangeal joint and first metatarsophalangeal joint dorsiflexion and to compare the mobility of the hallux interphalangeal joint between participants with and without limited first metatarsophalangeal joint dorsiflexion (hallux limitus). METHODS: Dorsiflexion of the hallux interphalangeal joint was measured in 60 normal feet and in 60 feet with hallux limitus to find correlations with first metatarsophalangeal joint dorsiflexion with the Spearman correlation coefficient and a simple linear regression equation...
January 2012: Journal of the American Podiatric Medical Association
Matthew Demore, Erigena Baze, Anthony Lalama, Patrick Branagan, Michael Bowen, Kiana Trent
BACKGROUND: Hallux limitus/rigidus is a painful arthritic condition affecting the first metatarsophalangeal joint that can be treated by implant arthroplasty, which, ultimately, may cause loss of the anatomical insertion points of the flexor hallucis brevis muscle. Preparation of the base involves resection of bone, thus compromising the insertion of the flexor hallucis brevis muscle. METHODS: We dissected 54 fresh-frozen cadaveric specimens and quantitatively measured the distalmost insertion point of the medial and lateral heads of the flexor hallucis brevis muscle...
January 2012: Journal of the American Podiatric Medical Association
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