• 1

    Grady JF. Axe TM. Zager EJ. et al: A retrospective analysis of 772 patients with hallux limitus. JAPMA 92: 102, 2002.

  • 2

    Lambrinudi C. Metatarsus primus elevatus. Proc R Soc Med 31: 1273, 1938.

  • 3

    Tagoe M. Brown HA. Reese SM. Total sesamoidectomy for painful hallux rigidus: a medium-term outcome study. Foot Ankle Int 30: 640, 2009.

  • 4

    Beeson P. Phillips C. Corr S. Classification systems of hallux rigidus: a review of the literature. Foot Ankle Int 29: 407, 2008.

  • 5

    Rao S. Bell K. Reliability and relevance of radiographic measures of metatarsus primus elevatus and arch alignment in individuals with midfoot arthritis and controls. JAPMA 103: 347, 2013.

    • Search Google Scholar
    • Export Citation
  • 6

    Horton GA. Park Y. Myerson MS. Role of metatarsus primus elevatus in the pathogenesis of hallux rigidus. Foot Ankle Int 20: 777, 2008.

  • 7

    Meyer JO. Nishon LR. Weiss L. et al: Metatarsus primus elevatus and the etiology of hallux rigidus. J Foot Surg 26: 237, 1987.

  • 8

    Bryant A. Mahoney B. Tinley P. Lateral intermetatarsal angle: a useful measurement of metatarsus primus elevatus? JAPMA 91: 251, 2001.

  • 9

    Christman RA. Flanigan KP. Sorrento DL. et al: Radiographic analysis of metatarsus primus elevatus: a preliminary study. JAPMA 91: 294, 2001.

    • Search Google Scholar
    • Export Citation
  • 10

    Coughlin MJ. Shurnas PJ. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 24: 731, 2003.

  • 11

    Hunt KJ. Anderson RB. Biplanar proximal phalanx closing wedge osteotomy for hallux rigidus. Foot Ankle Int 33: 1043, 2012.

  • 12

    Lucas DE. Hunt KJ. Hallux rigidus: relevant anatomy and pathophysiology. Foot Ankle Clin 20: 381, 2015.

  • 13

    Roukis TS. Scherer PR. Anderson CF. Position of the first ray and motion of the first metatarsophalangeal joint. JAPMA 86: 538, 1996.

  • 14

    Roukis TS. Metatarsus primus elevatus in hallux rigidus: fact or fiction? JAPMA 95: 221, 2005.

  • 15

    Usuelli F. Palmucci M. Montrasio UA. et al: Radiographic considerations of hallux valgus versus hallux rigidus. Foot Ankle Int 32: 782, 2011.

  • 16

    Bouaicha S. Ehrmann C. Moor BK et al: Radiographic analysis of metatarsus primus elevatus and hallux rigidus. Foot Ankle Int 31: 807, 2010.

  • 17

    Beeson P. Phillips C. Corr S. Cross-sectional study to evaluate radiological parameters in hallux rigidus. Foot 19: 7, 2009.

  • 18

    Bonney G. MacNab I. Hallux valgus and hallux rigidus: a critical survey of operative results. J Bone Joint Surg Br 34: 366, 1952.

  • 19

    Coughlin MJ. Shurnas PJ. Hallux rigidus. J Bone Joint Surg Am 85: 2072, 2003.

  • 20

    Shariff R. Myerson M. The use of osteotomy in the management of hallux rigidus. Foot Ankle Clin 20: 293, 2015.

  • 21

    Coughlin MJ. Shurnas PJ. Soft-tissue arthroplasty for hallux rigidus. Foot Ankle Int 24: 661, 2003.

  • 22

    Coughlin MJ. Shurnas PJ. Hallux rigidus surgical techniques. J Bone Joint Surg Am 86(supp 1): 119, 2004.

  • 23

    Elliot AD. Borgert AJ. Roukis TS. A prospective comparison of clinic, radiographic, and intraoperative features of hallux rigidus: long-term follow up and analysis. J Foot Ankle Surg 55: 547, 2016.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Roukis TS. Clinical outcomes after isolated periarticular osteotomies of the first metatarsal for hallux rigidus: a systematic review. J Foot Ankle Surg 49: 553, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Roukis TS. Jacobs PM. Dawson DM. et al: A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus: short-term follow-up and analysis. J Foot Ankle Surg 41: 158, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Roukis TS. The need for surgical revision after an isolated Valenti arthroplasty for hallux rigidus: a systematic review. J Foot Ankle Surg 49: 294, 2010.

  • 27

    Cicchinelli LD. Camasta CA. McGlamry ED. Iatrogenic metatarsus primus elevatus: etiology, evaluation, and surgical management. JAPMA 87: 165, 1997.

    • Search Google Scholar
    • Export Citation

Metatarsus Primus Elevatus Resolution After First Metatarsophalangeal Joint Arthroplasty

Eliminating Elevatus Without an Osteotomy–A Preliminary Study

Patrick J. Sanchez Foot and Ankle Institute, Oak Lawn, IL.

Search for other papers by Patrick J. Sanchez in
Current site
Google Scholar
PubMed
Close
 DPM
,
John F. Grady Foot and Ankle Institute, Oak Lawn, IL.

Search for other papers by John F. Grady in
Current site
Google Scholar
PubMed
Close
 DPM
,
Robin C. Lenz Department of Podiatry, Jesse Brown VA Medical Center, Chicago, IL. Dr. Lenz is now with the Ocean County Foot and Ankle Surgical Associates, PC, Toms River, NJ. Dr. Park is now with the San Francisco Foot and Ankle Center, San Francisco, CA. Dr. Ruff is now with OSF Medical Group, Peoria, IL.

Search for other papers by Robin C. Lenz in
Current site
Google Scholar
PubMed
Close
 DPM
,
Sarah J. Park Department of Podiatry, Jesse Brown VA Medical Center, Chicago, IL. Dr. Lenz is now with the Ocean County Foot and Ankle Surgical Associates, PC, Toms River, NJ. Dr. Park is now with the San Francisco Foot and Ankle Center, San Francisco, CA. Dr. Ruff is now with OSF Medical Group, Peoria, IL.

Search for other papers by Sarah J. Park in
Current site
Google Scholar
PubMed
Close
 DPM
, and
Jake G. Ruff Department of Podiatry, Jesse Brown VA Medical Center, Chicago, IL. Dr. Lenz is now with the Ocean County Foot and Ankle Surgical Associates, PC, Toms River, NJ. Dr. Park is now with the San Francisco Foot and Ankle Center, San Francisco, CA. Dr. Ruff is now with OSF Medical Group, Peoria, IL.

Search for other papers by Jake G. Ruff in
Current site
Google Scholar
PubMed
Close
 DPM
Restricted access

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.

Corresponding author: Patrick J. Sanchez, DPM, Foot and Ankle Institute, 4650 Southwest Hwy, Oak Lawn, IL 60453. (E-mail: patricksanchezdpm@gmail.com)