Background: The literature contains several techniques for calculating metatarsal adductus angle. Most common systems use the fourth metatarsal cuboid joint and the fifth metatarsal cuboid joint. Although both systems are quite different, normal values of metatarsus adductus angle have not been established with each system of measurement.
Methods: Two hundred six radiographic images of feet in dorsoplantar projection were used to measure the metatarsus adductus angle using two different reference points: the joint between the fourth metatarsal and the cuboid and the joint between the fifth metatarsal and the cuboid.
Results: Comparison of the results of the two measurement techniques showed significant differences (P < .05). The values of the metatarsus adductus angle also showed significant differences in men versus women (P < .05). The reliability of the measurements was checked by using an intra- and inter-evaluator test performed by two evaluators.
Conclusion: Data showed the reliability of both systems of measurement, although significant differences in the metatarsal adductus angle mean value were found using these systems of measurement in the same foot. On the other hand, significant differences were found in mean values of metatarsus adductus angle between male and female feet. (J Am Podiatr Med Assoc 98(5): 364–369, 2008)
We performed a bibliographic review of the systems proposed by various researchers to evaluate physiologic metatarsal protrusion. The system of measurement devised by Hardy and Clapham to evaluate the protrusion between the first and second metatarsals was adapted to study the whole metatarsal parabola. We studied the five metatarsals of 52 normal feet. Mean metatarsal protrusion relative to the second metatarsal was +1.21% for the first metatarsal, −3.84% for the third metatarsal, −9.66% for the fourth metatarsal, and −16.91% for the fifth metatarsal. (J Am Podiatr Med Assoc 96(3): 238–244, 2006)
Background: We designed this study to verify whether the sesamoids of the first metatarsal head are longer than normal in feet with incipient hallux limitus, and whether feet with incipient hallux limitus are in a more proximal than normal sesamoid position.
Methods: In a sample of 183 dorsoplantar radiographs under weightbearing conditions (115 of normal feet and 68 of feet with slightly stiff hallux), measurements were made of the length of both the medial and the lateral sesamoids and of the distance between these bones to the distal edge of the first metatarsal head. These variables were compared between the normal and the hallux limitus feet. The relationship between these variables and the hallux dorsiflexion was also studied.
Results: We found significant differences between the two types of foot in the medial and lateral sesamoid lengths, but no significant difference in the distance between the sesamoids to the distal edge of the first metatarsal. A poor-to-moderate inverse correlation was found between hallux dorsiflexion and medial sesamoid length and between hallux dorsiflexion and lateral sesamoid length.
Conclusions: The length of the sesamoid bones of the first metatarsal head could be implicated in the development of the hallux limitus deformity. (J Am Podiatr Med Assoc 98(2): 123–129, 2008)
Background: The aim of this study is to confirm whether the absolute and relative lengths of the first metatarso-digital segment is greater than normal in incipient hallux limitus deformity.
Methods: In a sample of 144 dorsoplantar radiographs under weightbearing conditions (94 of normal feet and 50 of feet with a slightly stiff hallux), measurements were made of the relative first metatarsal protrusion, the length and width of the first metatarsal and of the proximal phalanx of the hallux, the length of the distal phalanx of the hallux, and the total length of the hallux.
Results: There were significant differences between the two types of feet in the relative first metatarsal protrusion, the width of the first metatarsal, the length and width of the proximal phalanx of the hallux, the length of the distal phalanx, and the total length of the hallux.
Conclusion: The size of the first metatarso-digital segment could be implicated in the development of hallux limitus deformity. (J Am Podiatr Med Assoc 97(6): 460–468, 2007)
Background: We performed an adaptation of the system of evaluation of metatarsal protrusion described by Oller in 1994 to study the metatarsal parabola group.
Methods: The system of measurement was applied to the five metatarsals of 169 normal feet (72 feet of women and 97 feet of men) according to the inclusion criteria established.
Results: The mean ± SD metatarsal protrusion angle with respect to the second ray in women was 87.49° ± 5.48° for metatarsal I, 70.00° ± 5.74° for metatarsal III, 63.47° ± 4.17° for metatarsal IV, and 56.38° ± 3.27° for metatarsal V. In men, the values were 85.30° ± 6.75° for metatarsal I, 68.00° ± 6.72° for metatarsal III, 60.56° ± 4.61° for metatarsal IV, and 54.13° ± 3.75° for metatarsal V. The comparative analysis between women and men showed significant differences (P < .05) for all of the values of metatarsal protrusion.
Conclusions: The comparative analysis between women and men indicates a possible difference between the anthropometric values of these variables in humans, suggesting a possible repercussion on the biomechanical patterns by sex. (J Am Podiatr Med Assoc 99(1): 49–53, 2009)
Background: Orthotic devices are used to help children progressively acquire a more physiologic walking pattern.
Methods: To determine the effect of an orthotic device with an out-toeing wedge along with a physiologic shoe as treatment for in-toed gait, angle of gait was measured in 48 children aged 3 to 14 years with in-toed gait. The following comparisons were made: angle of gait in children unshod versus children shod without treatment, angle of gait in children shod without treatment versus children shod plus orthoses, and angle of gait in children unshod versus children shod plus orthoses.
Results: Using a correctly fitting shoe increased the angle of gait in a nonsignificant manner, but a significant increase was revealed in the comparison of the angle of gait in children unshod versus children under treatment. The results showed that the behavior in boys and girls was similar to that in the total sample. Regarding side, the corrective effect of the orthotic device was similar in the two feet. However, the data showed a greater corrective effect of the shoe in the right foot.
Conclusions: Orthotic devices with out-toeing wedge combined with correctly fitting shoes, as well as shoes alone, are useful tools in the treatment of in-toed gait in children. (J Am Podiatr Med Assoc 100(6): 472–478, 2010)
The aims of this study were to determine whether individuals with mild hallux limitus show a diminished capacity of internal rotation of the lower limb compared with those without hallux limitus and whether individuals with mild hallux limitus show an increased foot progression angle.
In 80 study participants (35 with normal feet and 45 with mild hallux limitus), the capacity of internal rotation of the lower limb (internal rotational pattern), hallux dorsiflexion, and the foot progression angle were measured. The values for internal rotational pattern and foot progression angle were compared between the two study groups, and the correlations between these variables were studied.
The capacity of internal rotation of the lower limb was significantly lesser in patients with mild hallux limitus (P < .0001). There was no significant difference in foot progression angle between the two groups (P = .115). The Spearman correlation coefficient was 0.638 (P < .0001) for the relationship between internal rotational pattern and hallux dorsiflexion.
Patients with mild hallux limitus had a lesser capacity of internal rotation of the lower extremity than did individuals in the control group. The more limited the internal rotational pattern of the lower limb, the more limited was hallux dorsiflexion. The foot progression angle was similar in both groups. (J Am Podiatr Med Assoc 101(6): 467–474, 2011)
The aim of this study was to determine whether the treatment of abnormal subtalar pronation restores functional (as opposed to structural) limited dorsiflexion of the first metatarsophalangeal joint (functional hallux limitus). We studied 16 feet of eight individuals with abnormal subtalar pronation. Orthoses were made for all of the feet, and hallux dorsiflexion was measured during weightbearing. Each patient was unshod without the orthosis, unshod with the orthosis fitted on the same day, and unshod with the orthosis fitted approximately 5 months later. The results suggest that in functional hallux limitus caused by abnormal subtalar pronation, hallux dorsiflexion will gradually be restored by the use of foot orthoses to control the abnormal subtalar pronation. (J Am Podiatr Med Assoc 96(4): 283–289, 2006)
Closely related pathologic disorders sometimes manifest with the same symptoms, making for a complex differential diagnosis. This is the situation in plantar fasciitis (PF) and myofascial pain syndrome (MPS) with myofascial trigger points (MTPs) in the sole of the foot. This research assessed the analgesic effect on plantar pain of combination therapy with interferential current stimulation therapy (ICST), treating MTPs in the great toe adductor muscle and the short flexor muscles of the toes in patients whose diagnosis was compatible with PF or MPS.
This study included 22 feet of 17 patients with a diagnosis compatible with PF or MPS with MTP. Participants received combination therapy with ICST for 15 sessions, and the decrease in pain was measured with an algometer and the visual analog scale. Both measurements were taken before and after every fifth session. The pressure pain threshold (PPT) results obtained with the Student t test and the pain intensity perception (PIP) results obtained with the Wilcoxon signed rank test were analyzed by comparing the measurements taken before the treatment and after the fifth, tenth, and 15th sessions.
The decrease in PIP was significant after the fifth, tenth, and 15th sessions (P < .001). The increase in PPT was also significant after the fifth (P = .010), tenth (P = .023), and 15th (P = .001) sessions (P < .05).
The suggested combination therapy of ultrasound with ICST is clinically significant for reducing plantar pain after 15 treatment sessions, with a 6.5-point reduction in mean PIP and a 4.6-point increase in PPT.
Ligamentous or joint laxity is a clinical entity characterized by increased joint mobility beyond the range of motion regarded as normal, and joint mobility is an effective indicator of the degree of laxity. We examined the influence of ligamentous laxity on the range of ankle dorsiflexion with the knee flexed and extended, comparing lax adults with a control (nonlax) group.
The sample comprised 400 individuals: 200 in the control group (mean ± SD age, 32.49 ± 11.06 years) and 200 in the lax group (mean ± SD age, 29.82 ± 9.40 years). The Beighton criteria were applied to each participant to diagnose laxity or nonlaxity, and sex, age, and angle range of bilateral dorsiflexion with the knee extended and flexed were recorded.
The mean ± SD dorsiflexion range with the knee straight was 16.14° ± 5.29° left ankle and 21.21° ± 4.93° right ankle in the lax group and 12.94° ± 4.17° left ankle and 17.08° ± 4.40° right ankle in the control group. The respective values with the knee flexed were 15.84° ± 5.31° and 21.21° ± 4.80° in the lax group and 12.95° ± 3.95 and 17.23° ± 4.25° in the control group.
In this sample, ankle dorsiflexion range in the lax group was 4° bigger than that in the control group in both knee positions.