Hyperextended hallux interphalangeal joint (IPJ) is observed frequently in clinical practice associated with limited first metatarsophalangeal joint (MPJ) dorsiflexion, although, to our knowledge, data regarding the prevalence of this alteration has not been reported. In a normal foot, the first ray should be able to become plantarflexed so that the transverse axis of the first MPJ alters its position during the propulsive phase of gait, enabling supination of the rearfoot and external rotation of the leg.1,2 When hypermobility of the first ray exists, the head of the first metatarsal is displaced dorsally in response to ground reaction force in this phase of gait, and there is a deficit in support that the subtalar joint has to compensate by pronating so that the first metatarsal bears part of the weight of the body. However, once the first ray is dorsiflexed, and the subtalar joint is pronated as a compensatory mechanism, the peroneus longus muscle does not stabilize the first ray, having lost its mechanical advantage.3–5 This incomplete support of the first ray is made up for by the proximal phalanx of the hallux, which adopts a plantarflexed position, translating the point of support from the head of the first metatarsal to the plantar region of the hallux IPJ and, thus, elongating the lever of the deficient first metatarsal. With this position of the proximal phalanx, the hallux IPJ is hyperextended to prevent the distal phalanx from being traumatized against the ground. However, this compensatory position gives rise to other signs and symptoms often present in participants with hallux limitus, such as subungual exostoses,6 overload on the heads of the external metatarsals and under the hallux,7–10 and ungual dystrophies by chronic trauma of the distal end of the distal phalanx against the toe box of the shoe.9,11 Therefore, these alterations should be treated bearing in mind the state of mobility of the first MPJ.
Although there are studies12 assessing the mobility of the hallux IPJ, to our knowledge, there are few works13–16 that contribute specific data on the relationship between the mobility of this joint and the mobility of the first MPJ. Understanding this relationship would enable us to know to what extent hallux IPJ mobility is affected when first MPJ dorsiflexion is reduced. Thus, the aims of this work were to assess the degree of correlation between hallux IPJ and first MPJ dorsiflexion and to compare the mobility of the hallux IPJ between participants with and without hallux limitus. The null hypotheses of this study were that 1) there is no correlation between first MPJ dorsiflexion and hallux IPJ mobility and 2) there is no difference in hallux IPJ dorsiflexion between individuals with normal feet and participants with hallux limitus.
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. : “ Dananberg, HJ , and AJ Phillips HE Blaakman A Rational Approach to the Nonsurgical Treatment of Hallux Limitus.,” inAdvances in Podiatric Medicine and Surgery. , Vol 2:, edited by . , p , Kominsky, SJ , TP Kalla , RM Jay et al 67. , Mosby-Year Book Inc. , St. Louis. , 1996. .
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