In weight-bearing AP radiographs, specific angles have been defined to quantify and understand the deformity ( Fig. Additionally, other conditions such as instabilities, joint degenerations and malalignment of other joints of the foot are assessed. 6Īnteroposterior (AP) and lateral weight-bearing radiographs of the entire foot are recommended for diagnostics and angular measurements to define the extent of the deformity. 5 Klaue defined hypermobility as a motion exceeding between 8 and 10 mm without a firm end-point. Dorsally directed force on the first metatarsal head then allows evaluation of the degree of instability of the first metatarsal with respect to the second. The mobility of the first TMT joint is evaluated with the tip of one thumb beneath the second metatarsal head and the tip of the other thumb beneath the plantar aspect of the first. 4 Limited range of motion in the first MTP joint indicates degenerative changes. Range of motion of the ankle, subtalar, transverse tarsal and MTP joints, and first tarsometatarsal (TMT) joint mobility can be evaluated with the patient seated. The degree of hallux deformity and the presence of pes planus are evaluated with the patient standing. Physical examination usually starts with observing the patient’s gait.
#First mtp joint skin#
Typical complaints are pain over the medial eminence, local skin or bursa irritation, medial deviation of the first ray, lateral deviation and pronation of the great toe. DOI: 10.1302/2058-5205.Įvaluation of the hallux valgus starts with careful history-taking. Post-operative radiographs are taken in regular intervals until osseous healing is achieved.Ĭite this article: Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M.
#First mtp joint full#
Depending on the procedure, partial or full weight-bearing in a post-operative shoe or cast immobilisation is advised. Hallux valgus correction is followed by corrective dressings of the great toe post-operatively. Recently, minimally invasive percutaneous techniques have gained importance and are currently being evaluated more scientifically. Surgical techniques include the modified McBride procedure, distal metatarsal osteotomies, metatarsal shaft osteotomies, the Akin osteotomy, proximal metatarsal osteotomies, the modified Lapidus fusion and the hallux joint fusion.
The role of stability of the first tarsometatarsal joint is controversial.
The decision on which surgical technique is used depends on the degree of deformity, the extent of degenerative changes of the first metatarsophalangeal joint and the shape and size of the metatarsal bone and phalangeal deviation. There are many operative techniques for hallux valgus correction. However, insoles and physiotherapy in combination with good footwear can help to control the symptoms. Non-operative treatment of the hallux valgus cannot correct the deformity. Anteroposterior and lateral weight-bearing radiographs of the entire foot are crucial for adequate assessment in the treatment of hallux valgus. Taking the patient’s history and a thorough physical examination are important steps. It is characterised as a combined deformity with a malpositioning of the first metatarsophalangeal joint caused by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone. Hallux valgus deformity is a very common pathological condition which commonly produces painful disability.