Measurement of Dorsal First Ray Mobility

NewsBot · Mar 24, 2019

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Measurement of Dorsal First Ray Mobility: A Topical Historical Review and Commentary
Ward M. Glasoe PhD, PT, ATC, Thomas C. Michaud, DC
Foot & Ankle International March 22, 2019

Despite evidence that instability of the first ray (first metatarsal and medial cuneiform) alters the loading mechanics of the foot, surprisingly few studies have linked the condition with disorders of the foot. A factor limiting this research is the difficulty associated with measuring first ray mobility (FRM). To quantify dorsal FRM, clinicians and researchers have devised a variety of methods that impose a dorsally directed load, and record displacement. The methods include manual examination, radiographs, mechanical devices, and handheld rulers. Since different methods yield different results; each of these methods is worthy of scrutiny. This article reviews the methods used to quantify dorsal FRM and offers commentary on how the testing procedures could be standardized. The measurement of dorsal FRM informs surgical decisions, orthotic prescriptions, and research design strategies mostly as it pertains to the identification and treatment of first ray hypermobility. This review found sufficient support to recommend continued use of radiographs and mechanical devices for quantifying dorsal displacement, whereas measurements acquired with handheld rulers are prone to the same subjective error attributed to manual examination procedures. Since measures made with radiographs and existing mechanical devices have their own drawbacks, the commentary recommends ideas for standardizing the testing procedure and calls for the development of a next-generation device to measure dorsal FRM. This future device could be modeled after arthrometers that exist and are used to quantify stability at the knee and ankle.
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Admin2 · Mar 24, 2019

Related Thread:
Hallux valgus and first ray mobility

NewsBot · Apr 18, 2020

The Validity and Reliability of a New Simple Instrument for the Measurement of First Ray Mobility
Pedro V. Munuera-Martínez et al
Sensors 2020, 20(8), 2207

Several methods have been described to quantify the first ray mobility. They all have certain disadvantages (great size, sophistication, or lack of validation). The objective of this work was to study the validity and reliability of a new instrument for the measurement of first ray mobility. Anterior-posterior radiographs were obtained from 25 normal feet and 24 hallux valgus feet, with the first ray in a neutral position, maximally dorsiflexed and maximally plantarflexed. The first ray mobility was radiographicaly measured in both groups, and was also manually examined with the new device. A cluster analysis determined whether normal and hallux valgus feet were correctly classified, and a graphic analysis of Bland-Altman was performed to compare the radiographic and manual measurement techniques. Based on the radiographs, the first ray mobility only showed significant differences in dorsiflexion between both groups (P = 0.015). First ray dorsiflexion, plantarflexion and total range of motion measured with the new device were different between both groups (P = 0.040, P = 0.011 and P = 0.006, respectively). The silhouette measure of the cohesion and separation coefficients from the cluster analysis was greater than 0.50 for the dorsiflexion, plantarflexion and total range of motion obtained from the radiographs and from the new device. The Bland-Altman graph suggested that 96% of the data presented agreement between both measurement methods. These results suggested that the new instrument was valid and reliable.
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NewsBot · Jun 24, 2020

Hypermobility of the First Ray: The Cinderella of the Measurements Conventionally Assessed for Correction of Hallux Valgus
Carlo Biz et al
Acta Biomed. 2020 May 30;91(4-S):47-59

Background and aim of the work: hypermobility of the first ray (FRH) began to be considered as a pathological entity from Morton's studies and was associated as a primary cause of hallux valgus (HV ). Currently, this relationship is in discussion, and various authors consider FRH as a consequence of the deformity. The purpose of this narrative review is to summarise the most influential publications relating to First Ray Mobility (FRM) to increase knowledge and promote its conventional assessment during clinical practice.

Methods: papers of the last century were selected to obtain a homogeneous and up-to-date overview of I-MTCJ mobility and HV, as well as their relationship and management.

Results: in recent years, FRH was studied from a biomechanical and pathophysiologic point of view. There is still not enough data regarding the aetiology of FRM. The higher rate of instability found in HV lacks an explanation of which is the cause and which is the effect. However, the Lapidus arthrodesis is still a valid method in cases of FRH and HV, even if is not rigorously indicated to treat both. When approaching FRH, radiographic or clinical findings are mandatory for the right diagnosis.

Conclusions: FRM is an important factor that must be considered in routine clinical practice and prior and post HV surgery, as much as the conventional parameters assessed. Surgeons should consider performing I-MTCJ arthrodesis only if strictly necessary, also paying attention to soft tissue balancing. Improving the measurement of FRH could be useful to determine if it is a cause or effect of the HV deformity.
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NewsBot · Jul 20, 2021

Comparative Reliability of a Novel Electromechanical Device and Handheld Ruler for Measuring First Ray Mobility
Oliver J Morgan et al
Foot Ankle Int. 2021 Jun 11

Background: Quantifying first ray mobility is crucial to understand aberrant foot biomechanics. A novel device (MAP1st) that can perform measurements of first ray mobility in different weightbearing conditions, foot alignments, and normalization was tested. The reliability of these measurement techniques was assessed in comparison to a handheld ruler considered representative of the common clinical examination.

Methods: The study included 25 participants (50 feet). Two independent raters performed baseline, test-retest, and remove-replace measurements of first ray mobility with MAP1st and the handheld device. The effects of non-, partial, and full weightbearing in subtalar joint neutral and the resting calcaneal stance position were assessed. Measurement normalization relative to foot size was also investigated. Intra- and interclass correlation coefficients (ICCs) were calculated for each device between the 2 raters. In addition, Bland-Altman plots were constructed to determine if fixed biases or substantial outliers were present.

Results: Similar intrarater ICC values were found for both devices (≥0.85). However, interrater ICC values were substantially improved by MAP1st compared with the handheld device (0.58 vs 0.06). Bland-Altman plots demonstrated biases of 1.27 mm for the handheld ruler, and 2.88 to 0.05 mm and -1.16 to 0.00 for linear and normalized MAP1st measurements, respectively. Improved reliability was achieved with MAP1st for normalized assessments of first ray mobility while the foot was placed in partial- and full-weightbearing resting calcaneal stance positions.

Conclusion: MAP1st provided reliable assessments of partial- and full-weightbearing first ray mobility. It should help investigators to explore the potential relationships between first ray function and aberrant foot biomechanics in future research.
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NewsBot · Nov 1, 2022

Reliability Study of a New Electromechanical Device Designed to Measure the Relative Dorsal Mobility of the First Ray of the Foot
Nils Reymond et al
Open Journal of Orthopedics > Vol.12 No.10, October 2022

Introduction: A new electromechanical instrument has been developed to measure relative dorsal mobility of the first ray in an objective and reliable way by simulating ground reaction forces during gait. This device equally applies a standardized, electronically controlled, and precise force under the first metatarsal head M1 as well as under the heads of the lesser metatarsals M2 to M5. The relative dorsal mobility between these two bearings is then measured. The purpose of this study is to assess the intra- and inter-examiners reliabilities of the measurements obtained with this device. Methods: The protocol included two examiners and 36 feet (18 volunteers with healthy feet and no history of forefoot disorders). A total of nine measurements were performed on each foot separated into three sets of three trials for the assessment of inter-rater and intra-rater reliability. For this purpose, the interclass correlation coefficient (ICC), the error of measurement (SEM) and the Bland and Altman (B&A) graphical analysis were computed. Results: Excellent ICC values (≥0.91) were obtained with the novel device for inter-rater and intra-rater reliability when using the FRRM calculation. The B&A analysis presented a bias between examiners of -0.25 mm ranging from -1.66 to 1.18 mm. Conclusion: This study demonstrated the capability of the developed device to reliably measure the relative dorsal mobility of the first ray of the foot. This is a promising first step for further studies to better understand, qualify and quantify first ray hypermobility.
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