Measuring First MPJ Stiffness

NewsBot · Oct 27, 2016

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A novel method of measuring passive quasi-stiffness in the first metatarsophalangeal joint
Marabelle L. Heng, Yaohui K. Chua, Hong K. Pek, Priathashini Krishnasamy and Pui W. Kong
Journal of Foot and Ankle Research20169:41

Background
First metatarsophalangeal joint (MTPJ) mobility is commonly assessed by its angular displacement (joint angle) or subjectively rated as ‘hypermobile’, ‘normal’ or ‘stiff’ by a clinician. Neither of these methods is ideal because displacement alone does not take into account the force required to displace the joint and subjective evaluation is not always reliable. This study presented a novel method to determine the passive quasi-stiffness of the first MTPJ. The reliability of the proposed method was also assessed. The first MTPJ passive quasi-stiffness of 13 healthy subjects were measured at two occasions, 7 days apart, by two testers (experienced and inexperienced). A tactile pressure sensing system was used to measure the force applied to dorsiflex the first toe by the testers. The torque (in Nmm) about the first MTPJ was calculated as the applied force (in N) multiplied by a moment arm (in mm), where moment arm was the length of the first proximal phalanx. A video camera recorded the motion of the first MTPJ, simultaneously with force measurements, to determine the joint angular displacement (in degrees) using the Dartfish software. The quasi-stiffness (in Nmm/degrees) was calculated as the slope of a graph where torque was plotted against first MTPJ angular displacement. Descriptive statistics of the first MTPJ quasi-stiffness were calculated. Intra-rater and inter-rater reliability were assessed using Bland and Altman plot, intraclass correlation coefficients (ICC), and standard error of measurement (SEM).

Results
First MTPJ quasi-stiffness of the subjects ranged widely from 0.66 to 53.4 Nmm/degrees. Intra-rater reliability for experienced tester was moderate (Session 1: 14.9 ± 14.6 Nmm/degrees, Session 2: 14.2 ± 8.5 Nmm/degrees, ICC = .568, SEM = 7.71 Nmm/degrees). Inter-rater reliability between experienced (12.6 ± 8.4 Nmm/degrees) and non-experienced (19.9 ± 9.2 Nmm/degrees) testers was poor (ICC = -.447, SEM = 11.29 Nmm/degrees).

Conclusions
First MTPJ passive quasi-stiffness can be quantified from torque and angular displacement measurements using simple equipment in a clinical setting. The tester’s experience affected the consistency in joint quasi-stiffness measurements.
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NewsBot · May 27, 2017

Measuring Joint Flexibility in Hallux Rigidus Using a Novel Flexibility Jig
Elizabeth A. Cody, MD, Andrew P. Kraszewski, PhD, Anca Marinescu, BA, Grace C. Kunas, BA, Sriniwasan B. Mani, BS, Smita Rao, PT, PhD, Howard H. Hillstrom, PhD, Scott J. Ellis, MD
Foot & Ankle International May 23, 2017

Background:
The flexibility of the first metatarsophalangeal (MTP) joint in patients with hallux rigidus (HR) has not been studied. Compared to measuring range of motion alone, measures of joint flexibility provide additional information that may prove useful in the assessment of HR. The purpose of this study was to assess the flexibility of the hallux MTP joint in patients with HR compared to controls using a novel flexibility device.

Methods:
Fifteen patients with Coughlin stage II or III HR and 20 healthy controls were recruited prospectively. Using a custom flexibility jig, each of 2 raters performed a series of seated and standing tests on each subject. Dorsiflexion angle and applied torque were plotted against each other to generate 5 different parameters of flexibility. Differences between (1) HR patients and controls and (2) the sitting and standing testing positions were assessed with t tests. Intrarater test-retest reliability, remove-replace reliability, and interrater reliability were assessed with intraclass correlation coefficients (ICCs).

Results:
Patients in the HR group were older than patients in the control group (P < .001) and had lower maximum dorsiflexion (P < .001). HR patients were less flexible as measured by 3 of the 5 flexibility parameters: early flexibility (first 25% of motion; P = .027), laxity angle (P < .001), and torque angle (P = .002). After controlling for age, only laxity angle differed significantly between HR patients and controls (P < .001). Generally, patients were more flexible when seated compared to standing, with this effect being more marked in HR patients. All parameters had good or excellent intra- and interrater reliability (ICC ≥ 0.60).

Conclusions:
Hallux MTP joint flexibility was reliably assessed in HR patients using a flexibility device. Patients with HR had decreased flexibility of the hallux MTP joint compared to control patients.
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mike weber · May 29, 2017

Hallux Rigidis Flexibility - well there is today oxymoron

Rigid - no movement

Limitus reduced range of Motion

Griff · May 30, 2017

I'd agree. Mean maximum dorsiflexion of ~30deg/20deg (when sitting/standing respectively) in the 'hallux rigidus' group. A reasonable debate of how this entity should be 'diagnosed' should probably follow.

Also, can't help but think the term 'flexibility' used throughout this paper should've just been replaced with 'stiffness'?

mike weber · May 31, 2017

Agree with that Ian, that they should be discussing stiffness not flexibility

NewsBot · May 30, 2018

Determination of Ankle and Metatarsophalangeal Stiffness During Walking and Jogging
Fabian Mager et al
Journal of Applied Biomechanics

Forefoot stiffness has been shown to influence joint biomechanics. However, little or no data exists on metatarsophalangeal stiffness. Twenty-four healthy rearfoot strike runners were recruited from a staff and student population at the University of Central Lancashire. Five repetitions of shod, self-selected speed level walking and jogging were performed. Kinetic and kinematic data were collected using retro-reflective markers placed on the lower limb and foot, to create a three-segment foot model using the Calibrated Anatomical System Technique. Ankle and metatarsophalangeal moments and angles were calculated. Stiffness values were calculated using a linear best fit line of moment versus of angle plots. Paired t-tests were used to compare values between walking and jogging conditions. Significant differences were seen in ankle range of motion (ROM), but not in metatarsophalangeal ROM. Maximum moments were significantly greater in the ankle during jogging, but these were not significantly different at the metatarsophalangeal joint. Average ankle joint stiffness exhibited significantly lower stiffness when walking compared to jogging. However, the metatarsophalangeal joint exhibited significantly greater stiffness when walking compared to jogging. A greater understanding of forefoot stiffness may inform the development of footwear, prosthetic feet and orthotic devices, such as ankle-foot orthoses for walking and sporting activities.
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mike weber · May 30, 2018

Looks interesting

NewsBot · Jul 22, 2018

An Ergonomic Testing System for the First Metatarsophalangeal Joint Stiffness.
Farhadi F et al
J Biomech Eng. 2018 Oct 1;140(10). doi: 10.1115/1.4040248.

Osteoarthritis sufferers commonly have first metatarsophalangeal joint (MTPJ) problems in which articular surfaces are changed permanently due to fatigue. Therefore, medical devices for early diagnosis would increase the opportunity for prevention of disease progression. In previous studies on stiffness of the first MTPJ many details, although functionally of great importance, have not been fully considered including: design and size of the device, tribology consideration, and errors from device. Therefore, the motivation of our research was to enhance the device design by reducing the size of the device, and device design was enhanced by minimizing measurement errors through development of a new ergonomic left and right foot instrument located medial to the first MTPJ (instead of beneath the foot). The first MTPJ stiffness (N mm/kg radian) measurement was taken on 28 subjects with two replicates per subject by the same tester. The first MTPJ stiffness ranged from 3.49 to 14.42 N mm/kg radian with the mean (SD) value of 8.28 (3.15) N mm/kg radian for the left feet and 3.91 to 11.90 N mm/kg radian with the mean (SD) value of 7.65 (2.07) N mm/kg radian for the right feet. Reliability evaluation was measured using intraclass correlation coefficient and described an excellent reliability between two tests.
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NewsBot · Oct 11, 2020

Test-retest reliability of a clinical foot assessment device for measuring first metatarsophalangeal joint quasi-stiffness
Yixuan Leow et al
Foot (Edinb). 2020 Sep 13;45:101742

Background: The stiffness of the first metatarsophalangeal joint (MTPJ) is of interest in cases such as hallux rigidus and apropulsive gait. Subjective rating of joint mobility as 'hypermobile, normal, or stiff' is an unreliable method. Previous instruments for the assessment of first MTPJ stiffness can be too hard and uncomfortable for test subjects. Recently, a new device using a load cell and optical fiber with fiber Bragg grating (FBG) sensors was developed to provide a comfortable means of clinical foot assessment. This study aimed to evaluate the test-retest reliability of this FBG-load cell device in measuring the first MTPJ quasi-stiffness.

Methods: The left foot of 13 female subjects were measured twice for their first MTPJ quasi-stiffness, approximately seven days apart. The FBG-load cell device measured the MTPJ range of motion from a resting position to maximum dorsiflexion and then returning to the resting start-position. The force applied by a clinician to displace the toe was simultaneously recorded using a load cell. The quasi-stiffness over the "working range" in loading and unloading directions were determined from the slope of the torque-angular displacement graph. The test-retest reliability of the MTPJ quasi-stiffness was evaluated using intra-class correlation coefficient [ICC (2,1)].

Results: The reliability was almost perfect for MTPJ quasi-stiffness over the loading phase (ICC = 0.814), moderate for MTPJ quasi-stiffness over the unloading phase (ICC = 0.477) and moderate for MTPJ maximum range (ICC = 0.486).

Conclusion: The foot assessment device based on FBG and load cell was able to reliably measure the first MTPJ quasi-stiffness in a clinical setting. The measurement reliability was higher during the loading phase than the unloading phase.
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NewsBot · Oct 5, 2022

Metatarsophalangeal Joint Dynamic Stiffness During Toe Rocker Changes With Walking Speed
Luke Nigro, Elisa S Arch
J Appl Biomech. 2022 Sep 12;38(5):320-327

Dynamic joint stiffness (or simply "stiffness") is a customization criteria used to tune mechanical properties of orthotic and prosthetic devices. This study examines metatarsophalangeal (MTP) joint stiffness during the toe-rocker phase of barefoot walking and establishes baseline characteristics of MTP joint stiffness. Ten healthy individuals walked at 4 speeds (0.4, 0.6, 0.8, and 1.0 statures·s-1) over level ground. MTP sagittal plane joint angles and moments were calculated during the toe-rocker phase of stance. Least-squares linear regressions were conducted on the MTP moment versus angle curve to determine joint stiffness during early toe rocker and late toe rocker. Multilevel linear models were used to test for statistically significant differences between conditions. Early toe rocker stiffness was positive, while late toe rocker was negative. Both early toe rocker and late toe rocker stiffness increased in magnitude significantly with speed. This study establishes baseline characteristics of MTP joint stiffness in healthy walking, which previously had not been examined through a range of controlled walking speeds. This information can be used in the future as design criteria for orthotic and prosthetic ankle and ankle-foot devices that can imitate, support, and facilitate natural human foot motion during walking better than existing devices.
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