Prediction of the First Ray Axis from Clinical Measurements

NewsBot · May 20, 2015

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Prediction of the First Ray Axis from Clinical Measurements: Implications for the Treatment of Bunion
Glasoe Ward M, Wolff Kristina, Wicks Andrew, Shaw Andrea and Smith Janie
Clin Res Foot Ankle 2:144. doi: 10.4172/2329-910X.1000144

Objective: Inclination of the first ray axis has been identified as a risk factor of bunion, but the actual orientation of a joint axis can only be quantified with motion analysis techniques. This investigation used a single-group regression design for the purpose of identifying a surrogate measure, or system of measurements, that could predict the orientation of the first ray axis.

Methods: The clinical measurements of the foot were performed on 20 women participants including 10 with, and 10 without bunion. Magnetic resonance images of the foot were acquired while the participant stood to simulate gait. Images were then rendered into virtual datasets from which first ray kinematics were decomposed into X, Y, and Z Cardan angles and helical axis direction cosine component parameters. Reliability of the clinical measurements was assessed, and multiple regression analysis determined the relationship amongst variables.

Results: Measurements of dorsum foot height, hallux dorsiflexion, hallux angle, intermetatarsal angle, and arch angle were reliable (ICC ≥ 0.67) and when used as variables in the regression analysis models, the curvilinear measure of hallux dorsiflexion and the linear measure of hallux angle combined to explain a significant (p=0.01) 49 percent (R2=0.49) of the overall variance in predicting the first ray axis.

Conclusion: Five of the clinical measurements, all except navicular drop and hindfoot valgus were judged reliable. Of these, only hallux dorsiflexion and hallux angle had a relationship with the first ray axis. This report marks the first attempt to identify measures that predict the loading behaviors of the first ray. Results may inform future work, as it is likely some other combination of measurements may more strongly predict inclination of the first ray axis which may, in theory, be amendable with non-operative treatment (i.e. orthoses) in the management of foot bunion.
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NewsBot · Sep 18, 2015

The Mechanical Axis of the First Ray: A Radiographic Assessment in Hallux Abducto Valgus Evaluation
Guido A. LaPorta, DPM, FACFAS, Ellianne M. Nasser, DPM, AACFAS, Jennifer L. Mulhern, DPM, AACFAS, D. Scot Malay, DPM, MSCE, FACFAS
JFAS; Article in Press

The present report describes a new method of hallux abducto valgus deformity correction planning using the mechanical axis of the medial column (mechanical axis planning). This method of radiographic evaluation identifies an ideal position for the first metatarsal after correction and is useful regardless of the surgical procedure chosen. We retrospectively reviewed 200 radiographs to identify a “normal” value for the mechanical axis angle. We reviewed 100 radiographs of patients with hallux abducto valgus deformity (deformity group) and 100 radiographs of patients without hallux abducto valgus deformity (control group). The deformity group revealed an M1-M2 anatomic axis angle of 13.5⁰ ? 2.83⁰ and an M1-M2 mechanical axis angle of 11.58⁰ ? 1⁰. The control group revealed an M1-M2 anatomic axis angle of 7.5⁰ ? 1.76⁰ and an M1-M2 mechanical axis angle of 11.19⁰ ? 0.9⁰. The differences in the M1-M2 anatomic axis angle and M1-M2 mechanical axis angle were statistically significant between the control and deformity groups. We sought to provide a reliable method for planning hallux abducto valgus deformity correction by aligning the mechanical axis of the medial column and the mechanical axis of the first ray to the “normal” value of 11⁰ to reduce the deformity.
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