'The First Metatarsal Rise Sign' in posterior tibial tendon dysfunction

Craig Payne · Jul 30, 2015

Members do not see these Ads. Sign Up.
I just stumbled on this 1996 paper that I either did not recall or missed; I have not come across this test in other sources either *or too dumb to recognize it!)

The First Metatarsal Rise Sign: A Simple, Sensitive Sign of Tibialis Posterior Tendon Dysfunction
Beat Hintermann, M.D. & Andr? G?chter, M.D.
Foot & Ankle International April 1996 vol. 17 no. 4 236-241

Although foot deformation starts in the early stage of tibialis posterior (TP) tendon dysfunction, this condition is often overlooked or misdiagnosed. We observed consistently a clinical sign of TP tendon dysfunction that, to our knowledge, has not yet been described. Patients were tested while they were standing and fully weightbearing with both feet. When the shank of the affected foot was taken with one hand and externally rotated, or when the heel of the affected foot was taken with one hand and brought passively into a varus position, the head of the first metatarsal raised in the case of TP dysfunction and remained on the ground in normal TP function. The purpose of this prospective study was to validate this clinical finding by surgical exploration, and to compare its sensitivity with other common clinical signs. Our series included 21 consecutive feet with TP tendon dysfunction (19 patients). The deformity was supple in 12 feet and fixed in 9 feet. Radiographs and magnetic resonance imaging were found to be unreliable in diagnosing dysfunction of the TP tendon. While other clinical signs (too many toes, the single-heel rise, and the double-heel rise) were noted to be negative in 20% to 35%, we found our first metatarsal rise sign to be positive in all cases of TP tendon dysfunction. This simple clinical test enables us to recognize and treat a dysfunction of the TP tendon at an early stage, when the foot is still supple. As the foot deformation progresses, early treatment may be the most effective measure in preventing long-term functional impairment.
Click to expand...

The sign:

Patients were tested while they were standing and fully weightbearing with both feet. When the shank of the affected foot was taken with one hand and externally rotated, or when the heel of the affected foot was taken with one hand and brought passively into a varus position, the head of the first metatarsal raised in the case of TP dysfunction and remained on the ground in normal TP function.
Click to expand...

The finding:

we found our first metatarsal rise sign to be positive in all cases of TP tendon dysfunction
Click to expand...

efuller · Jul 30, 2015

The sign:
Quote:
Patients were tested while they were standing and fully weightbearing with both feet. When the shank of the affected foot was taken with one hand and externally rotated, or when the heel of the affected foot was taken with one hand and brought passively into a varus position, the head of the first metatarsal raised in the case of TP dysfunction and remained on the ground in normal TP function.
The finding:
Quote:
we found our first metatarsal rise sign to be positive in all cases of TP tendon dysfunction
Click to expand...

I'm thinking about the supination resistance test in relation to this test. I remember Craig talking about how some feet would "break the supination resistance machine". I don't remember if it was medially deviated axis feet or PT tendon dysfunction feet that broke the machine. Regardless, My sense is that there is a high correlation between those feet. Then you look at the test where they take one hand and externally rotate the shank. Or they take one hand to move the heel into varus. Something is not adding up. One hand is a lot less than breaking the machine. If a subject keeps the same ratio of weight on the forefoot and the rearfoot, it is really hard to move the foot by grabbing the leg and twisting. Does the article have pictures of the test?

Eric

Craig Payne Moderator

efuller MVP

'biological plausibility' and 'theoretical coherence'

'The night of' (foot sub plot)

'Therapeutic Ultrasound' Shows Bone Stress Injuries

'The Clinic Online' in the UK - any experiences?

3rd metatarsal dislocated fracture

Supination? Callus? 5th metatarsal area?

Avascular necrosis of the first metatarsal head

Share This Page