First Metatarsal Motion and Metatarsal Load Distribution

NewsBot · Jun 3, 2018

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Relationship Between First Metatarsal Motion and
Metatarsal Load Distribution During Walking
Christopher Casillas, James Becker. Montana State University,
Bozeman, MT.
Presented at ACSM Mtg, 2018

Hypermobility of the first metatarsal (M1) has been theorized to alter plantar loading,
and thus be one contributing factor in the development of second (M2) and third (M3)
metatarsal stress fractures. To date, most studies examining these relationships have
used static measures of M1 mobility. However, it has been shown that there is poor
agreement between static measures of M1 mobility and M1 mobility during gait.
PURPOSE: To quantify the relationship between sagittal plane M1 range of motion
(ROM) during walking gait and vertical load distribution among the metatarsals.

METHODS: Participants were 10 physically active individuals (sex: 5 M, 5 F; age:
21.8 ± 3.0 years). A 12-camera motion capture system recorded foot kinematics during
walking while plantar pressures were recorded concurrently with a plantar pressure
mat located over the force plate. Participants completed 3 trials with both left and
right feet (total: 60 trials). A multi-segment foot marker set was used to calculate
movement of M1 relative to the midfoot. The plantar pressure data was used to identify
the entire metatarsal region, as well as each individual metatarsal. Peak load in the
metatarsals and percent of peak carried in each metatarsal were then calculated. A
linear regression was used to determine the relationship between M1 ROM and percent
peak load carried in each metatarsal.

RESULTS: Peak load in the metatarsals was 1.25
(± 0.25) % body weight. At peak loading, M1, M2, M3 carried 19.14 (± 7.89), 24.53
(±3.92), and 28.37(±4.09) % of the load, respectively. Average ROM for M1 relative
to midfoot was 7.84 (± 2.60°). There was not a significant relationship between M1
ROM and percent load under M1 (R2 = 0.05, p = 0.22), M2 (R2 = 0.01, p = 0.70), or
M3 (R2 = 0.02, p = 0.25).

CONCLUSION: Our results do not support the hypothesis
that M1 hypermobility increases loading of M2 and M3. Future studies should examine
whether other aspects of dynamic M1 mobility instead of simple ROM may be related
to increased loading of M2 and M3.
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Craig Payne · Jun 3, 2018

Shame they measured first ray ROM and not first ray stiffness --> clinically relevant ...

NewsBot · Nov 26, 2018

Static Range of Motion of the First Metatarsal in the Sagittal and Frontal Planes.
Tavara-Vidalón SP et al
J Clin Med. 2018 Nov 21;7(11). pii: E456. doi: 10.3390/jcm7110456.

The first metatarsal and medial cuneiform form an important functional unit in the foot, called "first ray". The first ray normal range of motion (ROM) is difficult to quantify due to the number of joints that are involved. Several methods have previously been proposed. Controversy exists related to normal movement of the first ray frontal plane accompanying that in the sagittal plane. The objective of this study was to investigate the ROM of the first ray in the sagittal and frontal planes in normal feet. Anterior-posterior radiographs were done of the feet of 40 healthy participants with the first ray in a neutral position, maximally dorsiflexed and maximally plantarflexed. They were digitalized and the distance between the tibial malleolus and the intersesamoid crest in the three positions mentioned was measured. The rotation of the first ray in these three positions was measured. A polynomic function that fits a curve describing the movement observed in the first ray was obtained using the least squares method. ROM of the first ray in the sagittal plane was 6.47 (SD 2.59) mm of dorsiflexion and 6.12 (SD 2.55) mm of plantarflexion. ROM in the frontal plane was 2.69 (SD 4.03) degrees of inversion during the dorsiflexion and 2.97 (SD 2.72) degrees during the plantarflexion. A second-degree equation was obtained, which represents the movement of the first ray. Passive dorsiflexion and plantarflexion of the first ray were accompanied by movements in the frontal plane: 0.45 degrees of movement were produced in the frontal plane for each millimeter of displacement in the sagittal plane. These findings might be useful for the future design of instruments for clinically quantifying first ray mobility.
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NewsBot · Aug 18, 2020

Descriptive quantitative analysis of first metatarsal sagittal plane motion
Andrew J. Meyr et al
JFAS: August 14, 2020

Evaluation of the sagittal plane motion of the first ray is a commonly accepted physical examination technique performed during the assessment and treatment of the hallux valgus deformity. Excessive or abnormal motion in this location, termed “hypermobility,” has also traditionally been strongly associated with surgical decision making and serves as a widely accepted indication for performance of the first metatatarsal-medial cuneiform arthrodesis procedure. The objective of this investigation was to perform an analysis of first ray sagittal plane motion from a large population in order to determine the descriptive quantitative characteristics of the data set. First metatarsal sagittal plane motion was measured from a group of 149 subjects (298 feet) with a Klaue device. The mean total first metatarsal sagittal plane motion was 9.37 ± 2.39mm (3.97-18.76). The data set was found to demonstrate many of the characteristics of a normally distributed population based on the histogram distribution, skewness (0.651), and kurtosis (0.761). No difference was observed between measurement of total sagittal plane motion between right and left feet (9.13 ± 2.37mm vs. 9.61 ± 2.40mm; p=0.081), nor between male and female subjects (9.29 ± 2.27mm vs. 9.58 ± 2.70mm; p=0.352). No substantial correlation was observed between total sagittal plane motion and subject age (Pearson correlation -0.053; p=0.522). Results indicate that first ray sagittal plane motion might be best considered as a continuous variable as opposed to categorical variable, and might help objectify the difference between “normal” and “abnormal” motion.
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NewsBot · Jun 12, 2022

Impact of First Metatarsal Hyperpronation on First Ray Alignment: A Study in Cadavers
Lalevée, Matthieu et al
Clinical Orthopaedics and Related Research: June 7, 2022

Background
There is increased evidence of first metatarsal hyperpronation in patients with hallux valgus, but its impact on the stability of the first metatarsophalangeal and metatarsosesamoid joints is unknown. A previous biomechanical study showed that an increase in hallucal pronation might lead to medial soft tissue failure of the first metatarsophalangeal joint. Conversely, dynamic studies on hallux valgus have shown that the first tarsometatarsal joint moves in supination during weightbearing, and supination was associated with an increase in the intermetatarsal angle (IMA) and hallux valgus angle (HVA).

Questions/purposes
(1) Does an increase in first metatarsal pronation cause an increase in hallucal pronation? (2) Can an intrinsic increase in first metatarsal pronation lead to first ray supination during weightbearing? (3) Can a combination of intrinsic first metatarsal hyperpronation and first metatarsophalangeal medial soft tissue failure increase supination of the first ray during weightbearing? (4) Is first ray supination during weightbearing associated with an increase in the IMA and HVA?

Methods
Twelve transtibial, nonpaired cadaver specimens without deformities were used. Each specimen underwent six weightbearing CT scans under different conditions. The first three CT examinations were performed without any osteotomy of the first metatarsal. The first was a simulated nonweightbearing condition. The second was a simulated weightbearing condition. The third was a simulated weightbearing condition with medial soft tissue release. Subsequentially, a 30° pronation osteotomy of the first metatarsal was performed, and the same sequence of weightbearing CT images was obtained. On each weightbearing CT image, the HVA, IMA, sesamoid rotation angle, metatarsal pronation angle (MPA), metatarsosesamoid rotation angle, and hallucal pronation (HP) were measured. Motions were calculated based on the differential values of these angular measurements produced by the six different conditions (weightbearing, medial soft tissue release, 30° pronation osteotomy, and combinations of these conditions). We compared means using a t-test for normally distributed variables and the Mann-Whitney U test for nonnormally distributed variables. Correlations were assessed with Pearson product-moment correlation coefficients.

Results
We found that 30° pronation osteotomy of the first metatarsal increased the MPA and HP by 28° ± 4° and 26° ± 6°, respectively, in the nonweightbearing condition. No differences between the increase in MPA and the increase in HP were noted (mean difference 2° [95% CI -1° to 5°]; p = 0.20). Therefore, an increase in first metatarsal pronation caused an increase in hallucal pronation. When a 30° pronation osteotomy of the first metatarsal was performed, the first ray motion during weightbearing went from pronation to supination (4° ± 2° in pronation without osteotomy versus 4° ± 2° in supination after the osteotomy, mean difference 8° [95% CI 6° to 9°]; p < 0.001). Therefore, an intrinsic increase in pronation of the first metatarsal led to a first ray supination motion during weightbearing. When a first metatarsophalangeal medial soft tissue release was performed in addition to the 30° osteotomy of the first metatarsal, the supination motion of the first ray increased (4° ± 2° without medial soft tissue release versus 11° ± 7° after the release, mean difference 8° [95% CI 3° to 12°]; p = 0.003). Therefore, a combination of intrinsic first metatarsal hyperpronation and first metatarsophalangeal medial soft tissue failure increased supination of the first ray during weightbearing. Regarding static angular measurements, the HVA and IMA were not correlated with the MPA (ρ = 0.20; p = 0.09 and ρ = 0.22; p = 0.07, respectively). Regarding motions, as the HVA and IMA increased from nonweightbearing to weightbearing the pronation decreased, with strong correlations (ρ = -0.82; p < 0.001 and ρ = -0.77; p < 0.001, respectively). Therefore, a first ray supination during weightbearing was associated with an increase in the HVA and IMA.

Conclusion
The combination of first metatarsal intrinsic hyperpronation and first metatarsophalangeal medial soft tissue failure led to a hallux valgus deformity in this cadaveric study. The static measurement of first metatarsal head pronation relative to the ground (MPA) did not reflect the real intrinsic pronation of the first ray, and foot and ankle specialists should be careful when interpreting these measurements. Hallux valgus is a dynamic condition, and the deformity could be more correlated with motions during weightbearing than with plain static measurements.

Clinical Relevance
First ray supination compensating for first metatarsal intrinsic hyperpronation might be an important factor in the hallux valgus pathogenesis. Further in vivo studies involving nonweightbearing and weightbearing comparative assessments of hallux valgus and controls should be performed to confirm this pathomechanism.
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NewsBot · Oct 28, 2022

Intra‑ and Inter‑observer Reliability of Yamaguchi's Method for the Assessment of First Metatarsal Pronation in Hallux Valgus Deformity
Jorge Javier Del Vecchio, MD, MBA et al
October 28, 2022

Pronation of the first metatarsal is a risk factor for the formation and progression of the hallux valgus deformity. Recently, Yamaguchi et al. published a study that showed how the round sign increases on digitally reconstructed radiography taken from a CT scan when pronation is applied. In this study, the shape of the lateral edge of the first metatarsal head was evaluated on weight-bearing dorsoplantar radiographs. Yamaguchi's signs were presented to observers after the visual presentation of each foot as an image. The best-fit circle was drawn using the PACS drawing function. Ninety radiographs of adults presenting hallux valgus deformities were classified as mild-to-moderate, based on hallux valgus angle and intermetatarsal angle. The global average observations were 3.72 ± 3.92 (Range 2.3 to 4.6°). The interclass correlation (Fleiss Kappa index κ = 0.225) and the Spearman correlation (0.16 of Kappa) coefficients were poor for inter-observer measurements and statistically significant. Using the linear model, there was no significant variability between the repetitions corresponding to each observer (t-value -1.527, p-value 0.127). Our findings show that the Yamaguchi method can be very subjective and should not be the exclusive technique to assess the rotation of the first metatarsal or head roundness.
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NewsBot · Feb 19, 2023

Sesamoid View Weightbearing Radiography vs Weightbearing Computed Tomography in the Measurement of Metatarsal Pronation Angle
Matthew J Siebert et al
Foot Ankle Int. 2023 Feb 16

Background: First metatarsal pronation angle (MPA) is increasingly relevant in the management of hallux valgus and is assessed on weightbearing computed tomography (WBCT) and sesamoid-view weightbearing radiography (WBR). The purpose of this study is to compare MPA measured by WBCT against WBR to determine if any systematic discrepancy in MPA measurement exists between the 2 modalities.

Methods: A total of 40 patients with 55 feet were included for study. MPA was measured in all patients by 2 independent readers on both WBCT and WBR with an appropriate washout period between measurement modalities. Mean MPA by WBCT and WBR were analyzed; interobserver reliability was calculated with an intraclass correlation coefficient (ICC) value.

Results: Mean MPA as measured by WBCT was 3.7 ± 7.9 degrees (95% CI, 1.6-5.9; range -11.7 to 20.5). Mean MPA measured on WBR was 3.6 ± 8.4 degrees, (95% CI, 1.4-5.8; range -12.6 to 21.4). There was no difference in MPA as measured by WBCT compared to WBR (P = .529). Interobserver reliability was excellent with an ICC of 0.994 for WBCT and 0.986 for WBR.

Conclusion: Measurement of first MPA by WBCT and WBR was not significantly different. In our cohort of patients with and without forefoot pathology, we found that either sesamoid view weightbearing radiographs or weightbearing CT can be used reliably to measure first MPA and will generate similar values.
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NewsBot · Feb 19, 2023

Sesamoid View Weightbearing Radiography vs Weightbearing Computed Tomography in the Measurement of Metatarsal Pronation Angle
Matthew J Siebert et al
Foot Ankle Int. 2023 Feb 16

Background: First metatarsal pronation angle (MPA) is increasingly relevant in the management of hallux valgus and is assessed on weightbearing computed tomography (WBCT) and sesamoid-view weightbearing radiography (WBR). The purpose of this study is to compare MPA measured by WBCT against WBR to determine if any systematic discrepancy in MPA measurement exists between the 2 modalities.

Methods: A total of 40 patients with 55 feet were included for study. MPA was measured in all patients by 2 independent readers on both WBCT and WBR with an appropriate washout period between measurement modalities. Mean MPA by WBCT and WBR were analyzed; interobserver reliability was calculated with an intraclass correlation coefficient (ICC) value.

Results: Mean MPA as measured by WBCT was 3.7 ± 7.9 degrees (95% CI, 1.6-5.9; range -11.7 to 20.5). Mean MPA measured on WBR was 3.6 ± 8.4 degrees, (95% CI, 1.4-5.8; range -12.6 to 21.4). There was no difference in MPA as measured by WBCT compared to WBR (P = .529). Interobserver reliability was excellent with an ICC of 0.994 for WBCT and 0.986 for WBR.

Conclusion: Measurement of first MPA by WBCT and WBR was not significantly different. In our cohort of patients with and without forefoot pathology, we found that either sesamoid view weightbearing radiographs or weightbearing CT can be used reliably to measure first MPA and will generate similar values.
Click to expand...

NewsBot · Feb 19, 2023

Sesamoid View Weightbearing Radiography vs Weightbearing Computed Tomography in the Measurement of Metatarsal Pronation Angle
Matthew J Siebert et al
Foot Ankle Int. 2023 Feb 16

Background: First metatarsal pronation angle (MPA) is increasingly relevant in the management of hallux valgus and is assessed on weightbearing computed tomography (WBCT) and sesamoid-view weightbearing radiography (WBR). The purpose of this study is to compare MPA measured by WBCT against WBR to determine if any systematic discrepancy in MPA measurement exists between the 2 modalities.

Methods: A total of 40 patients with 55 feet were included for study. MPA was measured in all patients by 2 independent readers on both WBCT and WBR with an appropriate washout period between measurement modalities. Mean MPA by WBCT and WBR were analyzed; interobserver reliability was calculated with an intraclass correlation coefficient (ICC) value.

Results: Mean MPA as measured by WBCT was 3.7 ± 7.9 degrees (95% CI, 1.6-5.9; range -11.7 to 20.5). Mean MPA measured on WBR was 3.6 ± 8.4 degrees, (95% CI, 1.4-5.8; range -12.6 to 21.4). There was no difference in MPA as measured by WBCT compared to WBR (P = .529). Interobserver reliability was excellent with an ICC of 0.994 for WBCT and 0.986 for WBR.

Conclusion: Measurement of first MPA by WBCT and WBR was not significantly different. In our cohort of patients with and without forefoot pathology, we found that either sesamoid view weightbearing radiographs or weightbearing CT can be used reliably to measure first MPA and will generate similar values.
Click to expand...

NewsBot · Feb 28, 2023

Is there radiographic remodeling of the metatarsals in hallux valgus and pes planus?
Rajesh Botchu et al
Source

Foot conditions such as hallux valgus and pes planus cause altered load across the metatarsals. We performed a retrospective review of 98 patients who had foot radiographs performed at our institution for forefoot pain. The patients were divided into two groups based on their age and whether they had normal or altered foot alignment. We found that there is a mild increase in the intramedullary thickness of the third metatarsal in patients with hallux valgus (HV) and HV with pes planus (PP), which we postulate to be due to altered biomechanics and relative decrease in load on the third metatarsal.
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First Metatarsal Motion and Metatarsal Load Distribution

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3rd metatarsal dislocated fracture

Supination? Callus? 5th metatarsal area?

Avascular necrosis of the first metatarsal head

"metatarsalgia" off the shelf.

First Metatarsal Stress Fracture

Fifth Metatarsal Fracture 23 wks later

Exercises for Metatarsalgia

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First Metatarsal Motion and Metatarsal Load Distribution

NewsBot The Admin that posts the news.

Craig Payne Moderator

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

3rd metatarsal dislocated fracture

Supination? Callus? 5th metatarsal area?

Avascular necrosis of the first metatarsal head

"metatarsalgia" off the shelf.

First Metatarsal Stress Fracture

Fifth Metatarsal Fracture 23 wks later

Exercises for Metatarsalgia

Share This Page

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