Hello all
Members do not see these Ads. Sign Up.
Wasn't sure whether to post this in biomechanics or surgery!
Anyway, I have a female patient 60yrs old who had a 1st mpj arthrodesis oct 2009. She had a very painful joint which is now painfree, in that respect it has been successful.
She came to see me in Dec 09 because she found walking difficult. I made alterations to her orthoses that I had made several years earlier. The mods were to accomodate the hallux, which I felt was fixed in a far to plantarflexed position. I also added a rocker bar to her shoe. This helped with mobility.
On return to her surgeon for follow up he told her he would prefer her not to use any shoe or insole and to weight bear on the toe until it was ok (she would get used to it).
She has returned to me to see if I can help. I note that she has adapted her foot position to accomodate the plantarflexed hallux i.e. she supinates the foot.
This is what I felt was not right about the final position of the fixed hallux:
The declination angle of the 1st ray is 20dgs relative to the ground plane. The hallux is dorsiflexed 5dgs -10dgs relative to the 1st ray (depending on how hard you push on the hallux to dorsiflex it. i.e. 10dgs is the most optomistic angle)
Therefore the hallux is actually plantar flexed relative to the ground plane by 5 - 10dgs. (see diagram).
Surely this is not correct since this allows no rocker action at the MPJ during propulsion.
ref- A Guide To First MPJ Arthrodesis For Active Patients
VOLUME: 18 PUBLICATION DATE: Dec 01 2005 Lawrence A. DiDomenico, DPM, and Alfonso A. Haro III, DPM quote "Temporarily fixate the hallux by utilizing two K-wires in the desired position. The position should be approximately 20 to 30 degrees dorsiflexed in relation to the first metatarsal declination"
What are your thoughts? As I'm no surgeon perhaps there is good reason for this hallux position?? Do you think I should make a shoe/orthotic to accomodate this and improve her walking or should I think about referring her back to her surgeon for corrective surgery.
Cheers Dave
Tags:
Loading...
- Similar Threads - Optimum Angle hallux
-
- Replies:
- 41
- Views:
- 17,133
-
- Replies:
- 3
- Views:
- 13,821
-
- Replies:
- 2
- Views:
- 7,005
-
- Replies:
- 0
- Views:
- 438
-
- Replies:
- 0
- Views:
- 481
-
- Replies:
- 0
- Views:
- 1,060
-
- Replies:
- 1
- Views:
- 1,426