A novel method of clinical first tarsometatarsal joint hypermobility testing and radiologic verification.
Clinical testing
Hallux valgus
Instability
Lapidus
Tarsometatarsal joint
Journal
Wiener klinische Wochenschrift
ISSN: 1613-7671
Titre abrégé: Wien Klin Wochenschr
Pays: Austria
ID NLM: 21620870R
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
10
03
2020
accepted:
08
06
2020
pubmed:
4
7
2020
medline:
20
3
2021
entrez:
4
7
2020
Statut:
ppublish
Résumé
First tarsometatarsal joint (TMT-1) hypermobility might cause hallux valgus deformity (HV), and recurrence following surgical correction. Anatomic findings, indicating tibialis anterior tendon (TAT) involvement in TMT‑1 stabilization, led to the development of cross-glide test allowing clinical TMT‑1 stability testing. Cross-glide test function was evaluated in anatomical specimens and in the clinical setting, compared to simulated weight-bearing computer tomography (CT) analysis. Cross-glide test was evaluated in 6 healthy lower leg specimens before and after TAT transection. Clinical testing was performed prospectively in 36 feet (6 controls, 21 HV, 9 recurrent HV); consecutive weight-bearing CT analysis was performed. Results from clinical testing were compared to CT analysis. TMT‑1 instability significantly increased in anatomic specimens following TAT transection (p = 0.009). In the clinical setting, all healthy feet were cross-glide test negative, 62% of HV cases and all recurrent HV feet were positive. In the CT analysis- Compared to controls the HV cases revealed significantly increased MT‑1 internal rotation (p = 0.003) and decreased dorsal angle (p = 0.002), considered as collapsing forefoot signs; HV recurrent cases revealed similar results. Positive cross-glide tested cases revealed increased MT‑1 internal rotation values (p < 0.001) and dorsal angle values (p < 0.001) in CT analysis. Strikingly, cross-glide test positive HV cases revealed significantly increased internal TMT‑1 rotation (p = 0.043) in CT analysis, and HV and IMT (intermetatarsal) angle were significantly higher (p = 0.005, p = 0.006). 15 HV recurrence cases, treated with TMT‑1 arthrodesis, revealed no recurrence during follow-up. Cross-glide test allows reliable clinical TMT‑1 instability testing, via TAT tension, and is less laborious than CT analysis. We recommend TMT‑1 arthrodesis in cases with instability in clinical testing, to avoid HV recurrence.
Sections du résumé
BACKGROUND
BACKGROUND
First tarsometatarsal joint (TMT-1) hypermobility might cause hallux valgus deformity (HV), and recurrence following surgical correction. Anatomic findings, indicating tibialis anterior tendon (TAT) involvement in TMT‑1 stabilization, led to the development of cross-glide test allowing clinical TMT‑1 stability testing. Cross-glide test function was evaluated in anatomical specimens and in the clinical setting, compared to simulated weight-bearing computer tomography (CT) analysis.
METHODS
METHODS
Cross-glide test was evaluated in 6 healthy lower leg specimens before and after TAT transection. Clinical testing was performed prospectively in 36 feet (6 controls, 21 HV, 9 recurrent HV); consecutive weight-bearing CT analysis was performed. Results from clinical testing were compared to CT analysis.
RESULTS
RESULTS
TMT‑1 instability significantly increased in anatomic specimens following TAT transection (p = 0.009). In the clinical setting, all healthy feet were cross-glide test negative, 62% of HV cases and all recurrent HV feet were positive. In the CT analysis- Compared to controls the HV cases revealed significantly increased MT‑1 internal rotation (p = 0.003) and decreased dorsal angle (p = 0.002), considered as collapsing forefoot signs; HV recurrent cases revealed similar results. Positive cross-glide tested cases revealed increased MT‑1 internal rotation values (p < 0.001) and dorsal angle values (p < 0.001) in CT analysis. Strikingly, cross-glide test positive HV cases revealed significantly increased internal TMT‑1 rotation (p = 0.043) in CT analysis, and HV and IMT (intermetatarsal) angle were significantly higher (p = 0.005, p = 0.006). 15 HV recurrence cases, treated with TMT‑1 arthrodesis, revealed no recurrence during follow-up.
CONCLUSION
CONCLUSIONS
Cross-glide test allows reliable clinical TMT‑1 instability testing, via TAT tension, and is less laborious than CT analysis. We recommend TMT‑1 arthrodesis in cases with instability in clinical testing, to avoid HV recurrence.
Identifiants
pubmed: 32617706
doi: 10.1007/s00508-020-01705-x
pii: 10.1007/s00508-020-01705-x
pmc: PMC7969572
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
209-215Références
J Foot Ankle Res. 2010 Sep 27;3:21
pubmed: 20868524
Ann Anat. 1992 Jun;174(3):185-95
pubmed: 1503236
J Orthop Surg Res. 2015 Sep 15;10:140
pubmed: 26370272
Foot Ankle Surg. 2013 Sep;19(3):155-61
pubmed: 23830162
Biomed Res Int. 2017;2017:9542125
pubmed: 28660212
J Foot Ankle Res. 2019 Feb 1;12:9
pubmed: 30733832
Foot Ankle Surg. 2017 Dec;23(4):250-254
pubmed: 29202983
Foot Ankle Int. 2013 Jan;34(1):124-30
pubmed: 23386772
Foot Ankle Int. 2018 Mar;39(3):349-354
pubmed: 29308658
Foot Ankle Int. 2002 Nov;23(11):1040-1
pubmed: 12449411
Ther Umsch. 1991 Dec;48(12):817-23
pubmed: 1805443
J Bone Joint Surg Am. 2017 Feb 1;99(3):247-255
pubmed: 28145956
Foot Ankle Int. 2002 Mar;23(3):248-52
pubmed: 11934068
Clin Biomech (Bristol, Avon). 2016 May;34:7-11
pubmed: 27015031
Bull Hosp Joint Dis. 1956 Oct;17(2):404-21
pubmed: 13413410
Dtsch Arztebl Int. 2012 Dec;109(49):857-67; quiz 868
pubmed: 23267411
Foot Ankle Clin. 2000 Sep;5(3):469-84
pubmed: 11232392
Foot Ankle Surg. 2008;14(3):138-41
pubmed: 19083631
Foot Ankle Int. 1999 Oct;20(10):651-6
pubmed: 10540997
Foot Ankle Int. 2004 Aug;25(8):537-44
pubmed: 15363374
Clin Biomech (Bristol, Avon). 2001 Oct;16(8):714-6
pubmed: 11535355