Hallux Rigidus Grade Does Not Correlate With Foot and Ankle Ability Measure Score

Nixon, Devon; Lorbeer, Karly F; McCormick, Jeremy J.; Klein, Sandra E.; Johnson, Jeffrey E.

doi:10.5435/jaaos-d-16-00878

Cited by 14 publications

(13 citation statements)

References 17 publications

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Section: Discussionmentioning

confidence: 86%

“…We did not assess the relation between elevation and grade of hallux rigidus because it was determined that the grade of hallux rigidus may be an unreliable assessment. 16 In addition, we cannot prove whether the elevation of the first metatarsal leads to hallux rigidus or vice versa given the retrospective nature of this study. In another study, several established measurements of MPE were used, including the index created by Seiberg for assessment of MPE, and found statistically significant differences between populations with hallux valgus, plantar fasciitis, and Morton's neuroma compared with a population with hallux rigidus.…”

Section: Discussionmentioning

confidence: 86%

“…We believe that the grading system itself is unreliable in terms of both clinical exam and radiographic analysis. 16 Strengths of our study include the establishment of novel parameters to assess MPE at the anatomical area of interest, the double-blind nature of the study, and the large patient population assessed in a case-control design. Furthermore, it establishes the reliability of the measurements taken by multiple readers at various levels of training.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Various Measurement Methods to Assess First Metatarsal Elevation in Hallux Rigidus

Jones

Sanders

DaCunha

et al. 2019

Foot & Ankle Orthopaedics

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Background: While metatarsus primus elevatus (MPE) has been implicated in the development of hallux rigidus, previous studies have presented conflicting findings regarding the relationship between MPE and arthritis. This may be due to the variety of definitions for MPE and the radiographic measurement techniques that are used to assess it. Additionally, previous studies have only assessed elevation of the first metatarsal with respect to the floor or the second metatarsal, and not with respect to the proximal phalanx. The aim of this study was to examine the reliability of new radiographic measurements that consider the elevation of the first metatarsal in relation to the proximal phalanx, rather than in relation to the second metatarsal as previously described, to assess for MPE. In addition, we aimed to determine whether the elevation of the first metatarsal was significantly different in patients with hallux rigidus than in a control population. Methods: A retrospective chart review was conducted from prospectively collected registry data at the investigators’ institution to identify patients with hallux rigidus ( n = 65). A size-matched control cohort of patients without evidence for first metatarsophalangeal (MTP) joint arthritis was identified ( n = 65). Patients with a previous history of foot surgery, rheumatoid arthritis, or hallux valgus were excluded. Five blinded raters of varying levels of training, including 2 research assistants, 1 senior orthopedic resident, 1 foot and ankle fellowship-trained orthopedic surgeon, and 1 attending musculoskeletal fellowship-trained radiologist, evaluated 7 radiographic measurements for their reliability in assessing for MPE in hallux rigidus and control groups. Four of the 7 were newly designed measurements that include the relationship of the first MTP joint. Inter- and intrarater reliability were calculated using intraclass correlation coefficients (ICCs) and categorized by Landis and Koch reliability thresholds. The measurements between the hallux rigidus and control populations were compared using an independent t test. Results: Six of the 7 radiographic measurements were found to have substantial to almost perfect interrater reliability (ICC, 0.800-0.953) between all levels of training, except for the proximal phalanx–first metatarsal angle, which showed moderate reliability (ICC, 0.527). Substantial to almost perfect intrarater reliability (ICC, 0.710-0.982) was demonstrated by the measurements performed by research assistants. All 7 of the measurements taken by the musculoskeletal fellowship-trained radiologist demonstrated significant differences in first metatarsal elevation between the hallux rigidus and control populations, with the hallux rigidus group showing increased elevation ( P < .001-.019). Conclusion: This study confirmed the reliability of 7 radiographic measurements used to assess for MPE, including 3 previously established and 4 newly described measurements. Observers across all levels of training were able to demonstrate reliable measurements. In addition, the measurements were used to show that patients with hallux rigidus were more likely to have MPE compared with patients without radiographic evidence for first MTP arthritis. These measurements could be used in future work to examine how the presence of MPE relates to the etiology and progression of hallux rigidus, and how it affects the results of operative treatment. Level of Evidence: Level III, retrospective comparative study.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of Various Measurement Methods to Assess First Metatarsal Elevation in Hallux Rigidus

Jones

Sanders

DaCunha

et al. 2019

Foot & Ankle Orthopaedics

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“…The flexibility jig was a reliable method to assess motion of the first MTP joint, especially when compared to the lower reliability of existing classification methods. 13 Moreover, the jig illustrates that the function of the first MTP joint as well as outcomes scores were related not just to conventional range of motion but to other inherent flexibility properties measured by the flexibility jig. Flexibility of the first MTP joint should be considered as we attempt to better diagnose and treat hallux rigidus.…”

Section: Resultsmentioning

confidence: 99%

“…3,4 While classification systems may provide a framework for assessing HR, clinical-radiographic grades do not always reliably correlate with patient-reported outcomes scores. 13…”

mentioning

confidence: 99%

Comparing First Metatarsophalangeal Joint Flexibility in Hallux Rigidus Patients Pre- and Postcheilectomy Using a Novel Flexibility Device

Henry

Kraszewski

Volpert

et al. 2020

Foot & Ankle Orthopaedics

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Background: Hallux rigidus (HR) is a common pathology of the first metatarsophalangeal (MTP) joint causing pain and stiffness. However, severity of symptoms and radiographic findings are not always concordant. A novel flexibility device, which measures the mobility of the MTP joint through its arc of motion, has been validated. This study compares flexibility in patients before and after cheilectomy (with or without proximal phalanx osteotomy) for HR. Methods: This is a single-center study of adult patients with HR who were indicated for cheilectomy or cheilectomy and Moberg (dorsiflexion closing wedge) osteotomy of the proximal phalanx based on symptoms and radiographs from 2013 to 2015. Pre- and postoperatively, patients underwent testing with a validated flexibility protocol to generate flexibility curves. Parameters included early and late flexibility, laxity torque, and laxity angle. Patients completed Foot and Ankle Outcomes Scores (FAOS) pre- and postoperatively. Twelve operative patients underwent preoperative testing, with 9 completing postoperative testing (mean age, 53.0 years; 67% female; mean 2.8-year follow-up). Results: Patients had significant improvements in early sitting and standing flexibility, sitting and standing laxity angles, standing laxity torque, and both sitting and standing maximum dorsiflexion after surgery (all P < .05). While preoperative early flexibility, laxity angle, and maximum dorsiflexion all differed significantly between patients and controls ( P < .015), postoperative early flexibility was similar to controls ( P > .279). FAOS scores for pain, symptoms, sport, and quality improved significantly after surgery. Conclusion: Surgical treatment with cheilectomy was associated with significant improvements in nearly all flexibility parameters for sitting and standing positions. However, most postoperative flexibility parameters did not improve to the level of normal controls. Regardless, patients still experienced significant improvements in outcomes. This study demonstrated that surgical correction is associated with significant biomechanical and clinical results. The flexibility device can be used in further studies to assess outcomes after other HR procedures. Level of Evidence: Level II, prospective comparative study.

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Youngswick osteotomy for treatment of moderate hallux rigidus: Thirteen years without arthrodesis

Slullitel

López

Calvi

et al. 2020

Foot and Ankle Surgery

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Hallux Rigidus Grade Does Not Correlate With Foot and Ankle Ability Measure Score

Abstract: Level III.

Cited by 14 publications

References 17 publications

Assessment of Various Measurement Methods to Assess First Metatarsal Elevation in Hallux Rigidus

Assessment of Various Measurement Methods to Assess First Metatarsal Elevation in Hallux Rigidus

Comparing First Metatarsophalangeal Joint Flexibility in Hallux Rigidus Patients Pre- and Postcheilectomy Using a Novel Flexibility Device

Youngswick osteotomy for treatment of moderate hallux rigidus: Thirteen years without arthrodesis

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