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02.07.2020 | original article | Ausgabe 5-6/2021 Open Access

Wiener klinische Wochenschrift 5-6/2021

A novel method of clinical first tarsometatarsal joint hypermobility testing and radiologic verification

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 5-6/2021
Autoren:
MD Martin Ornig, MD Sebastian Tschauner, MD Patrick Lukas Holweg, MD Gloria Maria Hohenberger, MD Gerhard Bratschitsch, MD Andreas Leithner, MD, PhD Lukas Leitner
Wichtige Hinweise

Video online

The online version of this article contains one video. The article and the video are online available (https://​doi.​org/​10.​1007/​s00508-020-01705-x). The video can be found in the article back matter as “Electronic Supplementary Material”.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author contributions

M.O., S.T. and L.L contributed to the conception of the study; M.O., S.T., P.H., G.M.H., G.B., A.L. and L.L. wrote the main manuscript text; M.O., S.T. and L.L. prepared figures and tables; M.O., S.T., P.H., G.B., A.L. and L.L. acquired and analyzed the data; all authors reviewed and corrected the manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Summary

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

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

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

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.

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Zusatzmaterial
This video shows the manual examination of first ray mobility using the cross-glide test. The ankle should be held in a neutral position during the examination, in maximum eversion of the foot whilst the lesser metatarsals are fixed and the first metatarsal is moved in a dorsoplantar direction by the examiner
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