Brief reportQuantification of first tarsometatarsal joint stiffness in hallux valgus patients
Introduction
The role of hypermobility of the first tarsometatarsal (TMT 1) joint in the etiology and surgical treatment of a hallux valgus deformity is still controversial. In general, in hallux valgus surgery, hypermobility of the TMT 1 joint is considered a factor requiring correction by a Lapidus procedure [1], [2], [3] (i.e. TMT 1 arthrodesis with repositioning of the first metatarsal bone in combination with a first metatarso-phalangeal soft tissue procedure). However, TMT 1 hypermobility cannot be quantified adequately; with the only clinical test available (Klaues test [4]), TMT 1 (hyper) mobility cannot be assessed objectively. In general, mobility of a joint is related to stiffness of this joint. Recently, a method using vibrations has been developed to measure joint stiffness in flat joints (articulatio plana) in vivo: doppler imaging of vibrations (DIV) [5]. The principle of this method is explained in a previous study [6]. Since low-energy vibrations (200 Hz) and ultrasound (colour doppler imaging) are used, this non-invasive method is patient friendly. DIV was shown to be reproducible and reliable for the sacro-iliac joint [5], [7]. In a previous study we applied this technique to the TMT 1 joint [6]. This study concerned healthy volunteers (without hallux valgus deformity) and produced DIV reference values for TMT 1 joint stiffness. In the present study DIV was applied to the TMT 1 joint in hallux valgus patients.
The aim of the present study was to relate the outcomes of the clinical test for TMT 1 joint mobility to DIV stiffness measurements of the TMT 1 joint.
Section snippets
Methods
Patients with a painful hallux valgus deformity who were planned for operative correction were asked to participate. Excluded were patients with systemic inflammatory diseases, patients who underwent previous operations on the foot and patients with clinical or radiographic arthritis of the first metatarso-phalangeal or TMT 1 joint. The study was approved by the medical ethical committee of the University Hospital Dijkzigt. All patients gave their written informed consent.
20 patients were
Results
The relation between the clinical test and the DIV measurement is shown in Table 1. The relation is studied in two ways. First, the feet were divided into three groups according to the clinical examination: 9 TMT 1 joints not hypermobile (i.e. both observers found a stable joint at both examinations), 17 indistinctly mobile (one or two of the four observations differed) and 6 unequivocally hypermobile (both observers found a hypermobile joint at both examinations). A statistically significant
Discussion
The choice for a Lapidus procedure in the surgical treatment of hallux valgus deformity is mainly based on the clinical diagnosis of hypermobility of the TMT 1 joint [1], [2], [3]. However, only non-specific, subjective tests such as the clinical test described by Klaue [4] can be used to assess TMT 1 hypermobility. Valid and objective tests with quantifiable results are not available but, considering the consequences, are certainly needed.
In general, stability of a joint depends on active
Conclusion
DIV stiffness measurement of the TMT 1 joint, as an objective test with quantifiable results, provides additional information to the clinical TMT 1 mobility test. Thus, it can support and rationalize the choice for a specific surgical procedure in hallux valgus deformity.
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