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Hypermobility of the first ray
1Foot and Ankle Service, Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland, USA. elaineb@helix.org
Foot and Ankle Clinics
|March 10, 2001
Summary
Hypermobility of the first ray, a key factor in hallux valgus, can be surgically corrected. The Lapidus procedure offers good outcomes, though nonunion is a potential complication.
Area of Science:
- Orthopedics
- Podiatry
- Biomechanics
Background:
- First ray hypermobility is a significant contributor to foot deformities like hallux valgus.
- It is often associated with a large intermetatarsal angle and metatarsus primus varus.
- Extrinsic factors and adolescent presentation can exacerbate hypermobility's role in hallux valgus.
Purpose of the Study:
- To review the clinical and radiographic evaluations of first ray hypermobility.
- To discuss the surgical indications and contraindications for treating this condition.
- To present the authors' preferred surgical approach and its outcomes.
Main Methods:
- Clinical assessment includes grasping and squeeze tests for sagittal and transverse motion.
- Radiographic evaluation involves the modified Coleman block test and squeeze test.
- Surgical treatment involves arthrodesis of the tarsometatarsal joint, exostectomy, capsulorraphy, and distal soft tissue release.
Main Results:
- The authors' surgical technique focuses on stabilizing the first metatarsal without involving the second metatarsal base.
- Common complications include nonunion, malunion, and dorsal elevation of the first metatarsal.
- Radiographic nonunion occurs frequently but often lacks clinical significance, with good to excellent results reported.
Conclusions:
- Surgical intervention, particularly arthrodesis of the tarsometatarsal joint, is typically indicated for first ray hypermobility.
- Contraindications include young age, generalized ligamentous laxity, short first metatarsal, and hallux MTP joint arthritis.
- The Lapidus procedure and its modifications provide effective stabilization and correction for hallux valgus associated with first ray hypermobility.