[Malalignment of the first ray : Clinical and radiological diagnostics]

Area of Science:

• Orthopedic Surgery
• Podiatric Medicine
• Radiology

Background:

• Forefoot surgical correction necessitates comprehensive pre-operative evaluation.
• Clinical assessment involves evaluating leg axis, hindfoot alignment, first ray deformities, and soft tissue status.
• The Silfverskiöld test identifies gastrocnemius muscle shortening, a factor in foot biomechanics.

Purpose of the Study:

• To outline the essential clinical and radiological examinations for surgical correction of forefoot deformities.
• To correlate clinical findings with radiological evidence of pathology.
• To inform therapeutic decision-making based on comprehensive foot assessment.

Main Methods:

• Clinical examination including gait, hindfoot alignment, first ray assessment, skin, pulse, and sensation.
• Specific tests like the Silfverskiöld test for muscle length.
• Radiological assessment including weight-bearing X-rays in two planes, measuring key angles and bone dimensions.

Main Results:

• Midfoot discomfort can indicate tarsometatarsal joint pathology, with the second joint often showing more degeneration.
• Callosities under metatarsal heads suggest first ray load transmission issues.
• Limited first metatarsophalangeal joint motion often correlates with degenerative arthritis, visible on X-ray.

Conclusions:

• Integrated clinical and radiological assessment is crucial for planning forefoot surgery.
• Radiological parameters like intermetatarsal and hallux valgus angles, along with tarsometatarsal joint stability, are key to surgical planning.
• Degenerative changes in the metatarsophalangeal joint and sesamoids may be present but not always clinically apparent.