Position of the
First Ray and Motion of the
First Metatarsophalangeal
Joint
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The purpose of this study was to
determine how a more dorsiflexed
position of the 1st
ray will affect the range of
motion of the 1st MPJ
in static stance.
Methods
-
10
males
(20
feet)
-
Inclusion
criteria
included
normal
amounts
of
nonweightbearing
motion
in
ankle,
subtalar
and
midtarsal
joints,
1st
ray
and
1st
MPJ
-
1st
MPJ
dorsiflexion
was
measured
in:
- Relaxed stance
- Relaxed stance with 1st ray dorsiflexed by 4 mm
- Relaxed stance with 1st ray dorsiflexed by 8 mm
-
Goniometer
was used
to
measure
closed
kinetic
chain
dorsiflexion
of 1st
MPJ
motion
in
each
of
three
above
situations
Results
-
1st MPJ doriflexion
was decreased by 19% with 1st
ray dorsiflexed by 4 mm
-
1st MPJ dorsiflexion
was decreased by 34.7% with the
1st ray dorsiflexed by 8 mm
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Significance of the
Article
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The position of the first
ray has significant
influence on the 1st
MPJ range of motion static
stance. As a result, any
structural or functional
deformity that leads to a
dorsiflexed position of the
1st ray will
likely lead to decreased
dorsiflexion of the 1st
MPJ. This decreased motion
of the 1st MPJ,
termed functional hallux
limitus, will lead to
development of pathology at
the 1st MPJ:
hallux abducto valgus or
hallux rigidus. The authors
hypothesized that the
pathway that leads to
pathology development is
related to the amount of 1st
ray range of motion
available during gait.
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Significance for
Orthotic Therapy
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Certain orthotic
modifications
can be used to
encourage a more
plantarflexed
position of the
1st
ray. The most
commonly used
modification is
the reverse
Morton's
extension as it
allows the 1st
metatarsal head,
which represents
the 1st
ray, to drop
into a more
plantarflexed
position.
Another option
would be
ordering a
minimal fill as
this would lead
to a more
plantarflexed
position of the
1st
ray within the
shell itself. In
addition,
modifications
which would
discourage
rearfoot
eversion, which
leads to
dorsiflexion of
the 1st
ray, would be
helpful. These
"anti-eversion"
modifications
include: medial
heel skive, wide
plate, and deep
heel cup.
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