INTRODUCCIÓN La limitación en el plano sagital del movimiento y el dolor de la primera articulación metatarsofalángica fue denominada por primera vez "hallux flexus" en 1887 por Davies-Colley. En 1888 Cotterill fue el primero en utilizar el término "hallux rigidus" para describir esta patología. Después del hallux valgus, el hallux rigidus es la patología que más frecuentemente afecta a la primera articulación metatarsofalángica, pudiendo ser más imposibilitante para el paciente.Después de más de 100 años desde esta descripción inicial todavía permanece abierto el debate en torno a la etiología de ésta patología. OBJETIVOSNuestro objetivo es concretar, con metodología científica, las variantes anatómicas que influyen en la etiopatogenia del hallux rigidus. MATERIAL Y MÉTODOSSe ha realizado un estudio retrospectivo de casos y controles.Los casos son una serie de pacientes afectos de hallux rigidus intervenidos en varios centros (Hospital Universitari de Tarragona Joan XXIII, Hospital Comarcal de Mora d'Ebre, Hospital de San Rafael y Hospital de Sant Pau i Santa Tecla). Se revisaron un total de 248 casos de hallux rigidus, de los cuales se seleccionaron 132, el resto fueron descartados por diferentes motivos. Se buscó un grupo control con pies clínica y radiológicamente normales. Ambos grupos eran comparables en cuanto al lado, el sexo y la edad.Se han estudiado las siguientes variables:A- Variables Clínicas y Morfológicas: se han recogido 9 variables en cada pie. B- Mediciones Radiológicas: se han realizado 14 mediciones en la proyección dorsoplantar en carga y 7 mediciones en la proyección de perfil en carga de cada pie. En la metodología estadística se ha realizado un análisis descriptivo, análisis univariable, análisis de la exactitud de las medidas y un análisis multivariable.RESULTADOSSe ha realizado un análisis estadístico comparativo de los resultados de las mediciones entre el grupo de casos de hallux rigidus y el grupo control. Asimismo se han descrito los resultados obtenidos en la diferenciación en función del sexo, de la edad, del grado de hallux rigidus, de la fórmula metatarsal y de la fórmula digital. Se han calculado los valores límite o de corte de los parámetros estudiados que han tenido significación estadística. Por último se ha realizado el análisis multivariable de las mismas.DISCUSIÓNSe realiza una comparación de nuestros resultados para cada variable con respecto a la bibliografía previa.CONCLUSIONES · La forma aplanada de la cabeza del primer metatarsiano está asociada con la presencia de hallux rigidus, siendo el punto de corte de mayor discriminación.· La mayor longitud del primer metatarsiano está asociada con la presencia del hallux rigidus.· En pies con hallux rigidus, el Ángulo Metatarsofalángico del Hallux es mayor de 14º. · Un Angulo Metatarsofalángico del Segundo Dedo mayor de -8º está relacionado con la presencia de hallux rigidus. · Una mayor distancia de los sesamoideos a la articulación metatarsofalángica del hallux está asociada con la presencia de hallux rigidus.· En nuestra serie no hay hipertrofia de la cortical medial del segundo metatarsiano en los casos de hallux rigidus.· No hemos encontrado relación estadísticamente significativa entre la Flexión Dorsal del Primer Metatarsiano y la presencia de hallux rigidus.· No hemos encontrado relación estadísticamente significativa entre la Flexión Plantar del Hallux y la presencia de hallux rigidus.· No hemos encontrado relación estadísticamente significativa entre las Alteraciones en el Retropié y la presencia de hallux rigidus.· No hemos encontrado relación estadísticamente significativa entre la existencia de un Pie Plano y la presencia de hallux rigidus. / INTRODUCTION Limitation of movement in the sagittal plane and pain in the first metatarsophalangeal joint was named "hallux flexus" for the first time in 1887 by Davies-Colley. In 1888 Cotterill was the first to use the term "hallux rigidus" to describe this condition. After hallux valgus, hallux rigidus is the disease that most commonly affects the first metatarsophalangeal joint, and can be more disabling for the patient.More than 100 years after this initial description, the debate on the etiology of this disease remains open. OBJECTIVESOur objective is to specify, by means of a scientific methodology, the anatomical variations that influence the pathogenesis of hallux rigidus. MATERIAL AND METHODSA retrospective study of cases and controls was performed.The cases were a series of patients afflicted with hallux rigidus operated on in several centres (Hospital Universitari de Tarragona Joan XXIII, Hospital Comarcal de Mora d'Ebre, Hospital de San Rafael and Hospital de Sant Pau i Santa Tecla). Out of a total 248 cases of hallux rigidus examined, 132 were chosen, the remainder being ruled out for various reasons. A control group with clinically and radiologically normal feet was established. Both groups were comparable in terms of side, sex and age.The following variables were studied:A- Clinical and Morphological Variables: 9 variables were collected from each foot. B- Radiological Measurements: 14 weight-bearing dorsoplantar projection measurements and 7 weight-bearing lateral projection measurements were taken of each foot. The statistical methodology included a descriptive analysis, univariable analysis, an analysis of measurement accuracy and a multivariable analysis.RESULTSA comparative statistical analysis of the resulting measurements between the group of patients with hallux rigidus and the control group was carried out. The results obtained from the differentiation according to sex, age, degree of hallux rigidus, metatarsal formula and digital formula were likewise described. Limit and cut off values were calculated for the parameters showing statistical significance. Finally a multivariable analysis of the latter was performed. DISCUSSIONA comparison of our results for each variable with those of previous bibliography is carried out.CONCLUSIONS · The flattened shape of the first metatarsal head is associated with the presence of hallux rigidus, constituting the most discriminating cut off point.· The increased length of the first metatarsal is associated with the presence of hallux rigidus.· The Metatarsophalangeal Angle is greater than 14º in feet suffering from hallux rigidus. · A Metatarsophalangeal Angle of the Second Toe greater than -8º is related to the presence of hallux rigidus. · A greater distance between the sesamoids and the metatarsophalangeal angle of the hallux is linked to the presence of hallux rigidus.· In our series, medial cortical hypertrophy of the second metatarsal was not observed in cases of hallux rigidus.· We have not found a statistically significant relationship between Dorsal Flexion of the First Metatarsal and the presence of hallux rigidus.· We have not found a statistically significant relationship between Plantar Flexion of the Hallux and the presence of hallux rigidus.· We have not found a statistically significant relationship between Rearfoot Disorders and the presence of hallux rigidus.· We have not found a statistically significant relationship between the occurrence of Flat Feet and the presence of hallux rigidus.

Reproduction de : Thèse d' exercice : Médecine spécialisée : Nancy 1 : 2002. / Thèse : 2002NAN11111. Titre provenant de l'écran-titre.

The work provides a comprehensive overview of the issues hallux rigidus with a focus on the first metatarsophalangeal joint replacement and development of our own implant. The development was built to perform anatomical studies, the results were the basis for the construction of hemiarthroplasty and total arthroplasty. It was necessary to measure the marrow cavities of the distal part of first metatarsal and proximal half of proximal phalanx. We measured the size of the metatarsal head in two planes, and its tendency to diaphysis on the dry preparations. Through these studies we obtained valid data for the construction all components of both hemiarthroplasty and total arthroplasty of specifying the size spectrum. We have verified and then corrected the shape of implant treatment during post-mortem tests on the models. The result is a new type of arthroplasty with their own design to guarantee restoration of joint function and coated with a high osteointegral potential. In clinical studies, we performed 22 implantations of hemiarthroplasty and one implantation of total arthroplasty. Clinical results suggest the fact that the implant will be successful. However the ultimate answer to this question will provide long-term study. The other results presented with a detailed anatomical description show to...

The work provides a comprehensive overview of the issues hallux rigidus with a focus on the first metatarsophalangeal joint replacement and development of our own implant. The development was built to perform anatomical studies, the results were the basis for the construction of hemiarthroplasty and total arthroplasty. It was necessary to measure the marrow cavities of the distal part of first metatarsal and proximal half of proximal phalanx. We measured the size of the metatarsal head in two planes, and its tendency to diaphysis on the dry preparations. Through these studies we obtained valid data for the construction all components of both hemiarthroplasty and total arthroplasty of specifying the size spectrum. We have verified and then corrected the shape of implant treatment during post-mortem tests on the models. The result is a new type of arthroplasty with their own design to guarantee restoration of joint function and coated with a high osteointegral potential. In clinical studies, we performed 22 implantations of hemiarthroplasty and one implantation of total arthroplasty. Clinical results suggest the fact that the implant will be successful. However the ultimate answer to this question will provide long-term study. The other results presented with a detailed anatomical description show to...

The human foot is a biomechanical marvel which forms the distal link in the lower limb kinematic chain. With its small polyarticular construct and flexibility, it supports the body and provides balance during walking. The first metatarsophalangeal joint (MTPJ) is a vital joint in the forefoot for normal load transmission and energy efficient locomotion. Albeit a lot in literature about this joint, paucity still exists in the biomechanical aspects. Also, there is a speculation in the biomechanical world that the time integral component of pressure recorded from the plantar pressure measuring devices maybe representative of the shear force recorded from force platforms. The aim of the current study was to quantify the kinematics of the first MTPJ in three dimensions and the pedobarographic data under the first MTPJ during each sub-phase of stance in the gait cycle of normal subjects and to assess the correlation between the shear force from the force plate of the motion capture system with the variables from the barefoot plantar pressure measuring device. Similar quantification will be undertaken for the patients with isolated hallux rigidus. After obtaining ethical approval, 40 normal subjects (80 feet) and 6 patients with varying grades of hallux rigidus were recruited for the study. The equipment used to collect data included the Vicon® motion analysis system, AMTI® force plate and the emed® plantar pressure measuring device. Various checks were performed to establish the reliability of the system setup. Four trials from each foot were taken. Of the 320 total trials from the normal subjects, the trial numbers varied for specific tasks as some trials which were suitable for testing one objective might not be suitable for testing the other. One of the patients’ data could not be used as the data quality was below par due to issues with marker tracking. The correlation between the shear force from the force plate and the anthropometric measurements/parameters from the plantar pressure measuring device was performed using the statistical regression model. The Vicon® data of the whole stance phase revealed that the first MTPJ’s sagittal plane motion ranged from 9° of plantarflexion to 53° of dorsiflexion. In the coronal plane, the maximum pronation was 34° and supination was 31°. In the transverse plane, the maximum varus was 11° and the valgus was 24°. There were two dorsiflexion peaks; one at the Initial contact and the other at Pre-swing. The joint moved from supination to pronation and varus to valgus during the progression of stance phase from Initial contact to Pre-swing. Considering the emed®-m, there were four basic parameters namely the force, area, peak pressure and maximum mean pressure from which the other parameters were derived. Only the basic parameters accounted for the sub-phases of stance and it came to light that the force under the first MTPJ was maximum in the terminal stance (22.1%). For the whole stance phase, the first MTPJ contributed about 11% of the contact area, 14.5% of the mean area, 24% of the maximum force, 56% of the peak pressure, 63% of maximum mean pressure, 44% of Pressure-time integral, 14% of Force-time integral and 14% of mean force. The correlation equation with reasonable number of dependent variables obtained by the statistical regression model could account for only 46% of the shear force. Among the paired correlation equations with single dependent variable, the one with the mean force was the best and even this could only account for 31.1% of the shear force. Albeit 3 patients were having similar radiological grading of the pathology and 2 others falling into another grade, their objective data were diverse and couldn’t be grouped together. The normal kinematics of the first MTPJ and the pedobarographic data under the first MTPJ were quantified during each subphase of stance. Attempt to use one system alone instead of two to calculate the shear force did not provide satisfactory results. The patients’ data questions the use of radiology alone in deciding the management plan which is a common scenario in the current clinical setting.

The present study utilizes finite element analysis in order to simulate a surgical operation in the treatment of a hallux rigidus case, as designed and developed by Episurf Medical AB (Stockholm, Sweden). The surgical intervention includes an initial cheilectomy as well as an insertion of an orthopedic implant. The goal of the study was to evaluate the current concept of the medical intervention as it is manifested today, as well as to give design suggestions as how to further improve the pre-planning of the surgery. MRI-images of the first metatarsophalangeal joint in the hallux was collected from a patient suffering from hallux rigidus, and used in order to build case-specific geometrical images to be used in the FE analysis. The simulation was setup as to simulate a normal motion in the first metatarsophalangeal joint during a normal gait pattern. The first simulation was conducted without any intervention, while the second was conducted after a pre-determined operation plan in accordance with the surgical operation that Episurf Medical AB wants to perform. The results was then compared and analyzed in order to determine the post-surgical effects that such an operation could have on the patient. A third and final simulation was then performed, by using optimization algorithms in order to make suggestions to the pre-planned cheilectomy shape, as well as orientation of the implant. Two parameters were being investigated in order to assess the surgical intervention as designed by Episurf Medical AB; the contact stress on the articular side of the metatarsal head, and the strain on the implant shaft. The current manifestation of the cheilectomy did not reduce the contact stress compared to the untreated condition, as the implant failed to be a load baring surface due to the two dimensional nature of which it is conceived. Instead, the contact surface area is reduced and positioned medial and lateral to the implant head. The optimization algorithm could reduce the maximum contact stress significantly, from 295MPa and 400MPa in the treated and untreated conditons respectively, to 160MPa after the optimization algorithm. It became clear that the angle of the cheilectomy as well as the orientation of the implant angle has an incriminating effect on the post-operative results. However, the shape of the cheilectomy as well as the design of the implant would need to be revised in future embodiments, as the current concept failed to provide joint with a new articulating surface. Further development of the models formulated in this thesis is advised, as well as validating the findings with clinical data. / Den aktuella studien använder finita elementmetoden i syfte att simulera en kirurgisk operation som har utvecklats av Episurf Medical AB (Stockholm, Sverige) för att behandla ett hallux rigidus fall. Det kirurgiska ingreppet utgörs av en inledande cheilectomi,  som sedan följs av att operera in ett ortopediskt implantat. Målet med studien var att utvärdera det nuvarande konceptet för det medicinska ingrepp så som den är uttänkt idag, samt att ge designförslag för hur man ytterligare kan förbättra planeringen av operationen. MR-bilder av den första metatarsalleden i stortån samlades in från en patient som lider av hallux rigidus, som användes sedan för att bygga patient specifika geometriska bilder för att användas i FE-analysen. Simuleringen var modellerad för att simulera en normal rörelse i första metatarsofalangealleden under en normal gångcykel. Den första simuleringen genomfördes utan något ingripande, medan den andra genomfördes efter en förutbestämd operationsplan i enlighet med det kirurgiska ingreppet som Episurf Medical AB vill utföra. Resultaten jämfördes sedan och analyserades för att bestämma de resultaten som en sådan operation skulle kunna innebära för patienten postoperativt. En tredje och sista simulering utfördes sedan, med hjälp av optimeringsalgoritmer för att ge förslag på förbättringar för den förplanerade cheilectomin, samt orienteringen av implantatet. Två parametrar undersöktes för att bedöma det kirurgiska ingrepp som designats av Episurf Medical AB, kontaktbelastningen på artikulära sidan av metatarsalhuvudet, och påfrestningen på implantatet. Den nuvarande utformningen av cheilectomin minskade inte kontaktbelastningen jämfört med det obehandlade tillståndet, då implantatet inte vart belastat på grund av den tvådimensionella profilen i dess utformning. Optimeringsalgoritmen kunde minska den maximala kontaktbelastningen markant, från 295MPa i den behandlade och 400MPa i den obehandlade simuleringarna, till 160MPa efter optimeringsalgoritmen. Det blev tydligt att vinkeln på cheilectomin samt orienteringen av implantatet har en avgörande betydelse för det postoperativa resultatet. Dock skulle formen på cheilectomin liksom designen av implantatet behöva revideras i framtida utformningar, då det nuvarande konceptet inte lyckades att ge leden en ny ledyta. Vidareutveckling av de modeller som utvecklats i avhandlingen rekommenderas, samt att validera resultaten med annan kliniska data.

The topic of this diploma thesis is "Influence of footwear on foot deformities in women - the role of nurses in prevention". The theoretical part is devoted to the foot anatomy, it describes the issue of heels on the foot and represents the Giraffe certification. The practical part of the qualitative research shows the role of nurses in preventing foot deformities for patients. This thesis has two goals. To find out what footwear affects the deformities of the legs in women and to find out what role the nurse plays in preventing this issue. The research questions are 1. What is the importance of wearing high-heeled shoes for women and how will this be reflected later? 2. What role do nurses attribute to the prevention in this issue? Data collection was collected by semi-structured interviews with nurses in the orthopaedic ward and orthopaedic clinics. The research sample consists of 20 respondents, the choice was deliberate and formed by snowball sampling. In February 2019, data was collected, which was subsequently terminated at the moment of theoretical saturation. The interview covered themes: wearing high-heeled shoes, leg deformities caused by high-heeled shoes, nurse-led prevention and education. The results show that only a fraction of nurses adhere to the role of a nurse who helps patients prevent leg deformities. The rest of the nurses leave prevention and education to doctors. This diploma thesis presents as a work output a poster, which can be an information material for nurses from the orthopaedic clinics and beds. The output of the thesis is an educational poster that will reflect the entire nursing issue in prevention (the role of a nurse, the deformity of the feet caused by high-heeled shoes, etc.).