In-vivo first metatarsophalangeal joint mechanics following cheilectomy: MRI and gait alterations
© Nawoczenski et al; licensee BioMed Central Ltd. 2008
Published: 26 September 2008
Cheilectomy surgery has been shown to provide pain relief for patients with hallux rigidus , however limited data exists regarding the effectiveness of this surgery in re-establishing normal first metatarsophalangeal (1st MTP) joint kinematics. A recent dynamic gait study has reported only modest improvement in 1st MTP motion following surgery, thus implicating the persistence of altered joint mechanics . The purpose of this study was to evaluate in vivo joint motion changes using MRI under 1st MTP loaded conditions in patients who received cheilectomy surgery. These data were compared to dynamic alterations during gait measured in a second cohort of subjects who previously underwent surgery.
20 subjects were enrolled for the MRI analysis. Pre- and post-operative data of 10 subjects with hallux rigidus (HR) were compared to a healthy control group of 10 subjects. Using a validated loading harness, all subjects underwent an MRI evaluation at varying angles of 1st MTP dorsiflexion, pre and post surgery (>3 months). Image J software was used to derive MRI measurements: 1st MTP dorsiflexion, instant centers of rotation, and sagittal translations of the proximal phalanx/1st metatarsal. Outcome measures were assessed using the Foot Function Index (FFI). MRI changes were compared to 3D gait analysis previously acquired on a second cohort of 20 surgical subjects using a magnetic tracking device.
All subjects had a significant decrease in FFI scores indicating an improvement in pain relief and function (p < .01).
Controls, Pre- and post-op MRI values
1 st MTP dorsiflexion
35.0° ± 8.8°
31.3° ± 10.0
64.4° ± 7.8°
8.9 ± 1.3 mm
8.6 ± 1.6 mm
4.2 ± 0.6 mm
1.6 ± 0.8 mm
1.5 ± 0.7 mm
5.5 ± 0.9 mm
Joint mechanics are significantly altered in patients with hallux rigidus. Although cheilectomy resulted in favorable outcomes as measured by FFI scores, surgery did not re-establish normal 1st MTP joint kinematics. Long term follow up of these patients will determine if altered kinematics lead to progressive arthritis over time and may suggest alternative intervention strategies.