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Biomechanics of the first ray

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Mart, May 27, 2008.

  1. Mart

    Mart Well-Known Member


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    Hi

    I am trying to get a copy of below paper, unable to get locally, anyone able to help me out by emailing me a .pdf?


    thanks

    Martin


    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com





    Biomechanics of the first ray. Part I. The effects of peroneus longus function: a three-dimensional kinematic study on a cadaver model.Johnson CH, Christensen JC.
    Northwest Surgical Biomechanics Research Laboratory, Providence Seattle Medical Center, WA 98122, USA.

    The closed kinetic chain effects of peroneus longus (PL) activity on the medial column of the foot were investigated in seven fresh-frozen cadaver specimens using a three-dimensional radiowave tracking system. Specimens, consisting of the distal half of the leg and the intact ankle and foot, were mounted on a nonmetallic loading frame which allowed positioning of the foot to simulate midstance position of gait. The tibia and fibula were axially loaded to 400 N. Receiving transducers were attached to the first metatarsal, medial cuneiform, navicular, and talus. Tarsal movements were measured as specimens were axially loaded and midstance motor function was simulated using pneumatic actuators. Tensile loads of 0-150% of predicted maximum force were incrementally applied to the PL tendon. Three-dimensional data sets recording osseous positions and orientations were collected and analyzed. Significant frontal plane rotation of the medial column in the direction of eversion occurred when PL strength was increased (p = .0001). Increasing PL loads produced significant but less pronounced angular changes in the sagittal and transverse planes of the medial column. The patterns of motion suggest that PL creates an eversion "locking" effect on the first ray of the foot, stabilizing the medial column.
     
  2. Lee

    Lee Active Member

    Hello Martin,

    It's the first of a few Christensen/ Johnson papers from the Journal of Foot and Ankle Surgery. You can access abstracts via pubmed and gain access to full text if you've got a subscription (or if your local podiatry school has).

    :eek:

    Johnson CH, Christensen JC. Biomechanics of the first ray. Part I. The effects of peroneus longus function: a three-dimensional kinematic study on a cadaver model.J Foot Ankle Surg. 1999 Sep-Oct;38(5):313-21

    Rush SM, Christensen JC, Johnson CH. Biomechanics of the first ray. Part II: Metatarsus primus varus as a cause of hypermobility. A three-dimensional kinematic analysis in a cadaver model. J Foot Ankle Surg. 2000 Mar-Apr;39(2):68-77

    Bierman RA, Christensen JC, Johnson CH. Biomechanics of the first ray. Part III. Consequences of Lapidus arthrodesis on peroneus longus function: a three-dimensional kinematic analysis in a cadaver model. J Foot Ankle Surg. 2001 May-Jun;40(3):125-31

    Roling BA, Christensen JC, Johnson CH. Biomechanics of the first ray. Part IV: the effect of selected medial column arthrodeses. A three-dimensional kinematic analysis in a cadaver model. J Foot Ankle Surg. 2002 Sep-Oct;41(5):278-85

    Johnson CH, Christensen JC. Biomechanics of the first ray part V: The effect of equinus deformity. A 3-dimensional kinematic study on a cadaver model. J Foot Ankle Surg. 2005 Mar-Apr;44(2):114-20
     
  3. Mart

    Mart Well-Known Member

    Thanks Lee, I was able to get a copy of #5 in the series but the others were not available, I am not sure why, hence request for help. I am trying to review lit for non invasive methodologies for 1st ray function hence wanting to look at whole paper not just abstract.

    cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  4. Bruce Williams

    Bruce Williams Well-Known Member

  5. Lee

    Lee Active Member

    Martin,
    What are non-invasive methodologies of 1st ray function? And what are invasive ones?
    I'm not sure what you mean by this statement or what your reviewing?
    Are you looking at a review of methods used to measure function of the 1st Ray? If so, surely you'd have to look at some invasive methods (as in some of the Christensen papers) along with your non-invasive stuff.
    Lee
     
  6. Mart

    Mart Well-Known Member

    Hi Lee

    avoiding exposure to radiation or bone implants.

    I am planning to do some data collection on 9 yr old ID twins with juvennile HAV see concurrent active thread

    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=11892

    I have no experience looking at 1st ray hypermobility other than looking at my stabilised plantar thumb position with plantarflexion and dorsiflexion of 1st ray.

    Given what I am trying to do, I am trying to get up to speed with a more quantative lab approach rather than cruder qualitative clinical approach.

    I do not have time to get ethical approval for any testing but would like to do as reasonably vigorous job as kids parents and I can agree to.

    This rules out static X ray / fluroscopy unless surgery is a serious consideration which is curently not the case.

    As you will see ont heother post I am trying to cobble something together something useful with the resourses I have. I do not have time to validate the methodolgy thoroughly but from what I have read so far seem to be in the right ball park and may be able to make some assumptions based on previous studies depending how the data looks.

    I do have high res US which can get very accurate measurements from cortical surfaces, problem is the probe head is only 12cm long, stitching together US measurements particularly in 2D/3D I think could be done but would take more time and validation than I have time for right now.

    Simon Spooner suggested using a Kilmartin Sag Raynger to measure 1st ray motion. I am not familliar with this and could not find much in the lit about it's function. I have looked at The Validity and Reliability of the Klaue Device, and what I am trying out seems to be along these lines but using a mitutoyo Digimatic Indicator in series with a force cell mounted on a tests stand instead of a depth gauge mounted on an AFO. I think my system may have the advantage of allow me to measure excursion for constant force (around 80 N seems ball park from cadaver studies).

    Thanks for interest please let me know if you have any thoughts on this

    cheers


    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  7. Lee

    Lee Active Member

    In the absence of radiography, you could use the manchester scale for HAV -

    "Garrow AP, Papageorgiou A, Silman AJ, Thomas E, Jayson MI, Macfarlane GJ.The grading of hallux valgus. The Manchester Scale.J Am Podiatr Med Assoc. 2001 Feb;91(2):74-8

    This article describes a new, noninvasive method of assessing the severity of hallux valgus deformity by means of a set of standardized photographs. Six podiatrists were independently asked to grade the level of deformity of 13 subjects (26 feet) on a scale of 1 (no deformity) to 4 (severe deformity). The reliability of the four-point scale for the severity of hallux valgus was investigated by means of kappa-type statistics for more than two raters. The results showed that the grading method had excellent interobserver repeatability with a combined kappa-type statistic of 0.86, making it a suitable instrument for clinical and research purposes."

    This might be your next best thing to Kevin's 10 year annual radiography suggestion. Could be good at assessing progression of deformity and success of each treatment (if you can use different intervention protocols for each of these patients).

    I think Simon and Kevin have covered many of the treatment and research bases. Do you have access to any motion analysis software to go with your video?
    It might be nice to look at sagittal plane motion of the first metatarsal/ medial cuneiform relative to a more proximal structure (eg. navicular/ midfoot) during gait to assess sagittal plane motion of these patients during stance. Although, how you'd successfully be able to do this with the patient shod with and without orthoses, pre and post intervention (eg. night splint) remains a mystery to me (I'm talking about a proper shoe, not one with a great big cut out at the side).

    Best of luck,
    Lee
     
  8. Mart

    Mart Well-Known Member

    Hi Lee

    Thanks for reply and suggestion; I'll check out paper.

    I do have synchronised 2 view Simi software/camera setup which I can run at 120 fps and intend to use this to do qualitative record, it does have scalable and calibated pixel measurement so may try adding some markers to look at (talonavicular drop)TDN if I get time.

    Interesting you talking about looking at motion in shod foot. I have been thinking about this for a while and here's an idea I'd like to test out..

    Place an elastically deformable wedge (compressible through ROM having minimal influence on motion) of material between the navicular and inside of shoe and measure the GRF (using thin film resistive sensor) at foot / wedge interface. Repeat measurement substituing wedge with foot orthoses.

    Measure the relationship between distance moved and vertical force applied in situ for wedge and foot orthoses at plantar nav site using test stand set up. If data reproducable then make assumption that we can measure vertical motion by using correlated change in force applied (against time).

    Have not had a chance to try this yet, it strikes me as a novel approach, have you come across anyone trying something like this? Will need a fair bit of validation but do you think there is in merit in this idea?


    cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  9. Adrian Misseri

    Adrian Misseri Active Member

    Could I hassle for a copy of the paper too?
    Pretty Please with cherries?
     
  10. Mart

    Mart Well-Known Member

    Adrian

    I cannot get JAPMA through my library but noticed this which is perhaps even more useful

    Radiographic validation of the Manchester scale for the classification of hallux valgus deformity.Menz HB, Munteanu SE.
    Musculoskeletal Research Centre, School of Physiotherapy, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria 3086, Australia. h.menz@latrobe.edu.au

    OBJECTIVES: Hallux valgus is a common orthopaedic condition affecting elderly people. Grading the severity of the condition commonly involves obtaining measurements from radiographs, which may not be feasible or necessary in some clinical or research settings. Recently, a non-invasive clinical assessment tool (the Manchester scale), consisting of four standardized photographs, has been developed; however, its validity has not yet been determined. Therefore, the objective of this study was to determine the validity of this tool by correlating Manchester scale scores with hallux valgus measurements obtained from radiographs. METHODS: Weight-bearing dorsoplantar foot radiographs were obtained from 95 subjects (31 men and 64 women) aged 62-94 yr (mean 78.6, s.d. 6.5), and measurements of the hallux abductus angle, intermetatarsal angle and hallux interphalangeal adbuctus angle were performed. These measurements were then correlated with the Manchester scale scores (none, mild, moderate or severe). RESULTS: The Manchester scale score was highly correlated with hallux abductus angle (Spearman's rho = 0.73, P<0.01) and moderately associated with intermetatarsal angle (rho = 0.49, P<0.01) measurements obtained from radiographs. Analysis of variance revealed significant differences in mean hallux abductus angles [F3 = 119.99, P<0.001] and intermetatarsal angles [F3 =29.56, P<0.001] between the four Manchester scale categories. CONCLUSIONS: These findings indicate that the Manchester scale provides a valid representation of the degree of hallux valgus deformity determined from radiographic measurement of hallux abductus angle and intermetatarsal angle. We therefore recommend the use of this instrument as a simple, non-invasive screening tool for clinical and research purposes.

    If you are unable to get this and interested emaiul me privately


    cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  11. Attached is one of the papers requested:

    Adam P. Garrow, Ann Papageorgiou, Alan J. Silman, Elaine Thomas, Malcolm I. V. Jayson, and Gary J. Macfarlane:The Grading of Hallux Valgus: The Manchester Scale.J Am Podiatr Med Assoc 2001 91: 74-78.

    What other papers are needed?
     
  12. Jeff Christensen, DPM, is a good friend of mine and was a classmate from the CCPM class of 1983. I'll e-mail him to see if he can provide us with more information regarding his papers. Jeff is one the leading researchers in first ray biomechanics in the world currently.
     
  13. David Smith

    David Smith Well-Known Member

    Mart

    This seems like a good idea.
    To characterise the change in arch height in terms of change in pressure sugnal you would require a foam inset that did not significantly change the displacement due to its stiffness. As the foam compresses the force between foot and insert increases and give a corresponding output via the ink film pressure sensor.
    This would require a sensor with a high resolution and small range within the expected pressure range. If the range was wide and the resolution low then you would not have a very sensitive calibration of change of pressure V's change in displacement.

    One difficulty would be defining the displacement in terms of foot action of interest. Since the arch would lower (and compress the foam) due to lengthening of the mediao lateral arch and due to eversion of the STJ and possibly frontal and transverse plane displacement of the knee. In which case you may need to measure these displacement also, perhaps with vicon 3D motion analysis or, with caution, 2D video analysis. Then do some tirgonometrical calculations to remove error due to those displacements.

    Some calibration to account for soft tissue compression in weight bearing may be a consideration. Also limiting the sensor to characterise only vertical displacement.
    perhaps by keeping the sensor area vey small would do this and horizontal displacement characterised as vertical displacement would be negligible.

    Perhaps a capacitor cell would be better since they do not record out of plane force so easily.

    Perhaps you could use a string potentiometer and measure arch extension and convert that to a change in height with some simple trig. This would only characterise single plane change of length (probably) unless there was some element of abduction / adduction causing bending in the transverse plane. :dizzy:

    There's always confounding variables in the simplest experiments but this sounds like a good idea.

    Cheers Dave
     
    Last edited: May 30, 2008
  14. Mart

    Mart Well-Known Member

    Hi Dave

    Thanks for your thoughts, the error problems which you mentioned I had thought about a little too especially the spatial ones.

    What I thought might be most realistic would be to create a function somewhat similar to the ankle flexibility lunge test value or foot supination resistance force which could be regarded as an index of relative control as opposed to an absolute measurement.

    One limitation in evaluating meaning of inshoe pressure measurement is that the forces measured at specific sites do not allow for any assumptions regarding motion. For example typically I will regard elevated plantar lateral midfoot peak pressures and force/time integrals a sign of metatarsal/cuboid joint dorsiflexion during midstance. Measurement of the same sites with foot orthoses usually increase these values, however this is likely due to increased ground reaction forces from change in foot / ground interface rather than increased joint dorsiflexion. By measuring the stiffness of the supporting surface in situ perhaps the force meaurement could take on some additional meaning.

    Transverse plane motion could be added to the equation by using a synchronized pressure sensor perpendicular to that plane, but error may start to get impossible to evaluate . There are lots of ifs and buts to test out. I have recently acquired a Tekscan USB DAQ which will work with small very high spatial resolution sensors (compared to their inshoe sensors) which I want to try. I have to explore the catalogue to look at sensitivity specs once I get a sense of the range of forces which need examining. Too much to do and too little time. Perhaps when I get a bit nearer to testing the idea out I could pick your engineering brain to keep me in realms of reality.

    Cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    Phone [204] 837 FOOT (3668)
    Fax [204] 774 9918
    www.winnipegfootclinic.com
     
  15. Mart

    Mart Well-Known Member

    One of the things I have been thinking about regarding measuring 1st ray range of motion is that there is likely to be significant limitation at 1st metatarsal/cuneiform joint weight-bearing compared to open chain not just because of locking attributed to Per Longus activity but also from tensile forces which will remove joint play and increasingly compress joint surfaces the more the foot is loaded if tensile elements are functioning in the fashion we assume with “autosupport”. This may be important because measurement of open chain motion only gives us a partial picture of what is loosely described as 1st ray hypermobility.

    To investigate this I have tried looking at a saggital view of my foot with US at the plantar joint margins.

    To give an impression of what US might have to offer I attached a couple of images of my foot. They were taken with US probe mounted in a rigid holder in saggital plane. The foot was placed in a thin walled polythene water bath and the linear probe coupled from below with US gel. US has high resolution and no spatial distortion and I think may be able to measure the cortical surface displacement with accuracy equal to or greater than radiographic exam with implanted marker. The problem is that it is difficult to evaluate contour shifting out of plane, but because the measurement can be recorded dynamically I think that this possible error may be estimated. The first image was taken with foot weight-bearing double limb stance with very low forefoot force and the second image with single limb stance equal force on forefoot and rearfoot about 60 frames (2 seconds) later. Care was taken not to allow foot to shift at contact sites so any off plane motion is due to metatarsal abduction.

    Measurements show change in relative height of met/cun joint ( 4.3mm)and also demonstrate the plantar joint margins separating slightly during loading. Once I have setup the system to measure open chain 1st ray motion I will be able to compare these values.

    Is anyone aware of any studies which have looked at differences in range of motion at metatarsal /cuneiform joint in open chain, partial and full weight-bearing?


    Cheers


    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     

    Attached Files:

    Last edited: May 31, 2008
  16. David Smith

    David Smith Well-Known Member

    Mart

    Can you add some markers and arrows with labels so that I can tell what I'm looking at?

    Many thanks Dave
     
  17. Mart

    Mart Well-Known Member

    Sorry I meant to annotate but have now updated images. If I get time tomorrow I want to try a different approach; a dorsal view quasi synchronised in saggital and coronal planes to try and seperate out the error from medial shift of met during loading.

    cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  18. David Smith

    David Smith Well-Known Member

    Annotate - that's the word I was looking for

    Dave
     
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