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Hi all
Not sure if there has been a question like this in the past, but I am interested in why the great toe joint seems to cause so many problems, particularly in later life, i.e. hallux limitus, rigidus, HAV etc etc. From an historical perspective, when our life spans were only 30 years or so I guess we would never had seen such conditions, but does the fact that now we are living much longer mean that the MTPJ isn't up for the job? Is this an evolutionary issue? Just curious to hear anyone elses thoughts on this.
cheers
SC.

The onset of hallux valgus varies. It may be congenital. It may manifest during adolescence or, later in adult life. Congenital hallux valgus is rare. However, a few isolated cases of the condition are reported (Thul, Stone and Gilarski 1985). Mahan and Jacko (1991) suggest that juvenile hallux valgus most commonly presents between the ages of 11 and 14 years, but provide little evidence to substantiate this conjecture.

Greenberg et al. (1963) in a study of 1,878 school children noted a prevalence of hallux valgus in the order of 6%. Sabbam (1965) reported a prevalence of bunions of 1.75% in a survey of 1,370 children under 15 years. In a survey of joint mobility and foot problems of 191 Australian children, Marr and D'Abrera (1985) noted a prevalence of hallux valgus of 11.8% in females, compared to only 3.5% in males. Kilmartin and Wallace (1990) reported a prevalence of 2.3% of 6,400 nine-year-old school children.

Adult and geriatric foot surveys have suggested a higher prevalence of hallux valgus: Merrill, Frankson and Tarara (1967) noted a prevalence of approx. 24% in their study of 1,011 nursing home patients of 60 years old and more. Schnitzer and Hoeffler (1974), in a study of 14,470 male American Navy recruits, reported a prevalence of 19.4%. Brodie et al. (1988) reported that hallux valgus was almost three times as prevalent in females as in males until the age of 64 years, when the prevalence between genders converged. However, this gap again widened at 75 years and older.

All of the above taken from: Spooner S.K.: Predictors of Hallux Valgus: A study of heritability. PhD Thesis, University of Leicester.

Hope this helps.

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An interesting question! I would suggest the evolution from barefoot to shoes has something more to do with it; as well as the evolution from walking to driving; the evolution of getting fat; the evolution of cheap fashion footwear.
Now people are living much much longer what is the condition of MTPJ in populations unaffected by above mentioned evolutions? There must be a small tribe of them somewhere.....

Here's something interesting to consider.

Take a look at an x-ray or skeletal model of the metatarsals and phalanges.

What is the difference between the 1st metatarsal and great toes, and the lesser metatarsals and toes?

The most obvious is the "lack" of a "middle" phalanx. Look more closely though at the shapes of the metatarsals and phalanges in all three planes.

What you soon discover is that the 1st metatarsal shares all the anatomical attributes of a proximal phalanx, and none of the attributes of the lesser metatarsals (physical shape, proportions etc). And the ratio of sizes of the distal,middle and proximal pahalges of the lesser toes are proportional to the ratio of the sizes of the distal phalanx, proximal phalanx and 1st metatarsal.

So the question is: why is the first metatarsal really just an oversized proximal phalanx?

LL

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Remember, it's just a foot.

Hi Sparky:

good question.

Looking at it from a different perspective.....is the 1st MTPJ any more prone to pathology than, say, the knee or hip or heart or lungs?

I think the life span of the human race has arrived to a point where we outlive our "parts."

Steve

Good points all. We also have to account for differences in shod/unshod populations and geographical distribution.  However, David H's favourite theory must surely have a bearing - in the Western world we walk on artificially hard, flat surfaces. Appreciate your morphology point LL.  Additionally, the ossification of the epiphysis of the 1st met. takes place at the base (like a phalanx), whilst that of the lesser mets. is at the anatomical neck.

In the final analysis, I am sure that SS & KK would point out that in addition to the above, the complexity of the sesamoid apparatus and the very complicated moments about the joint during ambulation are involved.

All the best

Bill Liggins

If you want to see something cool along this line, look at the Vadoma tribe in [western Zimbabwe. A nurse here in the clinic (from Zimbabwe) told me about them. Her grandfather, as medical officer did some of the first research on them.

IMG]http://http://darkcreek.com/vadoma_ectrodactyly[/IMG]

They are in a remote area, away from roads. They are known for their running and tree climbing ability.

Quite a sturdy looking first ray, huh? No hypermobility issues in these feet!

Cheers

Frederick

Hi Fred:

Watched the video.........wow.

When I was in my residency we had a patient with Lobster Claw Deformity. I haven't seen one since. Apparently it's an autosomal dominant trait.

Thanks

Steve

Hard, flat/level surfaces.

Cave men didn't have concrete. The first MTPJ is unable to plantar flex at the appropriate time and the hallux can not extend over the met head during propulsion. This repeated millions of times a decade = pathology.

Different stroke for different folks - individual tissue stress variables = variable pathologiesbetween individuals.

regards

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Graham Curryer

None of us know what we are doing, but some of us know more about what we are not doing than others!::