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Hi All,

Does anyone have any good ref's on the classification of Hallux Rigidus.

I am looking at critically evaluating it as a health outcome measure

thank you

scott

Not sure exacty what you are after, but as hallux rigidus is no motion at the first MPJ, the classification is simply:

1. They have hallux rigidus
2. They don't have hallix rigidus

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Scott

If you are after some guidelines in this area, I don't think you can go past the American College of Foot & Ankle Surgeons Clinical Management Guidelines for 1st MTP Joint Disorders .

Check out the link.

LL

Craig,

sorry for not being clear, i want look at the grading system. is it good enough to use observation and test rom or do you need to gain radiographic measurment. i am looking at it as a outcome measurement tool and trying to conclude if i can give it a grade without radiographic evidence.

should i use the grading system chairside?

LL,

thankyou i already have this ref

thankyou scott

Hi Scott,
I think Craig Payne was suggesting that you may be looking for a classification system for hallux limitus rather than rigidus. I'm no help apart from that...
cheers

__________________
Craig Tanner
Podiatrist
ASPETAR-
Qatar Orthopaedic and Sports Medicine Hospital
Doha
QATAR
http://www.aspetar.com/

CraigT, your right!!!

its the grading process for Hallux Limitus

Try:
Grade I: limited motion of the first MPJ, mild pain, no significant degenerative joint disease (DJD), minimal osteophyte
Grade II: limited motion, pain, early DJD, osteophyte
Grade III: limited motion, pain, DJD, osteophyte
Grade IV: joint ankylosis, end stage DJD

From:
http://www.podiatrytoday.com/article/6826

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Dorland's Illustrated Medical Dictionary 28th Edition p 731

hal.lux ri'gidus

painful flexion deformity of the great toe in which there is limitation of motion at the metatarsophalangeal joint.

I suggest the preferred term can vary depending on the audience. Many a GP will not have a clue what h. limitus means but could understand 'early' hallux rigidus. I have fought this for years e.g. hallux valgus / hallux abducto-valgus etc and ad nauseum, but I have found by accepting the 'common' understanding of the medical terms in use by other health professions, it can assist communication, and, at the very least substantially reduce the verbiage in my letters to other HCP. On a forum such as this h. limitus is probably the preferred term.

Or perhaps we should consider renaming this e.g. increased 1st MTP joint motion stiffness, or some such thing to further obfuscate the meaning.

Hi All,

thank you for your reply's.

I have no problem with the classification of Hallux Limitus.

I am researching how we come to a diagnosis, is it enough to clinically test ROM and patient perception of symptoms or do we need radiograph evidence to back up our grading score?

i think what i am asking- is it enough to go on clinical findings alone????

cheers scott

Scott

Classification systems will usually combine clinical findings with XRF. It is quite possible to see a clinically 'stiff' joint which on XRF shows a good covering of apparently healthy articular cartilage. So without XRF you will not have the 'full' picture you might otherwise have.

I guess there is no reason why you cannot devise a clinical rating excluding XRF but I am not sure how useful this might be. What are your objectives?

The concept of joint stiffness/compliance is an accepted scientific measure of the load-deformation characteristics of joints of the human body by the international biomechanics community. It is mathematically quantifiable, precisely defined, unambiguous and is understood by engineers and biomechanists. Can the same positive statements be made of the terms "hallux limitus" and "hallux rigidus"??? Talk about obfuscated meanings!!.....Dieter, just look at the previous postings on the subject on this thread....does anyone agree with anyone else regarding the terms "hallux rigidus" and "hallux limitus"! NOT!!

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Hi,

I am looking at outcome measurement tools in general. I have choosen to look at Hallux Limitus/Rigidus.

What are the pro's/con's of using the grading system, both chairside and through radiograph evidence?

Is their a standard way of measuring chairside and can it be repeated without variables each time?

cheers scott

Kevin

How do you suggest that we/I classify 1st MTPJ stiffness/ROM in a clinical situation. (We dont all have one of those Craig Payne patented torture machines ).

Thanks.

__________________
''The bottom line is too many people prescribe devices who haven't got the faintest idea of what they are doing. There are certain unscrupulous labs supporting this. There are too many people in it for the money.'' paraphrasing Simon Spooner

My comment was directed toward unclear (i.e. obfuscated) terminology. My comment was not directed toward what the clinician should do when examining a patient. 1st metatarsophalangeal joint (MPJ) dorsiflexion stiffness can only currently be assessed in the laboratory situation, not in the clinical setting. This could be done more accurately for patients with hallux limitus/rigidus with a hand held force measuring device and a device to also measure range of motion of the hallux in a non-weightbearing setting, but I see this being too labor-intensive to be practical clinically.

However, if we want to talk about unclear (i.e. obfuscated) terminology, then we need to look no further than the terms "hallux limitus", "functional hallux limitus" and "hallux rigidus". To the biomechanist who wanted to study this subject, he/she would want to measure the load-deformation characteristics of the 1st MPJ in dorsiflexion. As follows are the necessary experimental steps:

1. Note the 1st MPJ position with no load on the hallux (or with a nominal load from GRF while the patient is standing).

2. Apply a known plantar load on the hallux at a known distance from the 1st MPJ medial-lateral axis so that dorsiflexion moment for that load may be calculated.

3. Measure the new more dorsiflexed position of the hallux as a result of the the load applied in #2.

4. Repeat steps #2 and #3 until pain is produced or no further hallux dorsiflexion is noted.

5. Construct a graph with the Y-axis being 1st MPJ dorsiflexion moment (in Newton-meters) and the X-axis being hallux (i.e. 1st MPJ) dorsiflexion motion (in degrees).

6. The slope at any point along that load-deformation curve would be the 1st MPJ dorsiflexion stiffness (in Nm/degrees) for that given dorsiflexion value of the hallux.

7. Mathematical comparison of the shape and values of the curve in different foot types and between different subjects would be much more clear mechanically than any of the obfuscated clinicial terms we currently use when we proclaim that a patient has "hallux rigidus", "hallux limitus" and "functional hallux limitus".

It is only the clinician that is resistant to understanding the basic mechanical functions of the foot and lower extremity through accepted biomechanical and engineering terminology that will have problems with these ideas. I am not one of those clinicians.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Quick question :

When measuring 1st MPJ dorsiflexion, are we measuring the angle of the hallux to the 1st metatarsal or the floor?

Rebecca

Was this a dumb question?

As far as I know, 65 degrees hallux dorsiflexion is considered 'normal' 1st MPJ dorsiflexion. Is this measured as the shaft of the proximal phalanx to the shaft of the 1st metatarsal or the supporting surface?? I've always thought the former but something I heard / read recently has made me think again.

Rebecca

Scott,

You may find the attached table useful. The references cited are:

Regnauld B. Disorders of the great toe. In: B. Regnauld, eds. Berlin: Springer-Verlag; 1986:345-359.

Hattrap SJ, Johnson KA. Subjective results of hallux rigidus following treatment with cheilectomy. Clinical Orthopaedics and Related Research 1988; 226:182-191.

Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot and Ankle International 2003; 24:731-743.

Cheers,

Hylton

Attached Files

Radiographic grading of hallux limitus and rigidus.pdf (31.2 KB, 18 views)