Relationship Between Clinical Measurements and Motion of the First Metatarsophalangeal Joint During Gait.

Nawoczenski DA, Baumhauer JF, Umberger BR (Department of Physical Therapy, Ithaca College-University of Rochester Campus; Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY), J Bone Joint Surg Am. 1999;81:370-376.

The purpose of this study was to analyze the relationship between commonly used clinical tests of motion of the first metatarsophalangeal (MTP)joint and the motion of that joint during gait.

The Flock of Birds electromagnetic tracking device was used to measure the 3-dimensional motion of the hallux relative to the long axis of the first metatarsal bone. Measurements were made during an active range-of-motion (AROM) with weight bearing test, during a passive range-of-motion (PROM) with weight bearing test, during a PROM with non-weight bearing test, and during a heel-rise test.

Significant differences between the results of the clinical tests were found using an ANOVA. Post hoc comparisons demonstrated that measurements during heel-rise differed from AROM and PROM with weight bearing; PROM with non-weight bearing differed from both AROM and PROM with weight bearing; and AROM with weight bearing differed from PROM with weight bearing. Pearson product-moment correlation coefficients were significant, ranging from 0.61 to 0.87, for all correlations between the maximum dorsiflexion of the MTP joint during the clinical tests and the maximum dorsiflexion during walking. Motion of the first MTP joint during heel-rise yielded the strongest relationship with walking (r=0.87). The next strongest relationship was the AROM with weight bearing test (r=0.80). However, the mean value for AROM with weight bearing was 44 degrees, and this value was closer to that during walking (42 [degrees]) than was the mean value during the heel-rise test (58 [degrees]).

The results of the heel-rise test and the AROM with weight bearing test were found to be strongly correlated with motion of the first MTP joint during gait. AROM with weight bearing may be a more appropriate choice for a clinical test because the mean value for dorsiflexion more closely matched the mean value during gait than did the mean value for the heel-rise test. The authors believed that these findings emphasize the need for consistency in assessment methods and for documentation of the clinical tests chosen for measuring motion of the first MTP joint.

According to the researchers, although this study demonstrated a correlation between the motion of the first MTP joint as measured with commonly used clinical tests and that required during normal walking, functional activities--such as squatting and stair climbing--may require additional motion.

Elaine Louise Bukowski, PT The Richard Stockton College of New Jersey Pomona, NJ