Kihara Takumi, Kimura Tadashi, Suzuki Naoki, Hattori Asaki, Saito Mitsuru, Kubota Makoto
Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan.
Institute for High Dimensional Medical Imaging, Jikei University School of Medicine, Tokyo, Japan.
J Bone Joint Surg Am. 2025 Mar 19;107(6):558-564. doi: 10.2106/JBJS.24.00437. Epub 2025 Jan 31.
The cause of hallux rigidus remains controversial. However, it is assumed that dysfunction of the windlass mechanism and metatarsus primus elevatus play a role in the pathology. Three-dimensional (3D) computed tomography (CT) imaging is ideal for analysis of movements of the foot, which involve 3D and rotational motion. The purpose of the present study was to compare the windlass mechanism in healthy normal feet with that in feet with hallux rigidus by 3D CT imaging.
A total of 17 feet with hallux rigidus and 21 normal feet were selected. Hallux rigidus was classified as grade 1 or 2 with use of the Coughlin and Shurnas system. CT imaging was performed during weight-bearing and non-weight-bearing with the first metatarsophalangeal joint in a neutral position or in 30° of dorsiflexion. We measured the rotation of each joint and the height of the navicular during dorsiflexion and weight-bearing. We also compared changes in the tarsometatarsal joint and metatarsus primus elevatus in the neutral position between the non-weight-bearing and weight-bearing conditions.
During dorsiflexion, there were significant differences between the 2 groups in eversion and adduction at the talonavicular and talocalcaneal joints (p < 0.05), with less movement of bones in the hallux rigidus group. There was a significantly greater increase in height of the navicular in the control group than in the hallux rigidus group (1.2 ± 0.6 mm versus 0.7 ± 0.6 mm; p = 0.02). There was also a significant difference in metatarsus primus elevatus during the non-weight-bearing and weight-bearing conditions (p < 0.01).
Hallux rigidus restricts the movement of the Chopart joint and hindfoot associated with dorsiflexion of the first metatarsophalangeal joint, suggesting an association between hallux rigidus and windlass mechanism dysfunction.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
拇僵硬症的病因仍存在争议。然而，一般认为绞盘机制功能障碍和第一跖骨抬高在其病理过程中起作用。三维（3D）计算机断层扫描（CT）成像非常适合分析涉及三维和旋转运动的足部运动。本研究的目的是通过3D CT成像比较健康正常足部与拇僵硬症足部的绞盘机制。
共选取17只拇僵硬症足部和21只正常足部。根据Coughlin和Shurnas系统将拇僵硬症分为1级或2级。在负重和非负重状态下，将第一跖趾关节置于中立位或背屈30°时进行CT成像。我们测量了每个关节的旋转角度以及背屈和负重时舟骨的高度。我们还比较了非负重和负重状态下中立位时跗跖关节和第一跖骨抬高的变化。
在背屈过程中，两组在距舟关节和距下关节的外翻和内收方面存在显著差异（p < 0.05），拇僵硬症组的骨骼运动较少。对照组舟骨高度的增加明显大于拇僵硬症组（1.2±0.6毫米对0.7±0.6毫米；p = 0.02）。在非负重和负重状态下，第一跖骨抬高也存在显著差异（p < 0.01）。
拇僵硬症限制了与第一跖趾关节背屈相关的Chopart关节和后足的运动，提示拇僵硬症与绞盘机制功能障碍之间存在关联。
预后水平III。有关证据水平的完整描述，请参阅作者须知。
