Saengsin Jirawat, Atthakomol Pichitchai, Pattamapaspong Nuttaya, Vaseenon Tanawat
Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Orthop Surg Res. 2025 May 15;20(1):463. doi: 10.1186/s13018-025-05856-3.
Hypermobility of the first ray is related to many foot problems. Existing methods to assess this condition have diverse advantages and disadvantages. The aims of this study were 1) to define the optimal cutoff points for ultrasound evaluation of first ray hypermobility reliant on Klaue device and 2) to evaluate the relationship between the demographic or radiological factors, and hypermobility or forefoot symptoms in patients with hallux valgus.
Thirty-two hallux valgus patients were enrolled. Patient's demographic and radiographic data were taken. Hypermobility of the first ray was assessed in all patients using both the Klaue device and ultrasound. Ultrasonographic evaluation, including dorsal translation, plantar and medial gapping of the first metatarsal cuneiform joint, was accomplished. Youden's J statistic was calculated for each sensitivity/ specificity pair to determine the optimal cutoff value for the ultrasound measurements to distinguish hypermobile from non-hypermobile group. Continuous outcome data were analyzed using the two-sample t-test. Categorical outcome data were analyzed using Fisher's exact tests. A separate multivariable logistic regression was used to re-evaluate individual variables that were significant on the univariate analysis while controlling for age, sex, and body mass index.
The cutoff points for each ultrasound parameter to diagnose hypermobility of the first ray were determined to be ≥ 1 mm increase in dorsal translation (sensitivity = 96.97%, specificity = 82.61%) or ≥ 0.8 mm increase in medial gapping (sensitivity = 72.73%, specificity = 86.96%) or > 1.1 mm increase in plantar gapping of the first metatarsocuneiform joint (sensitivity = 81.82%, specificity = 91.30%). The increase in width of the foot and the increase in hallux valgus angle were correlated with hypermobility of the first ray, while the increase in hallux valgus angle and the first-second intermetatarsal angle were correlated with symptoms in hallux valgus patients.
The ultrasound technique measuring three parameters of the first ray motion provides acceptable accuracy for the first ray mobility assessment. Width of the feet and hallux valgus angle were associated with hypermobility of the first ray while an increase in the hallux valgus angle and the first-second intermetatarsal angle were associated with symptoms among hallux valgus patients.
第一跖骨过度活动与许多足部问题相关。现有的评估该状况的方法各有优缺点。本研究的目的是：1）确定依赖克劳厄器械进行超声评估第一跖骨过度活动的最佳截断点；2）评估拇外翻患者的人口统计学或放射学因素与第一跖骨过度活动或前足症状之间的关系。
纳入32例拇外翻患者。记录患者的人口统计学和影像学数据。使用克劳厄器械和超声对所有患者的第一跖骨过度活动情况进行评估。完成超声评估，包括第一跖楔关节的背侧移位、跖侧和内侧间隙。计算每个敏感度/特异度对的约登指数，以确定超声测量区分过度活动组与非过度活动组的最佳截断值。连续结局数据采用两样本t检验进行分析。分类结局数据采用费舍尔精确检验进行分析。使用单独的多变量逻辑回归重新评估在单变量分析中有显著意义的个体变量，同时控制年龄、性别和体重指数。
诊断第一跖骨过度活动的各超声参数截断点确定为：背侧移位增加≥1mm（敏感度=96.97%，特异度=82.61%）或内侧间隙增加≥0.8mm（敏感度=72.73%，特异度=86.96%）或第一跖楔关节跖侧间隙增加>1.1mm（敏感度=81.82%，特异度=91.30%）。足宽增加和拇外翻角度增加与第一跖骨过度活动相关，而拇外翻角度增加和第一、二跖骨间角度增加与拇外翻患者的症状相关。
测量第一跖骨运动三个参数的超声技术为第一跖骨活动度评估提供了可接受的准确性。足宽和拇外翻角度与第一跖骨过度活动相关，而拇外翻角度增加和第一、二跖骨间角度增加与拇外翻患者的症状相关。
