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Surgery 1- 1st ray-MTPJ (1-25-08)(5) - Surgery First...

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Surgery 1-25-08: First Ray/MTPJ Appleton Page | 1 First Ray Transverse plane instability o As you get an increase of hallux abductus, as the toe moves this is how you get retrograde movement of the 1 st metatarsal How to assess for transverse plane instability o Extract the hallux away to pull off the retrograde force of the base of the proximal phalanx of the 1 st metatarsal , and push in on 1 st metatarsal See if the metatarsal moves in at the met-cuneiform joint, or if it reduces o Meaning does it have any mobility on the transverse plane This is clinically important- a lot of times may have to cut the Adductor tendon cause it comes down the lateral side of the joint and pushes the 1 st metatarsal out o If 1 st met doesn’t move at all, usually a squaring off at the met-cuneiform joint- much more aggressive (breaking bone) to reduce intermetatarsal angle First MTPJ Range of Motion Route technique, dynamic Hicks test, transverse plane motion Be expected to know in clinic After evaluating the first met-cuneiform joint, go the to first MPJ- determine ROM (plantarflexion and dorsiflexion), quality of motion (rotates into valgus or not), crepitation or no crepitation, and axis o When you dorsiflex the toe, when someone has hallux abducto valgus, you will see when you dorsiflex the toe many times it will want to drift back towards second toe Determine the maximum plantarflexion and dorsiflexion STJ in neutral position and locking of midtarsal joint, normally 65- 75 of dorsiflexion Bisect the 1 st metatarsal and the proximal phalanx; place thumb over IPJ (not distal) and measure angle ROM When do this you get retrograde pressure similar to midstance Why important?
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