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

BACKGROUND: The range of joint motion is a commonly reported outcome measure in assessment of the great toe. Although motion of the first metatarsophalangeal joint during gait is of primary functional importance, clinicians rely on relatively static clinical measures to assess this joint. The relationship between the results of commonly used clinical tests of motion of the first metatarsophalangeal joint and motion of this joint during gait was assessed in a study of thirty-three subjects who had no history of a pathological condition of the foot or ankle. METHODS: An electromagnetic tracking device was used to acquire three-dimensional orientation data on the hallux with respect to the first metatarsal. Receivers were secured to the skin overlying the proximal phalanx of the hallux, the first metatarsal, and the medial aspect of the calcaneus. Measurements were recorded during four clinical tests. These tests assessed the active range of motion of the first metatarsophalangeal joint with the subject weight-bearing, the passive range of motion with the subject weight-bearing, the passive range of motion with the subject non-weight-bearing, and the motion during a heel-rise. The data collected with these tests were compared with motion of the first metatarsophalangeal joint during walking. The focus of the analysis was the dorsiflexion component of rotation. RESULTS: With the exception of the passive range of motion with the subject weight-bearing, the ranges of motion measured during all of the clinical tests exceeded the motion of the first metatarsal joint that is required during normal walking. The motion measured during heel-rise (r = 0.87, p < 0.001) and the active range of motion with the subject weight-bearing (r = 0.80, p < 0.001) had the strongest correlations with motion of the first metatarsophalangeal joint during gait. The mean dorsiflexion during the test of the active range of motion (44 degrees) was closer to the mean dorsiflexion during gait (42 degrees) than was the mean value measured during the heel-rise test (58 degrees). This study also demonstrated that the clinical tests are not interchangeable as their mean results differed by as much as 21 degrees. CONCLUSIONS: The selection of a reliable and valid clinical test and an understanding of the relationship of the results of this test to the motion requirements during normal gait will help to standardize reporting techniques and will improve the ability of the clinician to determine the outcomes of treatment. This study showed that measurement of the active range of motion with the subject weight-bearing was a reliable and valid test and that the results were strongly correlated with motion of the first metatarsophalangeal joint during gait.