A Clinical Sign for Diagnosis of the Hypermobile First Ray. Issue 4 (16th October 2019) - Foong, Weisheng
Category: Midfoot/Forefoot Introduction/Purpose: The aim of this study is to describe a new clinical sign for diagnosis of hypermobility of the first tarsometatarsal joint (TMTJ). We propose a method of qualifying and quantifying the degree of hypermobility of the first tarsometatarsal joint which is easily reproducible and does not require the use of specific medical devices. Methods: 23 patients were examined and graded positive for hypermobility of the first ray by a heterogenous group of doctors using this method. This clinical sign of hypermobility of the 1st tarsometatarsal joint is then quantified by measuring the amount of dorsal displacement using a bedside ruler. All patients underwent Lapidus procedure for fusion of the 1st tarsometatarsal joint. Clinical results are documented at 2 years post surgery. Results: All 23 patients diagnosed with hypermobility of the first ray had a mean dorsal displacement of 7.95 ± 0.20 mm. Clinical results showed significant improvement in visual analogue scores and AOFAS scores at 2 years. Conclusion: Diagnosis of the hypermobility of the first ray can be made clinically using this easily reproducible method. The degree of subluxation of the 1st tarsometatarsal joint can be quantified without the use of cumbersome medical equipment.