Severity of pronation and classification of first metatarsophalangeal joint dorsiflexion increases the validity of the Hubscher Manoeuvre for the diagnosis of functional hallux limitus

Abstract

Background: Functional hallux limitus (FHL) is diagnosed with a static test known as the Hubscher Manoeuvre, the validity of which has been previously questioned.

Objectives: To investigate the validity of this Manoeuvre and whether introducing severity of pronation as a second concurrent test would increase this validity.

Method: 30 participants with a hallux dorsiflexion <12◦ were divided into 2 equal groups, depending on their severity of pronation according to the Foot Posture Index. A single video camera, placed perpendicular to the plane of motion of the 1st MPJ, captured its movement, from which the angle of maximum dorsiflexion of this joint was measured.

Results: 10 males and 20 females, aged 18–56 years (mean 28 yrs, SD ±12.1 yrs) participated. There was no significant relationship between non-weight bearing and dynamic maximum dorsiflexion (p = 0.160), and between weight bearing and dynamic maximum dorsiflexion (p = 0.865). A significant relationship between 1st MPJ dynamic maximum dorsiflexion and severity of pronation (p = 0.004) was found.

Conclusions: None of the participants exhibited a complete lack of hallux dorsiflexion. A positive Hubscher Manoeuvre test, on its own, is not a good indicator of limited 1st MPJ dorsiflexion during dynamic motion. However, as pronation increases, 1st MPJ maximum dorsiflexion during gait decreases.