A dynamic study of hallux dorsiflexion in mild and severe pronated feet.

Abstract

Background This study was undertaken to determine the relationship between the severity of pronated feet and hallux dorsiflexion in subjects with Functional Hallux Limitus during gait. It also sought to investigate any correlation between static weight bearing and dynamic first metatarsophalangeal joint dorsiflexion; the validity underpinned by the Hubscher Maneuver test. This was designed since the usefulness of static lower extremity measurements in assessing dynamic function, is still an area of doubt and controversy despite the frequent use of these measurements in the clinical setting.

Research Method The study employed a non experimental correlation research design. A sample of 30 subjects all having a positive Hubscher Maneuver test were recruited; mean age of 28 years (ranging from 18years to 56 years). This sample included two groups matched for age and gender- Group 1 had 15 subjects with mild pronation while Group 2 had 15 subjects with severe pronation. The right foot of all subjects was measured. The Foot Posture Index was used to quantify the severity of pronation while Goniometry was used to measure maximum dorsiflexion of the first metatarsophalangeal joint (1st MTPJ) in static nonweight bearing and weight bearing positions. Dynamic measurement of the same joint dorsiflexion, was taken using two dimensional gait analysis with one video camera placed perpendicular to the movement occurring at the sagittal plane.

Results The findings of this study showed no significant correlation between static and dynamic hallux dorsiflexion (r = -0.033, p = 0.865) implicating that the Hubscher Maneuver test is not a valid test in predicting dynamic function. However if this test is used in conjunction with severity of pronation, a better outcome is obtained. In fact a significant relationship was found between the severity of pronation and first metatarsophalangeal joint during gait, where severely pronated feet had less dorsiflexion available when compared to mild pronation. This was further strengthened by the significant negative correlation found between FPI and first metatarsophalangeal joint during gait.

Conclusions Clinicians should not rely solely on the Hubscher Maneuver test to detect the presence of FHL. Performing this test in the static weight bearing position is not a good predictor of what is happening during gait implying that treatment should not be influenced by the findings of this test. The severity of a pronated foot posture in patients with a positive Hubscher Maneuver test was found to be effecting hallux dorsiflexion during dynamic movement thus supporting the Reversal of the Windlass Mechanism theory. Furthermore, this research provides the clinician with a more valid predictor of the presence of FHL. The more severe the pronation the more likely it is that there is a reduction in the 1st MTPJ dorsiflexion in patients with a positive Hubscher Maneuver test.