Hallux valgus in children. Biomechanical aspect: A literature review

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BACKGROUND: The study comprehensively describes the issues of the normal biomechanics of the first toe, first metatarsophalangeal joint, and first ray when walking. Understanding the fundamental processes of the functioning of these structures is a leading aspect in the study of the etiopathogenesis of hallux valgus and is important in treatment planning.

AIM: To analyze the literature concerning the kinematic and kinetic indicators of the first toe, first metatarsophalangeal joint, and first ray of the foot when walking in the final support phase.

MATERIALS AND METHODS: The characteristics of periods, gait phases, kinetic and kinematic movements were analyzed.

RESULTS: To perform a “push-off” when walking, sufficient extension of the first toe in the first metatarsophalangeal joint is necessary, which is fully accomplished only in combination with flexion and eversion of the first ray of the foot. Muscular control of the position of the first toe in the first metatarsophalangeal joint is carried out by the short and long flexors of the first toe with the sesamoid apparatus of the first metatarsal bone, whereas functions of the first ray and midfoot joints are stabilized by the peroneus longus muscle.

CONCLUSIONS: The influence of kinematic and kinetic indicators of movements in the lower-limb joints in the horizontal plane on the flexion of the first ray and extension of the first toe in the metatarsophalangeal joint and the determination of the nature and volume of movements in midfoot joints in various phases of the gait cycle remains a pressing issue.

作者简介

Valery Umnov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: umnovvv@gmail.com
ORCID iD: 0000-0002-5721-8575
SPIN 代码: 6824-5853

MD, PhD, Dr. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Dmitriy Zharkov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: striker5621@gmail.com
ORCID iD: 0000-0002-8027-1593

MD, orthopedic and trauma surgeon

俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Vladimir Novikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: novikov.turner@gmail.com
ORCID iD: 0000-0002-3754-4090
SPIN 代码: 2773-1027

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

Dmitriy Umnov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: dmitry.umnov@gmail.com
ORCID iD: 0000-0003-4293-1607
SPIN 代码: 1376-7998

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, 64-68 Parkovaya str., Pushkin, Saint Petersburg, 196603

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补充文件

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1. JATS XML
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2. Fig. 1. Phases of terminal support (a) and preswing (b). The black line indicates the vector of the support reaction forces, or the vector of the body

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3. Fig. 2. Axis of movement of the first ray: a, horizontal plane; b, frontal plane (Michaud T. Foot orthosis. Baltimore, 1993; [55], with modifications)

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4. Fig. 3. Movement of the first ray: a, horizontal plane; b, sagittal plane

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5. Fig. 4. Sesamoid apparatus of the foot. L, lateral sesamoid bone; M, medial sesamoid bone

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6. Fig. 5. Projection of the centers of rotation of the first metatarsophalangeal joint (a) (1–4), rotational movement of the head of the first metatarsal bone (b), sliding movement of the head of the metatarsal bone (c), and compressive movement of the first metatarsal bone head (d) (Ronald L. Valmassy. 1994, [22], with modifications)

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7. Fig. 6. Projection of the center of pressure on the foot during normal walking according to A.K. Mishra [48]. The solid line is the evaluated limb, and the dotted line is the contralateral limb (Ronald L. Valmassy. 1994, [22], with modifications)

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8. Fig. 7. Function of the short and long flexors and short and long extensors of the first toe in the midstance phase (a). During this phase, the projection of the ground reaction force vector is located behind the first metatarsophalangeal joint and does not have any effect on it. The localization of the first toe on the surface neutralizes the flexion torque of the center of gravity of the first toe and determines the stabilizing effect of the flexors and extensors of the first toe of the proximal phalanx of the first toe against the head of the first metatarsal bone. The function of the long flexor of the first toe, short flexor of the first toe, and sesamoid apparatus in the third rocker phase (b). The vector of ground reaction forces is located anterior to the first metatarsophalangeal joint, creating an effective extension torque lever. The sesamoid bones and the displacement of the center of rotation of the first metatarsophalangeal joint to the anterosuperior parts of the head increase the flexion torque of the short flexor of the first toe, which provides active counteraction to the passive extensor action of the ground reaction forces. The blue line indicates the torque lever arm of the center of gravity of the first toe, the green line indicates the torque lever arm of the short extensor of the first toe, the brown line indicates the torque lever arm of the extensor muscles of the first toe, and the gray line indicates the torque lever arm of the ground reaction forces

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9. Fig. 8. Position of the first ray and foot in the loading response and initial midstance phases in the sagittal and frontal planes (a, b). Position of the first ray and foot in terminal stance and preswing phases in the sagittal and frontal planes (c, d). Explanations are given in the text

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10. Fig. 9. Mechanism for blocking the first ray of the foot. See text for explanations

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11. Fig. 10. Location of the axes of the first toe abductor and peroneus longus relative to the resulting axis of movement of the first ray of the foot. See text for explanations

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