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FIRST MPJ PAIN - Coggle Diagram
FIRST MPJ
PAIN
ANATOMY
Muscles
Extrinsic
Peroneus brevis
Tibialis anterior
Extensor hallucis longus
Extensor hallucis capsularis
Flexor hallucis longus
Intrinsic
Extensor hallucis brevis
Flexor hallucis brevis
Abductor hallucis
Adductor hallucis
Joints
Hallux interphalangeal joint
First metatarsophalangeal joint
proximal phalanx hallux
first metatarsal head
Sesamoid - metatarsal joint
sesamoids
first metatarsal head
First metatarsal - medial cuneiform joint
first metatarsal base
medial cuneiform
HALLUX ABDUCTOVALGUS
AETIOLOGY
& PATHOLOGY
F>M
trauma
genetic
age
metatarsus primus varus
hypermobility
met head shape
TREATMENT
Conservative
Footwear
length
width
depth
support
pressure
Orthotics
improve function
reduce stress on the joint
Protection
simple protective padding
thermal
Mobilisation
improve/maintain mobility
Surgery
Osteotomies
Hallux
Akin
shaft, fixation
First Metatarsal
Distal
Austin
AKA Cheveron, V
more stable
Reverdin
variations
Wilson
oblique
unstable
Mitchell
step down
shortens met
Shaft
Scarf or Z
fixation (x2)
more stable
Proximal
Opening
Closing
Metatarsal-Cuneiform fusion
Lapidus
fixation
Joint Replacement
full implant
semi implant
Historic
Arthrodesis
rarely used for HAV
Post-operative
complications
post-op infection
excess scar
neurovascular
haematoma
complex regional
pain dysfunction
neuromas
over/under correction
e.g. hallux varus
delay/non union
osteomyelitis
implant rejection
Simple
bunionectomy
soft tissue alignment
release/tightening
Arthroplasty
Kellers
Corticosteroid Injection
careful assessment
x-ray
HALLUX LIMITUS/RIGIDUS
AETIOLOGY
trauma
increases with age
joint disease HAV, RA
dorsiflexed 1st ray
F>M
genetic/family history
footwear
long phalanx
post surgical
PATHOLOGY
TREATMENT
Conservative
Footwear
correct fit
stiff soled
Orthotics
de-stress 1st MPJ
Mobilisation
early stages
Surgical
Arthrodesis
joint fusion
end to end
fixation x2
Joint
Replacement
full or semi
Osteotomies
plantarflexion
Cheilectomy
removal of
excess bone
no long term
increase in ROM
CLASSIFICATION
Regnauld system
(adapted)
Grade I
x-ray - no joint changes
IPJ hyperextension
functional
ROM is reduced
reduced dorsiflexion
on wgt bearing
(Grade IV)
joint space obliteration
arthrodesis
<10 degree ROM
deformity - malalignment
Grade II
x-ray -flattening met head
adaptive joint changes
periarticular lipping
dorsal exostosis
ROM reduced
pain - end range
Grade III
joint changes - marked dorsally
& severe flattening
joint space narrowing
pain on full ROM
osteophytes
ankylosing
OTHER
CAUSES
OF PAIN
Overloading
cavus foot type
plantarflexed 1st ray
forefoot equinus
ankle equinus
Sesamoiditis
trauma
overloading
Neuroma
Bursitis
Skin Lesions
callous
corns
verruca pedis
foreign body
Inflammatory
Gout
Rheumatoid arthritis
others?
Infection
septic arthritis
RADIOLOGICAL
ASSESSMENT
weight-bearing for
all views
Anterior - Posterior A/P
Projection/View
Lateral
Projection/View
Oblique
Projection/View
General
bone quality
PATIENT
ASSESSMENT
History
presenting complaint
how long for?
trauma?
pain - type & frequency
better with?
worse with?
previous treatment
affecting daily activities?
affecting work?
Medications
current
past
recreational?
Allergies
medications
others
Medical
&
Surgical
History
current
past
trauma
congenital
family
Personal
&
Social
History
Work
type
special footwear?
standing period?
home situation for
post-op recovery
Recreation
sports
dog walking
walking generally
others
JOINT ASSESSMENT
Range of motion ROM
move the joint
Quality of motion QOM
move the joint
Skin integrity