<![CDATA[Journal of Orthopaedic & Sports Physical Therapy

<![CDATA[Journal of Orthopaedic & Sports Physical Therapy - Mary K. Allen, MPT,MS]]> http://www.jospt.org/marykallen Wed, 30 Apr 2008 09:05:25 EST 0 Comparison of First Ray Dorsal Mobility Among Different Forefoot Alignments http://www.jospt.org/issues/articleID.466/article_detail.asp Mary K. Allen, Ward Mylo Glasoe, Paula M. Ludewig, Lisa Selby-Silverstein
Study Design: Experimental design using 1-way analysis of variance and regression analysis to test the influence of 3 forefoot alignments on the dorsal mobility of the first ray. Objectives: To determine the effect of forefoot alignment on the magnitude of first ray dorsal mobility to an imposed load and to describe any association between forefoot alignment and age on dorsal mobility of the first ray. Background: Instability of the first ray has been implicated as a primary mechanical etiology of many foot problems. It has been proposed that a relationship exists between forefoot alignment and mobility of the first ray, with a varus aligned forefoot contributing to the development of an unstable first ray. Methods and Measures: Sixty female (n = 34) and male (n = 26) subjects aged 18-77 were assigned into valgus, neutral, and varus foot groups (20 per group) based on a clinical measurement of forefoot alignment. A load cell device measured dorsal mobility of the first ray under a standard load of 55 N. Within-day repeat measures were taken from a subsample of subjects. In addition to reliability analysis, analysis of variance and regression analyses tested the relationship between forefoot alignment, age and sex, and mobility of the first ray. Results: The forefoot valgus group demonstrated significantly less dorsal mobility of the first ray than neutral or varus groups. The varus and neutral groups were not significantly different from one another. Forefoot alignment and sex were significant linear predictors (R2 = 0.40) of first ray dorsal mobility. Age had no significant association to dorsal mobility of the first ray. Conclusion: Subjects having a valgus aligned forefoot had less dorsal excursion of the first ray than subjects having a neutral aligned forefoot. This investigation provides evidence supporting a relationship between forefoot alignment and mobility of the first ray. J Orthop Sports Phys Ther. 2000;30(10):612-623. Key Words: first metatarsal, forefoot valgus, forefoot varus]]> http://www.jospt.org/issues/articleID.466/article_detail.asp Weight-Bearing Immobilization and Early Exercise Treatment Following a Grade II Lateral Ankle Sprain http://www.jospt.org/issues/articleID.555/article_detail.asp Mary K. Allen, Bruce F. Awtry, Ward Mylo Glasoe, H. John Yack
Study Design: Case study. Objectives: To describe a protocol used in the rehabilitation of a grade II lateral ankle sprain, emphasizing brief immobilization with a removable boot, weight bearing as tolerated, and progression of early exercise. Background: The optimum conservative treatment of severe grade II ankle sprains remains undefined. Short-term benefits of early mobilization have won favor over immobilization by casting; however, pain and ankle joint instability often linger. The timing of weight bearing as a variable that influences recovery has largely been ignored when either treatment is considered. Methods and Measures: The patient was a 17-year-old girl who had sustained a left ankle inversion sprain while playing high school basketball. The sprained ankle was placed in an immobilizer boot for 1 week, and weight bearing was encouraged. She received instructions for active exercise and for resistive exercise with elastic tubing. Volumetric and active range of motion measurements and gait observation provided indicators of rehabilitation progress. A digital inclinometer was used to measure active range of motion in the sagittal plane. Vertical ground reaction forces recorded with an instrumented treadmill documented gait symmetry. Results: The patient responded well to the course of treatment, returning to full participation in basketball 2 weeks after the injury. The injured ankle had 29% (19°) less active range of motion than the nonimpaired ankle at the beginning of physical therapy. The injured ankle also displaced 50 mL more water compared with the nonimpaired ankle at the start of treatment. Four weeks after beginning treatment, the sprained ankle had 4° less active range of motion and displaced 5 mL more water compared with the nonimpaired ankle. As a college athlete, the patient has remained free of subjective complaints of ankle pain, instability, and swelling. Conclusion: Weight-bearing immobilization combined with early exercise provided safe and effective treatment for this patient, who suffered a grade II lateral ankle sprain. J Orthop Sports Phys Ther. 1999;29(7):394-399. Key Words: gait, immobilizer boot, rehabilitation.]]> http://www.jospt.org/issues/articleID.555/article_detail.asp Dorsal First Ray Mobility in Women Athletes With a History of Stress Fracture of the Second or Third Metatarsal http://www.jospt.org/issues/articleID.121/article_detail.asp Mary K. Allen, Ward Mylo Glasoe, Ted Kepros, Laurie Stonewall, Paula M. Ludewig
Study Design: Retrospective case-control study.

Objective:To examine the amount of dorsal first ray mobility in subjects having a history of stress fracture of the second or third metatarsal as compared to control subjects, and to test the influence of navicular drop, length of the first ray, and generalized joint laxity on the measure of dorsal mobility.

Background: Instability of the first ray may cause the lesser metatarsals to carry greater weight and contribute to the incidence of metatarsal stress fracture. Stability of the first ray is believed to be compromised when subtalar joint pronation continues into late stance, the first metatarsal is short, or an individual has generalized joint laxity. To date, no research has assessed the relationship of these etiological factors to the measure of first ray mobility.

Methods and Measures: Fifteen women athletes having a history of a second or third metatarsal stress fracture were matched by age, body mass, and sport activity to women athletes without fracture. Dorsal first ray mobility was quantified by a device using a standard load of 55 N. Change in vertical height of the navicular during stance was the measure of foot pronation. Relative length of the first ray navicular segment compared to the length of the second ray navicular segment was measured by caliper. Generalized joint laxity was evaluated using the Beighton 9-point scale. Within-day repeated measures assessed reliability. Differences between groups were determined by independent t test. Multiple polynomial regression analysis assessed the relationship between dorsal mobility and navicular drop, length of the first ray, and joint laxity.

Results: Interrater reliability coefficients ranged from 0.36 for metatarsal length to 0.71 for navicular drop. The intrarater reliability coefficient for dorsal first ray mobility was 0.93. Dorsal first ray mobility was not significantly different between the 2 groups. With regression analysis, the Beighton score was the only variable retained as a significant predictor of dorsal mobility (R 2=0.24). Conclusion: Results do not support the theory that describes the unstable first ray as a common cause of metatarsal stress fracture. In addition, this investigation found generalized joint laxity to be a significant predictor of dorsal first ray mobility.

J Orthop Phys Ther 2002;32(11):560–567.

Keywords: dorsal mobility, first metatarsal, generalized joint laxity

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