Hallux Valgus Observations: A Controlled Series Study

OBSERVATIONS
ON
Based
R. FT.
In
view
worth
of tile
while
to
comparable
be
varied
merely
a series
or
at
natural
exact
observations
any
that
least
related
Tile
material
from
the
Naval
Royal
attend
Of
in
to,
only
rigidus
three
examined
250
in
awaiting
rather
less
years
with
per
examined
Twelve
of the
suffering
without
101
from
patients
remaining
selected
and
the
group
1) Occurrence
of symptoms.
(the
symptoms
case
for
who
was
nature
a
might
would
either
material
College
and
waiting
sent
and
or
be
from
the
Hospital,
men
and
of
of those
examined
ranged
ages
of thirty-five
to
per
cent)
attended
were
and
one
excluded
one
men
250
in
from
or more
the
for
with
hallux
total
list
therefore
of
he
twenty
to
sixty-six
years
(Fig.
2).
Of
children.
the
already
patients
attended
should
fifty-one
from
had
the
who
valgus
the
were
of pain
patients
of
hallux
borne
those
to
briefly
eighty-nine
nineteen
proportion
from
him
was
symptoms
Of
of
operation
asking
which
with
joint.
; the
had
one,
of
feet)
and
cent)
Keller’s
each
examination,
both
males;
per
for
to
purpose
for
one
suffering
rigidus
a lengthy
attempt
of morning,
except
as judged
stated
investigation
had
: eleven
bilateral
operations
Control
was
few
preliminary
drawn
training
fashion
for
with
set
hallux
down
shoes
operation
should
be
out-patient
purposes
valgus
was,
in a suggested
making
in
in orthopaedic
made
to meet,
and
evening
instances
5)
of course,
order
to
a continuance
3) Suitability
here).
4) Willingness
Ability
to
highly
of importance:
preferable
included
department.
of research.
from
so far
times
of those
group-Eighty-four
were
are
reach
of
to submit
University
College,
times.
afternoon
in the
patients
factors
2) Environment
of
investigation
at
An
selecting
influence
operation
London,
376
ages
of eighty-nine
following
of
They
exist,
with
groups
benefit.
The
to
were
hallux
patients
(42
were
(54
of 250
were
Eight
The
bilateral
two
: morbid
metatarso-phalangeal
cent)
between
forty-seven
sources
themselves
first
per
who
cent.
such
University
A letter
(affecting
manner
a preponderance
women
were
12
the
operation
three
the
presented
males.
a similar
a list
valgus
(12
were
Keller’s
than
was
who
of
if any
the
differences.
from
investigation,
twenty-nine
between
it seemed
together
Portsmouth.
hallux
region
from
Hospital.
an
in man
cases
MATERIAL
controls
there
persons
the
only
investigation
the
10!
uncorrected
deformity
written
1949
for
the
from
at
valgus
established
factor,
such
London
of hallux
differences
to
drawn
Orthopaedic
department
explained.
was
Hospital;
May
National
tilis
suffering
survey
Barracks
group-In
the
and
the
Orthopaedic
Royal
Morbid
at
of
National
ENGLAND
College,
on
a predisposing
closely
LONDON,
history
marked
CLINICAL
Royal
Series
University
of the
\Vhile
it is likely
them,
a Controlled
of A natonzy,
of
of controls.
accidental,
among
Department
accounts
attempt
number
found
the
VALGUS
1. C. R. CLAPHAM,
and
HARDY
From
on
HALLUX
who
persons
among
school
the
at
as possible,
refused
were
staff
University
all
of attendance.
of person
by
offering
were
paid
for
all
in the
same
way
as the
a choice
who
attended,
payment.
investigated
and
types
Fares
students
College
of
University
Hospital.
THE
College
Fifty-two
JOURNAL
OF
(62
BONE
morbid
and
AND
per
the
cent)
JOINT
group.
nurses’
were
SURGERY
OBSERVATIONS
women.
One
there
was
hallux
nurse
no
valgus
between
tile
ages
to
mostly
so
to
the
that
The
a desire
and
twenty
years
bilateral
not
sixty-five
(Fig.
1).
the
Royal
a standard
and
nineteen
rigidus
comparable
years
In
and
hallux
closely
with
addition
a large
to these
Naval
plantar
those
\s’ilo
were
Portsmouth,
radiograph.
of
age
;
the
of
l)rep11derand
persons
Barracks,
years
; otherwise
to
were
These
total
tile
were
range
was
years.
any
those
concern
from
with
diagnosis
recruits
advanced
to
377
VALGt’S
were
of
seventeen
controls,
for
ratings
examination
forty-five
nurses
naval
sixteen
between
London
The
factor.
from
clinical
expressed
ages
ranged
naval
HALLUX
from
Their
forty-two
recruits
seventeen
or two
to be suffering
of sixteen
a brief
young
Of
one
and
fully,
submitted
found
morbidity.
group,
investigated
from
was
marked
ON
or
were
all
were
selected
advice
those
does
available
by
College
University
Colldition
tile
not
from
a Chief
were
of their
feet
appear
tile
Petty
to
volunteers
and
none
have
been
traillillg
school
at
Officer
according
of
with
only
elllpllaSis,
a StrOllglV
selective
relevant
monient.
the
to
whom
any
their
freedonl
from
721
66
60
5.
48
42
/3 /82328
4
..-
1
FIG.
Histograms
of
48 53 58 63 68
#fRs)
of
age
of
Figure
group.
other
commitments,
changes
s’ere
slight
and
present
symptoms
only
in the
; these
one
region
were
showed
unilateral
addition
to
Radiographic
taken,
which
of
that,
“arch
height
adult)
under
in
attributed
to
INVESTIGATION
clinical
examillation
100
the
33
an
degrees)
B,
NO.
3,
axis
Figure
his
feet
1-Control
; advanced
joint
a single
osteoarthritic
which
instance
four
of the
AUGUST
second
a similar
1951
were
and
gave
of severe
methods
of
down,
rise
to
traunia.
collecting
data
measurements
to
a base
of ±1
.5 millimetres;
metatarsal
standard
and
to
lead
in
in the
a transverse
of
to
± 15
considerable
were
and
line-usually
deviation
radiograph
which
(Venning
talus
found
plantari-dorsal
measurements
investigation
laid
of the
deviation
conditions
to take
a preliminary
head
silowed
standard
possible
conditions
the
a standard
between
about
medio-lateral
found
In
tile
(from
“
showed
of angle
it was
comparison.
found
VOL.
and
groups.
grotip.
metatarso-phalangeai
OF
examination-Standard
from
purpose
from
history
two
interest
first
and
in
used.
were
the
a full
subjects
2-Moriid
an
of the
METHODS
In
2
11G.
distribution
the
Hardy
plantar
tarsal
degrees.
errors
for
the
it
was
1951)
lateral
about
s were
significant
radiograph
of
45 millimetres
view
measurements
base
Small
in
line
(usually
departures
measurement
in
37$
H.
(Figs.
3 and
4).
radiograph
standard
one
leg
the
ground.
‘file
the foot,
represented
of
the
of
the
for
knee
the
base
heel,
to
of tile fjfth
Standard!
A B,
base
Figure
lateral
tile
H.
from
CLAPHAM
each
radiographs
extended;
distance
a line
made
C.
plantar
and
seven
from
each
the
was
joining
100
was
as follows:
knee
centimetres,
the base
film
tile
was
other
The
was
flexed,
and
tile
centimetres.
The
stood
the
distance
central
For
the
flexed
film
iii such
the
base
were
in
120
a way
of
a
radiograph
about
tile
3-
Lateral
EF,
;
axis
of
tarsal
tile
ray
Photography-A
and
of
included
secondi
line.
passed
incorporating
the
apex
was
lateral
and
measurements
made
were
and
Goniometry
and
ergometry-Bv
means
measure
of tile
of movement
the
that
foot
was
of the
phalangeal
leg,
isometric
the
foot
on
transmitted
tile
axis
in
Footprinting-Two
the
respectively.
leg,
of the
4
a rigilt-angled
j)ounds.
of range
of
A
of
types
an
mean
of
the
to
The
three
and
footprint
the
were
used:
the
same
of
bar,
the
leg
to
side
the
for
were
JOURNAL
8 and
great
at
right
to
metatarso-
in
pounds
ions
The
of
by
of
force
was
which
calibrated
each
on
movements
10).
deflect
9) an
toe
angles
the
exerted
certain
(Fig.
the
THE
means
Twelve
(Figs.
and
force
of the bar was
produced
mirrors
By
of the
be
malleolus
one
7).
prints.
and
taken
taken
of
5 to
device
on
lateral
exerted
the
photograph.
a resistance
was
of force
of
enlarged
in executing
against
deflection
eye
the
metatarsal;
arrangement
the
was
taken
and
overlying
second
(Figs.
each
foot
muscles
readings
an
foot
mechanical
a ground-steel
five
the
of
the
from
case
upright
sheet
of the
and
from
also
of
foot,
lever
of
of
of
were
inch.
movement
means
in each
trunk
centimetres.
by
of the
groups
on
knee
views
recorded
tue
a perspex
head
100
directly
prominence
different
toe
the
of a simple
Readings
of
and
vere
of movement
through
in thousandths
observations
range
contraction
b’
measured
Tile
passing
joints
tile
exerted
made.
observations
on
the
was
taken
measurements
approximate
general
of
posterior
with
rested
through
distance
photograph
stool
a
foot
passed
cathode-film
medial,
scales,
just
meta-
OIl
of the
ray
cleft,
‘fiie
multiple
plantar,
of
mid-point
length.
sat
sole
central
tile
line.
tile
a plane
view.
arch
subject
the
interdigital
first
straigilt
the
degrees;
that
off
metatarsal.
radiographs.
Figure
line;
CI),
arch
height
4--i’lantar
view.
AB,
tarsal;
CI), transverse
J)iallt(tr
to
erect
toes
from
cleft to
of the first interdigital
11 .5
subject
with
FIG.
knee
lateral
observations.
fully
by
J.
.-N1)
were
general
cathode-film
back
below
to
position
with
HARDY
measurements
in addition
The
on
Ten
H.
for
were
the
observation.
force
Four
recorded.
by
OF
pressing
BONE
AND
a
JOINT
tilin
sheet
SURGERV
OBSERVATIONS
OX
HALLUX
VALGUS
:37!
FIG.
FIG.
Figuire
taking
1)etai!
Figtire
6
5-(k’Ili’ral
view
of
muiltiple
photographs.
of
arrangenlent
7-Specinlen
of Illuiltiple
7
appara
tuis
Figure
of
mirrors.
photograph.
FIG.
VOL.
33 B,
F
NO.
3,
AUGUST
195!
10
1
6-
3S0
H.
(0.5
millimetres)
ridges
sheet
Specimens
were
taken
inked
from
designed
of each
kind
plain
on
to
of
to
an
are
and
C.
its
CLAPHAM
of paper;
the
undersurface
indication
silown
an
H.
a Slleet
on
give
prillt
footprint
J.
ANI)
bearing
hut
heights
the
H.-HI)Y
rubber
inked
similarly
of different
foot.’
plain
of
a rubber
of
H.
of tile
in
obtained
of
over
and
of pressure
by
means
intersecting
pressure
1!
Figures
estimate
Otiler
a set
12.
tile
Six
distribut
rtibber
sole
of the
measurements
ion
was
made
from
thit’ other.
lI(;.
Fiuire
ii
11G.
1 i-l’lain
id I c
ntact
minus
angle
fo tprint.
Illd(l
I SI
tiolu
lille
0
footprint
; L F,
allg!e
with
latera!
A . Figuire
\veigllt
is
\laxillltiIll
12
lines.
.-IB,
; I)C,
midline.
projection
con tact
line
1 2-\Veight
tindler
distril)ui-
the
hem!
of
first
illetatarSal.
Personal
details-A
taken,
ali(1
of each)
detailed
a history
foot
was
of
history
tile
together
IllaCle,
of
feet
family’s
with
general
so
a note
far
health
as
and
of
possible.
of the
the
feet
A detailed
clistributioll
in
Partict1ltr
clinical
of wear
on
was
examination
the
bottom
of
tile
si ioe.
Statistical
method--All
statistical
analysis,
coefficient.
\\‘hienever
or
history
In
subjective
and
not
to
recorded
subjects
which
el lea!
collected
possible
each
unless
appear
objective
foot
was
of interest
recorded
were
measurements
of the
otherwise
to he
were
of correlations
nunlber
subject
as
stated.
Only
in relation
a
ro
by
were
or observer
treated
on
tested
by
and
means
of tile
correlated
means
a tin it so that
to
forina
sui)jected
with
of the
recorded
facts
observations
and
past
observations
or
the
ill
test.
Chi-square
figures
those
to
correlation
refer
to
feet
correlations
of high
are
statistical
themselves.
significance
Thus
data
a large
observations
comparisons
general
the
and
type
C
of
rps
tootprinting
t( ot
sui rvev,
Illat
a Ill
was
k mdl
dlesiglled
v suipphied
by
Harris
th rouigh
and
Beath
t he Canadian
THE
(I 947)
High
JOURNAl.
for
Com
OF
the
Royal
Ill issioner
BONE
ANI)
Canadian
in
JOINT
-\rmy
I.OIld()n.
SURGERy
OBSERVATIONS
OBSERVATIONS
Degree
of
hallux
radiograph
is
tile
measurement
ON
valgus-An
first
made
is of
MORBID
objective
requisite
the
in
angle
VALGUS
H.-LLUX
()N
AND
CONTROL
measure
defining
between
the
tiie
Fiu.
of
GROUPS
valgus
of
terms
axis
:3$
of
deformity
reference
the
first
on
of
metatarsal
the
this
l)lanttr
paper.
an(I
that
ax(’S
of
valgmms
ill
The
of
the
13
1/822263
..AL64$/NX6.4.
14
FIG.
Figure
1 3--Ra(liOgraphic
nletatarSal
and
first
control
proxiIntl
levels,
was
; the
phalallx
joining
obtained
by
did
l)l1altIlx
the
not
points
a line
ailow
measuiremunt
proximal
phalanx.
Figum re
grotip.
first
of
applied
of geometrical
Statistical
valgums.
Angle
1 4--i
)istrihumtion
15 -1 )istrihum t mon 111 morl)i(l
was
obtained
bisection
and
by
visual
division
of halluix
Figure
.V : between
of halhmix
groump.
by bisecting
the
shaft
of
extending
tile line
ill
1)0th
estimation,
at
two
because
levels
(Fig.
the
the
metatarsal
directions
irregular
: the
outline
at two
second
of
the
1 :3).
ilOte-----Ihe
terlll
‘ ‘ statistically
sign ificallt
‘ ‘
is imse(l
conventionally
thu
mmgla )ii t tim is
pa per,
significant,
the
probability
o)f the
findings
being
dume
to) chance
is more
than
0)110’
ill
twenty
significant,
probability
less
than
one
ill tVeIlt\’
; /img/ulv smgn i/icon!,
l)ru!)ul)ilit’
less than
one in a hundred
i’CVV
Ii ig/mlv Sign ijica nt prol)al)iiitv
less
thai)
one
ill a thotmsand.
The
correlation
coeftmciellt
is tmsedl
as
a measure
of tile
interdepenulence
of two
oimmalltitlo’s.
If
thd’
variables
are
in(lepo’Ildlent,
the
correlation
coefficient
will
l)e zero).
If the
interdlepelldence
is complete
and
tile
relationship
linear
tIle
correlatioll
coefficient
will
be
1, tilt’
positive
sigll
indicatmg
that
high
values
of one
variable
occur
vitll
higil
valtmes
of tile other
and a negative
sign
In(imcating
timat
llmgh
ahmmes
of one
occuir
wmth
low
values
of the
other.
id’.,
VOL.
not
33
B,
NO.
3,
AUGUST
1951
I
The
dhistrii)utioll
14 and
(Figs.
and
in the
mori)i(l
two
groups
of the
the
IlleaIlS
tie
t-test
of
15).
The
lay
degree
of
12-16
157--
l63
TIhe
feet,
degrees
FIG.
in
perhaps
dealing
and
perniissiik’
with
as 4-25
section
control
“
degrees
normal
(the
(probability
is
degrees
the
modes
between
by
estimated
+6
degrees,
and
it
1$
angle.
Amlgle
17-Distribution
lS-1)istribtution
distribution
+2 x standard
“
mean
60 degrees;
T lie difference
series
illd’tatarSa!
Figumre
F’mgumre
histogranis
C) to 36
16
of
Illetatarsals.
grormp.
to take
12 to
significant
the
from
of
mllorbi(1
in
for
the age
deviation)
.‘t’ :
mlletatarsal
groump.
group
for
hetwd’en
angle
of the controls
we are
purpose
of analysis
tile
reference.
First
the
from
the
in
ranged
FIG.
second
control
is shown
feet)
respectively.
highly
of
measurement
aild
groups
(252
17
16-Radiographic
first
two
degrees
very
deviation
Fmc..
1”mgtmre
axes
of
OLAPHAM
excluded)
32-36
is
H.
controls
cases
and
degrees)
C.
the
in
in the
operated
standard
J.
AND
valgus
of valgus
(165
at
<001).
1-IARI)Y
angle
group
(32.0-
-
tile
H. H.
angle
intermetatarsal
axes
of
(Fig.
the
and
first
16).
In
the
-This
second
252
angle
nietatarsals,
feet
of the
was
Oi)taine(l
obtained
control
i)v
by the
series
this
THE
measuriilg
the
method
angle
JOL’RNAL
given
ranged
(IF
BONE
angle
in
from
.-NI)
between
the preceding
()-1 7 degrees,
JOINT
SURGERY
is
OBSERVATIONS
with
tile
mode
degrees.
by
4-27
tile
occurring
tile
Keller’s
from
in
In
177
operation,
degrees
nlorbidl
these
at
8-9
defective
as
with
group
well
was
degrees
feet
as
a mode
ON
(Fig.
angle
tile
in
at
tile
1:3 degrees.
17).
Ihiere
feet
(Fig.
intermetatarsai
those
18).
of
the
The
highly
angle
that
cases
had
preceding
mean
was
been
ranged
section)
intermetatarsal
significant
S’S
treated
angle
het\veell
difference
nieans.
FIG.
Figure
19-
C,
cemltre
nletatarsal
It
group
will
be
is not
observed
It
that
is to
in a morbid
symmetry
is not
Relative
33
so.
B,
NO.
3,
AUGUST
20
21
Fin.
the
distribution
diagram
of intermetatarsal
symmetrical,
with
mean
and
be
that
\vhell
symptoms
expected
mode
)trmmsmon.
of
groump.
angle
coinciding.
are the
series the series will lack llomogeneitv.
statistically
metatarsal
19
Radiograph
me neasum
remimt’n
t
of
rulative
metatarsal
ir
of circle
of which
.1 aildl
13 are
arcs.
F’igtmre
20-Distribution
protrtismon
in control
grouip.
Figtmre
21-Distribution
in morl)id
is approximately
inclusion
VOL.
mean
in
is a very
Fin.
tiliS
The
uncorrected
degrees
353
VALGUS
(measured
165
14-15
HALLUX
Iii
chief
However,
in
the
the
selecting
tile
control
morbid
group
factor
departure
significant.
protrusion-This
1951
is a somewhat
vexed
question
i)ecause
tue
for
from
defInition
384
of
H. H.
terms
The
difficult
and,
However,
for
is
obscure.
axes
tarsal
of
line
posterial
the
then
drawn
of
The
+
falls
at
control
Tilis
millimetres
amounts
than
in
to
iention
head
tile
objection
first
first
metatarsal.
of
ally
regard
mid-point
of
identifiable
the
by
the
heads
is,
in
as to make
It
is, of course,
the
first
must
two
those
out
subjects
circles
of approximately
tilere
will
be
metatarsal
a
displacement-The
seventh
1 to
in
position,
6 degrees
the
showing
of
morbid
Rotation
that
tile
this
observation.
tile
estimate
to
Army
a
tile
+2
millimetres).
mode
of
is longer
highh’
as an estimate
at
apparent
to
angle
(Harris
and
Beath
centred
was
on
not
in
tile
accurately
of circles
but
is
to measure
of circles
be
the
shortening
redundant
axis,
of
functional
open
intermetatarsal
should
far
point
perpendicular
of the
which
arcs
the
this
survey
metatarsal
so
used
an
arcs
point
these
angle,
to
relating
centred
on
practice
distant
from
the
measure
the
absolute
angle
their
metatarsal
of the
will
with
be
joint
contains
by
It
inherent
means
bias,
arcs
of
intermetatarsal
relative
lengtils
surfaces.
an
compared
a smaller
the
angle.
protrusion
90
the
the
per
from
axis.
cent
of displacement
(Figs.
axis-It
Rotation
was
from
22).
axis
I to
to
Thus,
and
In
of
the
showing
in
252
3 or
of
23
and
24).
was
not
said
radiograph
THE
to the
the
head
metatarsal
in the
not
7 degrees
therefore
the
in relation
sesamoid
(Fig.
of
to
sesamoids
medial
way
side
its long
proximal
of
Thus
the
first
varus.
the
lateral
their
suggested
underestimate
in this
rotation
of
here
as those
with
about
desirable-to
irregularity
metatarsal
readings)
of
and
is nevertheless
of the
between
the
He
it is clearly
Canadian
Ideally
primus
displacement,
degrees
as
series
very
from
lead
widening
the
by
radius
medial
is entirely
(174
is
group
morbid
metatarsal
conception
it
will
calcaneum,
position
of the hallux
of
same
recorded
series
4 or more
measure
found
it
his
but
metatarsal,
of comparison
slightly
on
the
metatarsal
distance
on
distance
tile
method
by
are
is entirely
first
first.
statistically
(1935).
second
the
that
first
of the
a larger
measured
of position
sesamoid
true
if it were
of metatarsus
was
degrees
the
tendency
Sesamoid
the
angle
intermetatarsal
because
with
metatarsal
measure
inconvenient.
the
in cases
of Morton
is based
In
possible-even
that
first
is
taken
the
morbid
of
a mean
the
means
is offered;
described.
small
nieasure
not
measured
represented
metatarsals
be pointed
that
of
and
a radial
of
here
radii
cases
the
mode
millimetres)
valgus
of
measure
be
as
aspect
the
work
axis
factor.
made
methods
of
the
in
‘ ‘
the
(with
two
this
the
and
was
that
than
were
first
arcs
indicates
right
+4
tile
of the
as a separate
posterior
the
measure
the
the
is greater
is,
intermetatars4
it may
was
tile
intersection
convergence
in
each
to
of hallux
criticism
to shortening
measurement
tilis
His
no
\Vhile
edluivalent
shift
the
surface,
the
in
metatarsal.
and
of
to
which
increase
second
; arcs
of the
of recording
sign
millimetres
between
point
articular
foot,
dvnaniically
1 947)
at this
the
tilat
tile
distal
purpose
the
line
placed
heads
between
21) ; that
+4
cases
the
and
of this
small.
of the
of
in the
millimetres)
cuboid
was
of the
are
way.
; a transverse
the
intersection
dividers
of
the
(mean
a perpendicular
of the
mechanics
i)Oth
be made
protrusion
intersection
that
“
and
to
difference
arithmetically
must
relative
a
20
of
terms
following
above
of
point
: a positive
that
indicate
(Figs.
the
For
in the
described
surfaces
(in
of the
made
surface
a pair
a sign
sign
millimetres
The
of
distance
millimetres
+2
a statement
although
significant,
±7
at
At
articular
by
as
articular
protrusion.
group
to
falls
controls.
tile
radial
measure
control
group
the
interpretation
was
drawn
point
touch
and
measure
navicular.
a negative
of this
the
the
is preceded
and
the
posterior
one
The
arcs
relevance
were
the
metatarsal
the
second,
with
the
metatarsal
so as to
of relative
llistograms
touch
of
19).
the
survey
metatarsals
to
other
(Fig.
the
defined,
second
as
J. c. H. CLAPHAM
AND
of the
second
between
than
when
purpose
tuberosity
the
measure
compared
of
the
the
witil
distance
greater
of
so
metatarsals
as the
to
and
of
axis
second
of
first
drawn
aspect
vith
the
the
was
even
the
HARDY
first
position,
contact
with
controls
the
less
of the
axis.
degrees
the
it
with
88
possible
to make
an
to
and
JOURNAL
be
present
from
d)F
in
the
is from
of displacement;
displacement,
found
medial
and,
spread
first
Seven
or
absent.
the
medial
BONE
AND
per
cent
objective
It
was
photograph
JOINT
SURGERY
O)BSERVATIONS
correspon(led
Cld)SCIV
was
that
observed
valgus
ilahltix
of
vaigus
was
Mobility
and
4 and
those
‘as
36
7)
Rotation
.
subjects
who
degrees,
HALLUX
and
s’as
VALGUS
only
found
rotation
showed
of those
who
of
did
not
in
the
the
niorhid
hallux
5110w
such
grouj
it
all(l
the
average
degree
rotatioll
tile
average
1 9 degrees.
of the
Possible.
firmly
(Figs.
of
ON
first
It
grasped
tarso-metatarsaljoint--Again
was
estimated
in one
attenipted
to
hand
flex
while
and
no objective
clinically
the
as
fingers
extend
it
in
follows:
of the
the
thle
other
grasped
vertical
,+?ED/AL
nieasure
tarsal
wilole
the
plane.
head
Tue
of
area
the
of
of tile
findings
o)i)servatio)n
tile
first
foot
was
Illetatarsal
were
recorded
as
LATERAL
‘0
20
(
)4
22
FIG.
23
FIG.
Figtmre
22-l)isplacement
in relation
positions
Fin.
of
to)
fret’ )1lO1)ilhtV,
group
59
mobility.
(l8S
tile
VOL.
cent
Tue
feet)
figures
group
free
tile
The
morbid
should
be pointed
33
B,
3,
AUGUST
out
1951
of
Fig
umrt’
Iii tile
168
group
w’ere
between
nienli)ers
cent
63
24
j
mlletatarSO-phalaflgeal
Figumre
1 )mstrmhum
t
24--
2!) per
difference
first
metatarsal.
first
groump.
niobilit\,
is statisticall\’
It
NO.
for
sesamomd
no inobilit’.
show’ed
respectively.
morbid
coiltro!
iiiobilit’,
llflhitt’d
per
the
in
displacenlent
medial
axis
of tilt’
)mstrmhumtuon
ii)
0)01-1)1(1
(sailors
limited
per
23-i
1)11
cent,
the
distributions
and
degree
per
of
and
cent
tile
SesamiloBi
ml.
excluded)
mobility,
18
mnt-sccn
of
go
of
and
control
control
the
1:3 iwr
cent
c(’nt
group
and
significant.
that
for
a given
age
of valgus,
tile
partial
110)
19 per
correlation
386
H. H.
between
but
stiffness
that
the
and
age
stiffness
between
any
altering
the
of
of
the
and
‘ ‘
one
following
gave
at
attribute
of hallux
Sex
that
men
the
and
no
group-Of
hallux
valgus,
results
are
shown
in Table
age
of onset
than
from
reports
the
of distribtition
\Iale
aiotis
Relative
metatarsal
by
of the
age
twenty
latter)
years
and,
of
years.
a degree
of hallux
(63 per
(siblings),
of lack
question
is,
grandfather,
children.
Only
of definition
for
eighty-four
valgus
cent)-that
: grandmother,
‘ ‘
in
the
the
of the
a
term
examination.
They
subjects
of whom
control
bunions.”
‘ ‘
factors
here
for
with
which
cent
; namely
the
a natural
desire
purpose
fifty-seven
who
the
significant
groups.
the
125
cases
differences
were
angle
cent
history
choice.
or sister(s)
between
group,
for
the
relative
metatarsal
SEX:
CONTROL
GROUP
-- -
Standlard
error
of
Value
of t
(123 degrees
differenCe
of
a
of bunions
brother(s)
control
investigated
and
by
being
is a favourite
differences
in the
aroused
of a rational
a family
33 per
father,
four
interest
heredity
avowed
of the
the
mean
seventy-three
three
measures,
protrusion.
The
I
ACCORDING
Mean
--
TO
measure
--
Male
Female
Female
110
14
145#{176}
7
10
83#{176}
Inter-metatarsal
angle
in
made
I.
Measure
of
that
be
estimate
than
with
sister
relations
with
intermetatarsal
DIFFERENCES
l)egrees
less
fifteen
because
TABLE
Mode
a definite
bunions
“
statistically
in the control
of
found
deformity-usually
in fifty-seven
16 per
Sex
or
group
fact,
were
give
of less
combined
in each
degree
could
history
of
of the
women.
it was
morbid
of
occurring
fifty-two
between
is no correlation
because
in the
selective
mother,
There
valgus
differences
were
observed
and
there
‘ ‘
cuneiforms
family
these
own,
an
children.
an
to
pain
brother,
history
highly
observing
implicated
cent
of
gave
most
sufferer’s
to
worth
cent
two
the
a cause
It is perhaps
degree
to
able
in comparison
family
least
were
suffered
to
of
medial
onset
(consanguineous),
attached
height
possible
two
of onset
cases
interest
a positive
are
4 per
be
as
age
relations
aunt
arch
is significant,
stiffness,
age.
was
who
a positive
inaccessibility
similar
per
was
of some
There
complaint
ninety-one
and
film.
cent)
an
the
can
nevertheless
per
dimension
“
valgus
“
and
the
height
of
a given
stiffness
the
arch
“
observation
(either
gave
the
degree
is, for
those
there
uncle,
significance
bunion
to
(46
cent)
of
the
between
condition
per
father,
and
gap
degrees,
one
limited
77
apparent
of fifty-two
(30
25
least
to
of this
history-Of
mother,
only
or between
valgus
out
than
are
valgus
of symptoms-Of
sixteen
Family
lowering
That
foot
J. C. H. CLAPHAM
AND
between
significant.
of the
their
twenty-four
less
and
estimate
an
relation
of onset
of onset
these,
not
and
foot
joint
correlations
radiological
almost
Age
this
are
stiffness
No
at
of
partial
HARDY
154#{176}
--0’78
D2l
-
9’G#{176}
109
4-
Probability
freedom)
(;iot
>‘
significant)
<‘001
(very
highly
significant)
3’77
0’
3 mm.
2 mm.
mm.
28
27
mm.
--1-!28
035
>
sunificant)
(;iot
protrusion
It
appears,
and
female
first
metatarsal,
females
over
then,
controls
but
the
that
in
males,
the
there
there
case
is no
of
is a mean
and
this
significant
severity
increase
difference
of
difference
hallux
between
valgus
and
of intermetatarsal
is statistically
angle
highly
THE
the
JOURNAL
means
relative
of
of
the
male
protrusion
of
the
1’3
degrees
in
the
AND
JOINT
SURGERY
significant.
OF
BONE
OBSERVATIONS
ON
HALLUX
387
VALGUS
CORRELATIONS
All
175
the
entries,
large
amount
was
transferred
intercorrelate
all
used
were
the
significance
be
expected
the
ilead
of
valgus.
degree
In
of
valgus
are
recorded
It
joint).
that
Correlation
is
are
of degree
recorded
this
and
groups
together,
morbid
not
set
necessary
down
is by
valgus
far
the
there
record
with
size
‘4
.
.
:
.
a few
the
and
page
a
of tile
which
severity
tile
the
occurrence
arch
‘ ‘
height
“
of
385-,,lo/ilitv
of these
correlations.
angle-
\vilOle
coefficient
series
between
Of
of cases,
tilem
071
of
all
the
control
It
.
is
.
.
. ...
.#{149}..::..
.
.
.
.
.
.“
....
,.,
.i’
.‘“
...:
..
iii such
.
.
13_’
:
.:‘‘#{149}..:“..
‘o
:#.
.
.
S
‘.
.:
:?:.:.‘
...
I
1
I
5#{149} l0
I
I
2o
I5
#{149}
‘
I
I
30
25
M’4LLOX
.\ii
dlmagram-llal!tmx
arrov
has
Plttct’(!
leen
at
worth
and
hallux
first
and
that
is,
angle
noting
valgus
second
for
average
Hence,
The
33
value
xo.
angle
in
3, AUGUST
the
“
control
is equivalent
of hallux
1951
valgus
the
and
t\V()
angle
I
-J
65’
60
angle
grOuipS
a radial
“
between
is almost
partial
in degrees.
(control
between
tile
first
group
arid
morhi(l
divergence
valgus
is only
of
fifth
and
03
for
nietatarsals,
by
is only
tile
degrees
is 45
the
nietatarsals
accounted
coefficient
first-to-second
splay-foot.”
and
entirely
correlation
morbid
whereas
to
I
56
intermetatarsal
into
correlation
tile
in
series
with
the
the
Thus
angle
I
50
cOrIiI)iIl(’(i).
correlation
angle.
I
45’
oeaees
25
between
this
tilat
first-to-second
association
B,
correlation
and
second-to-fifth
if “splay-foot
significant
tile
intermetatarsal
a given
is low.
that
is 062,
IN
valgums
in degrees
correlated
the
level
(If stmggested
division
groups
perhaps
I
10
3
VALGC/5
FIG.
Correlation
VOL.
Over
1’
.
than
is to
grOut).
of the
(see
the
It
is a departure
with
of intermetatarsal
striking.
2O
the
more
is a correlation
2S.
-03)
age
test
is a lowering
age
to
of significance.
most
3o_
appear
morbid
tile
lowering
to
to
variety.
there
advancing
solely
is used
“
series,
between
to
test
there
in
Illade
measurements
will
instance
between
in order
X2
observations
combined
attributable
of hallux
correlations
tile
was
objective
somewilat
radiograph
correlation
statistically
or
coniprising
attempt
correlations
For
lateral
from
apparent
tile
no
in many
grouj).
in the
is a correlation
the
is
that
morbid
line
there
fact
whereas
yes,
‘ ‘
investigation,
no
Where
irrelevant
to note
the
tested.
quoted,
of a
coefficient
Similarly
larso-inela/arsal
Tilose
in
base
tile
(correlation
symptoms.
be
of this
Althoughl
were
of apparently
observations
well
can
subject
system.
correlations
it is of interest
towards
each
card
observations
number
and
talus
fairly
hallux
many
coefficient
a large
for
a punched
subjective
control
the
of foot
and
correlation
that
correlates
of
of data
method,
from
collected
to
items
between
blunderbuss
of data
the
0:3:
first-to-fiftil
higher
degrees
tilan
higher.
there
is no
388
H. H.
lile
correlation
division
of the
slope
is less
0’36
are
053.
into
above.
valgus
or
An
at
it is found
difference
that
a
25
of intermetatarsal
Angulation
valgus-A
of the
further
metatarsus
in
angle
valgus
(correlation
first
is
it
observing
to
the
severity
Age
factor
for
causing
The
high
in
(correlation
and
the
the
morbid
to
031).
be
atavistic
Thus,
“
for
than
angle
foot
metatarsal
is, the
symptomatic
subject
the
severity
with
the
severe
with
valgus
the
second,
second
tends
valgus,
in
and
a low
while
to
wide
be
in
the
a
intermetatarsal
THE
between
angle,
first
metatarsal
the
There
was
no
OF
BONE
for
significant
valgus
short
a given
and
is also
of
JOURNAL
the
relative
for
0.33)
which
and
in
of
correlation
However,
(coefficient,
angle
cases
stage
the
degree
greater.
general
significance.
(0’ 1 6)
valgus.
the
angle
the
same
not
;
significant
of
so that
angle
low
is
0.10)
is not
limited
intermetatarsal
for
age
All
the
be
unfortunately
with
hallux.
correlation
intermetatarsal
a high
would
intermetatarsal
the
valgus
with
angle,
age
age
stage)
iiallux
the
angle)
correlation
is of onh’
of
correlation
The
the
determining
are
with
to
of
coefficient,
a sense,
of the
correlation
a high
in
low’
of
lead
the
valgus
between
of
age
a
angle
members
correlations
hallux
that
deviation
are,
base
angle
the
advancing
(correlation
be
there
to
correlation
intermetatarsal
0.01).
group
two
vere
angle
would
is
is a higher
and
the
and
of
group
of the
(that
and
a negative
greater
intermetatarsal
onset
the
the
these
coefficient,
here
above.
angle
intermetatarsal
angle
intermetatarsal
protrusion-Tilere
of valgus
(coefficient,
tends
of
first
intermetatarsal
\‘algus
correlation
morbid
significance
with
degree
the
correlation
disease
and
of
described
immediately
of
of
results
The
was
the
metatarsal
valgus
halltix
this
of
the
and
angle
061).
valgus
a widening
equivocal.
of
considerations
between
expected.
given
valgus
between
instance,
correlation
line
the
measure
axis
nevertheless
correlation
a
(hallux
If,
base
angle
(coefficient,
after
of
This
the
cases
a high
with
hallux
relation
of
the
intermetatarsal
low
between
base
0.59).
of
a given
looking
differences,
a widening
angle
valgus,
that
to
inquiry
age.
there
of
in such
with
metatarsals.
hallux
from
is associated
without
a
than
correlation
angle
as
of hallux
in terms
sides;
correlated
namely
tarsal
for
two
two
tarsus
itself,
the
correlation-These
an
intermetatarsal
this
hallux
valgus
‘ ‘
is obtained
of the
between
()7l)
higher
metatarsal
first
of
interpret
sides
second
that
of
(coefficient,
is
the
tile
divisions
of the
degrees
angle
the
two
transverse
is true
a correlation
and
metatarsal
and
by
metatarsal
of
the
coefficient
the
While
Metatarsums
omnis
varus-axis
of
secollol
metatarsal
displaced
to
indicate
that
in suich
a case
tile
angle
between
tile
axis
of tile
first
and
the
base
line
(X)
will
be snlail,
but
that
tile intermetatarsal
allgie
will
also)
be
snlall.
the
point
two
critical
“
to
between
‘ ‘
26
28
association
respect
between
estimated
protrusion
of this
in this
between
Relative
of a
attempt
this
the
division
at
on
to be a natural
for
theoretical
whole
metarsus
in relation
to the
association
immediately
suggests
yams
(Fig.
26) and hallux
valgus,
omnis
Fin.
any
constancy
discrepancy
a
the
constituents
shown
Before
coefficients
hesitatingly
but
is
appears
of 25 degrees.
with
‘ ‘
degrees,
there
justified.
difference
iligil
here
to speak
of the
show
region
angle
that
correlation
abnormal
“
possible
vet
intermetatarsal
be seen
in the
agreement
approximately
which
It can
respective
and
“
confirmation
of feet
the
is some
is not
and
25).
diagram
and
is therefore
pathology
additional
pairs
it,
normal
“
It
occurring
etiology
‘ ‘
There
measure
suggested
after
valgus
(Fig.
in the
than
J. C. H. CLAPHAM
AND
hallux
diagram
observations
steep
and
‘algus
at
between
correlation
accompanVing
HARDY
and
instance
first
AN1)
a
a
high
of
the
metatarsal.
JOINT
SURGERY
OBSERVATIONS
Sesamoid
displacement-There
displacement
(measured
valgus.
Tile
coefficient
Mobility
of first
movement
in this
hallux
valgus
This
of
valgus
in
the
24’7
stiff
and
for
Rotation
of hallux-There
; those
feet
which
do
very
highly
Age
of onset-There
valgus
not
is an
which
show’
the
Wearing
of
show
rotation
with
is low’.
Arch
height
association
early
between
have
an
valgus
of
severe
and
valgus
of this
and
1) There
two
was
is
of liahlux
limitation
height
of
show
valgus
out
of
above
is the
and
by
a mean
21 ‘7 degrees.
the
correlation
determining
factor
but
tue
of
those
is statistically
severity
of hallux
Tilere
correlation
is a tendency
shoes.
definite
valgus
or factors
predisposing
measurements
intermetatarsal
was
longer
the
of
higher
remainder
first
angle
in
those
(coefficients,
than
measure
than
factor
and
correlation
was
amount
negative
heels.
in
the
in
the
differences:
a mean
angle
1 1 .08)
high
a comparison
in the
metatarsal
by
(X2=
to any
the
than
group
control
cases
the
second
tile
metatarsal
the
by
to
valgus
with
and
be
a
0’53).
a mean
For
tends
high
cases
0’36
of 4 millimetres.
when
mean
tile
15’S
measure
a high
longer
degree
than
is associated
the
with
iligh
group
group
intermetatarsal
sex
angle,
difference
in
influencing
available.
It
factor
NO.
between
3,
in the
AUGUST
the
can
only
departure
1951
was
very
was
among
mean
morbid
but
medial
morbid
overlap
in
sesamoid
group
the
between
that,
two
stated
observed
controls
of
in the
angle
even
showed
distributions
the
so,
in the
tile
(98
of
degree
of
there
cent)
this
morbid
clearly
the
first
from
and
it is important
an
and
second
to know
sex
is only
difference
13
degrees.
importance.
elucidated
group
had
controls.
of minor
positive
tilose
rest
32#{149}0
degrees
significant
only
is no
of
in the
group
the
was
difference
is probably
be
morbid
while
axes
per
mean
tile
the
group
a statistically
cannot
that
morbid
8#{149}5
degrees
of ‘omen
groups
; in
:36 degrees
between
and
showing
observations
be
of the
of the
correlation
tile
group
largely
measure
the
cent
little
of valgus
of valgus
The
only
per
a high
degree
degree
consisted
the
displacement
88
observed
in the
a lateral
whereas
valgus.
average
degrees.
degrees
morbid
control
age
not
The
130
There
of hallux
was
was
There
groups.
19 degrees.
the
there
or less,
more.
an
was
of
two
severity
hallux
controls
Since
or
had
of tile
33B,
first
rotation
metatarsals
controlling
0’7)
,
degrees
greater
the
of the
of
present
to point
between
of 3 degrees
in
and
showing
of
degree
and
CONCLUSIONS
of correlation
of 4 degrees
Rotation
tile
difference
between
worn
Nevertheless,
intermetatarsal
of the
observation
that
the
morbid
metatarsal
first
in
and
degrees,
angle.
displacement
that
group
cent
a displacement
that
hallux
35’8
Tilis
high-heeled
outstanding
25
in the
a significantly
intermetatarsal
average
the
of
degrees.
of having
several
than
a low
3) In 90 per
cases
shows
(coefficient
greater
control
valgus
the
of
valgus
a significant
AND
valgus.
degree
combined
the
second
rotation
I 85
worn
be used
hallux
groups
a high
of valgus
2) In
VOL.
a mean
association
histor
to have
cannot
of
of 2 millimetres;
role
sesarnoid
of symptoms.
the
never
t’pe
control
groups
degree
Thus
of
severity
movement
pointed
average
significant
onset
shoes---There
of valgus
development
morbid
i
the
between
limited
joint
arch
a barely
of an
severity
A surve\’
4)
a mobile
been
average
is onh’
history
with
the
this
degree
and
association
with
As has
SUMMARY
of
feet
significant.
rotation
an
high-heeled
the
those
of
the
22))
significant.
and
between
to
is an
Those
those
a given
between
only).
valgus.
highly
389
(Fig.
joint-There
degrees
joint
correlation
group
hallux
VALGUS
of displacement
tarso-metatarsal
and
high
degrees
(morbid
is statistically
and
a
HALLUX
correlation.
valgus
for
is 0’8
joint
of
difference
is
in seven
ON
from
the
The
data
indication
that
the
observations.
control
age
at
is a
390
R. H. HARDY
J. C. H. CLAPHAM
AND
APPENDIX
This
which
appendix
are
Use
of
A
pressure
of
the
following
feet
For
feet
Occurrence
at
the
450
joint
tile
was
1 per
made
show
flat
Observations
the
as
is,
the
lateral
lowering
of
of the
medial
and
the
length
pronhinelice
the
base
head
of
head
of
negative
correlation
using
hallux
of
the
rigidus;
the
PraCtical
Correlation
any
protrusion
first
metatarsal
the
first
first
(average).
significant.
in the footprint
radiographicallv.
There
and
is no correlation
a relative
protrusion
joint-An
is strikingly
of
were
cent
joint.
had
Those
excursion
made:
In
flat
joint.
a
feet
in the
its
of
the
great
flattening
radiographs
occurrence
feet
In
madle
of
at
in which
those
(goniometer)
the
the
a clinical
where
no
a radiological
toe
and
were
measurement
limited
mobility
those
in which
between
of the
apparent
observable
Observations
per
total
total
the
excursion
such
assessment
of
64
degrees.
of
arch-The
headi
between
of
the
the
the
the
arch
talus
height
to
a
measured
was
base
line
joining
as the
the
vertical
lowest
points
talus
and
coefficient
lowering
the
and
“
surface
of
the
of
is 0’8;
slope
the
of the
first
there
inClination
first
is thus
of
metatarsal-that
metatarsal,
(at
as
seen
an association
least)
the
in
the
between
member
anterior
arch.
significant
correlation
following
clinical
tilting
with
appearance
the
other
a
in
any
a lowering
pronation
inquiry
into
valgus
and
assessments
the
per
the
of
‘ ‘
flat
cent arch height/
foot ; subcutaneous
foot.
It
age
there
‘ ‘
“
is
and there
is a
that
it is w’orth
foot.”
increasing
: ‘ ‘ pronation
overcrowding
“
of
of the
‘ ‘
looked
at from
behind;
It therefore
appears
foot.
metatarsalgia;
deformities
‘ ‘
as
cavus
hallux
clinical
anterior
:
calcaneum
of
further
of
between
assessments
of the
between
following
skin;
a number
height
superior
correlation
of talus;
plantar
arch
‘ ‘
extending
measures
and
a flat
average
on
well as the correlation
between
age andi the
callosities
14
longitudinal
line;
radiographical
these
Age-As
correlation
on
between
the
millimetres
observations
made
average
an
a line
longitudinal
is a very
highly
ratio
and
the
There
arcll
an
point
between
View,
measured
Correlatioll
metatarsal
(average).
compared
with
the goniometric
the
clinical
observation
of
with
had
the
26
rigidus.
following
this is tile Case.
is a high correlation
angle
as
08).
sesamoids
of the first metatarso-phalangeal
joint.
In order
to relate
to the relative
size of the foot under
consideration,
this observation
is
cent
arch
height/arch
length
(Fig. 3). If in fact the lowering
of an arch
also
this
ratio
will
tend
to lose
some
of its significance,
but
it is by no means
lengthening
that
There
survey
the
per
the
and
cent
medial
lowest
the calcaneum
and
the absolute
measurement
clear
valgus
(coefficient,
under
by
metatarsal
hallux
was
show
of
its
‘algus
87 degrees.
are statistically
very
highly
significant.
This finding
is of some
interest
in
Harris
and Joseph
(1949)
on the metacarpo-phalangeal
joint
of the thumb,
an association
between
flat joint
and limitation
of mo’ernent.
joint
on the
from
not
and
toe
The
made
These
differences
of the work
of
where
the’
observed
iiiduces
hallux
high
hallux
inquiry.
metatarso-phalangeal
first
radiographs
mobility
View
expressed
is
to the
of
under
the
first
by 4#{149}2
millimetres
second
first
of the
great
limitedi
without
the
with
joint.
was
distance
head
odd
of
assessment
pressure
second
pressure
than
of the
the
rnetatarso-pha!angeal
flat
maximum
associatetl
excursion
Those
future
between
13)
is statistically
very
highly
under
the second
metatarsal
beyond
the first as measured
characteristically
of
the
than
of flattening
assessment
of
longer
is longer
surface
throughout
to
intermetatarsal
angle
is not sufficiently
high
to be of
this is almost
entirely
due to the correlation
with
‘algus.
under
metatarsal
heads
(Fig.
12) and relative
metatarsal
with
The
difference
maximum
pressure
second
nletatarsal
total
a lead
(Fig.
maximum
is
metatarsal
is
lines
radiograph
with
metatarsal
joint
incidental
give
order:
For
of this
r#{233}sum#{233}
of observations
or
surveys-Correlation
the
1 1) and
0.5) and
distribution
(coefficient,
between
and
11)
(Fig.
“
interest
in further
(Fig.
value
a brief
general
of footprints
footprint
‘ ‘ Angle
is
contains
either
is also
; tilt
of
the
a positive
calcaneum;
deformity
of
worth
noting
perhaps
the
toes;
that
of
the first
metatarsal
sesamoids
were
observed
(thirty-six
subjects)
only nine were over the age of twenty-five
years.
In the control
group
there
was only one such-a
woman
aged twenty-seven
years.
In the morbid
group,
in every
one of the eight cases
the condition
was unilateral.
It is therefore
possible
to suggest
that in general
there is a union
of the multiple
centres
of ossification
during
the third
decade.
tile
total
Degree
number
of
of
subjects
in
whom
multiple
ossific
centres
of
made
of the association
of a high degree
of hallux
valgus
following
clinical
assessments
show
a statistically
very
highly
significant
correlation
with
the
severity
of hallux
‘algus:
“pronation”
of the
foot;
subcutaneous
prominence
of the head
of the talus,
plantar
callosities;
“overcrowding”
deformity
of the toes; limitation
of mobility
in the “transverse
tarsal
joint
“;
hammer
toe.
and!
various
valgus-Mention
other
foot
has
deformities.
been
The
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY
OBSERVATIONS
Range
ofmovement
ratio
and limitation
and Beath
1948.)
ofanklejoint-There
of extension
Child-bearing-Those
lowering
of
Pain
in the
pain
had
a ratio
foot
an
length
This
ratio
difference
metatarsalgia
callosities-The
average
26!- lb.
In
\Ve
\Visil
to
the acadlenlic
the Director
Burrows
for
many
grant
technical
and
tile
patients
from
tile
staff
staffs
arch
of
sense
of the
of the
HARRIS,
R. I., and
HARRIS,
R. I., and
and
Joint
Surgery,
MORTON,
I). J.
VENNING,
P.,
radiographs
VOL.
33
(1935):
and
of
B,
30-A,
NO.
tile
3,
T.
\‘oung
for
was
30
ilis
iIlterest
College
for
of Ortilopaedics
(1948):
beneath
significant
it
for
This
and
the
lb.
fiexors
in
nlailV
the
\\‘e
The
are
work
force
anterior
This
those
with
border
d)tller
partictilar
line
Illeml)ers
of
obligations
partictiiarlv
cases.
paper.
with
(average).
is on
have
kindness,
morbid
of
toe
and
We
help.
patient
the
tile
28
The
‘ ‘
cases
difference
criticism,
their
their
was
of such
showed!
heads)-This
normality.
‘ ‘
in tiiose
of
lb.
metatarsal
from
contraction
it
to Mr
also
has
to
Jackson
grateful
been
done
to the
vith
a
E NCES
J. (1949): Variation in extension
Journal
of Bone
and Joint
Surgery,
BEATH,
T. (1947): Army
Foot Survey.
BEATH,
lengtil
Harris
who complained
did not complain
who
departures
of isometric
without
JOSEPH,
tilumb.
those
pain
other
REFER
joints
height/arch
(Contrast
a statistically
region-Those
localised
facilities
Ile gave
for
tile
investigation
of
and
volunteers
who
pro’ide
the
stibstance
Siloe
alld
Allied
Tradles
Research
Association.
H., and
HARRIS,
showed
flexors
(ergometric
measure)
those
without
nietatarsalgia
Uiliversitv
Institute
of
numerous
force
of
children
cent, while
significant.
those
J. Z.
Professor
thank
aIld
or more
194 per
is statistically
the general
condition
showed
a low correlation
with
of the isonietric
contraction
of the toe
metatarsalgia
was 20 lb. (average).
In
difference
is very
highly
significant.
Plantar
one
longitudinal
(in
plantar
callosities
was
of statistical
significance.
391
VALGUS
ratio.
to the
height/arch
cent.
borne
length
HALLUX
is no correlation
between
a low arch
joint
(goniometric
measurement).
ankle
had
who
height/arch
attributable
arch
of 20 per
Anterior
at the
women
arch
the
ON
Hvpermobile
of
tile
metacarpo-phalangeal
31-B,
Ottawa:
flat-foot
and
interphalangeal
547.
National
witil
short
Research
tendo
Council
achiiiis.
of Canada.
Jotirnal
of
Bone
116.
Tile
HARDY,
foot.
AUGUST
Human
R.
H.
British
1951
Foot.
(1951)
Journal
New
York:
Sources
of
Radiology,
of
Coltimbia
error
in
24,
the
18.
University
Press,
prodtiction
and
167.
meastirement
of
standardi