ES2607252B2 - Methacrylate device with millimeter scale to measure the mobility of the first and fifth radii of the foot in loading and unloading - Google Patents

Abstract

Methacrylate device with a millimeter scale to measure the mobility of the first and fifth radii of the foot in loading and unloading that aims to quantify the movement of dorsiflexion and plantarflexion of the first and fifth radii of the foot, providing clinicians with an easy-to-use tool, Small and light, which would complement the usual exploration maneuver of this movement, totally subjective. Its main use will be the diagnosis of functional alterations of the first and fifth rays, such as the first (or fifth) dorsalflexed and plantarflexed radius (in its flexible, semi-rigid and rigid variations), and the first (or fifth) hypermobile radius.

Description

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DESCRIPTION

Methacrylate device with millimeter scale to measure the mobility of the first and fifth radii of the foot in loading and unloading.

Object of the invention

The object of the present invention is a millimeter-scale methacrylate device to quantify the movement of dorsiflexion and plantarfl exion of the first and fifth radii of the foot, providing clinicians with an easy-to-use, small and light tool that complements the usual exploration maneuver of this movement, totally subjective. Its main use will be the diagnosis of functional alterations of the first and fifth rays, such as the first (or fifth) dorsalflexed and plantarflexed radius (in its flexible, semi-rigid and rigid variations), and the first (or fifth) hypermobile radius.

The invention is intended for health professionals, more specifically to the Podiatry sector, and very specifically to the field of physical and clinical exploration of the foot for the diagnosis, and subsequent treatment, of foot function abnormalities.

State of the art

In the literature no references have been found to any instrument designed for measuring the mobility of the fifth radius. However, the first clinical test to assess the mobility of the first radius was the one described by Root et al. In 19711, which is in turn the most used when performing the joint scan of the foot. This maneuver consists in placing the subastragaline joint in a neutral position, while one hand holds the heads of the second to fifth metatarsals, and the other holds the head of the first metatarsal. In this position, the head of the first metatarsal is brought to maximum dorsiflexion and maximum plantarflexion. The range of motion is determined by comparing the position of the index fingers and thumbs of the explorer when performing the movements. This technique, however, does not allow quantification of mobility in dorsiflexion and plantarflexion of the first or fifth radius. Based only on the clinical experience, Root and collaborators2 proposed that the average range of motion of the first radius consisted of 5 mm of dorsiflexion and 5 of plantarflexion, thus having a total range of movement in the sagittal plane of 10 mm in a normal foot .

It should be noted that, because in the first radius the dorsiflexion movement is accompanied by inversion, and the plantarflexion movement is accompanied by eversion3, 4 5, and in the fifth the dorsiflexion is accompanied by eversion and the investment plantarflexion, The explorer's hand should describe an arch of lateral concavity when mobilizing the head of the first metatarsal up and down. Therefore, the instrument that is intended to be registered allows the measurement of mobility in the sagittal and frontal planes, both in the first and fifth rays, unlike other existing ones.6, 7

As stated earlier, the maneuver described by Root et al. Is widely used for the clinical exploration of the first radio. The registration of the mobility of the first radius obtained by performing this technique is totally subjective, therefore subject to great inter-explorer variability. That is why instruments are needed to quantify the mobility of the first radius,

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taking into account the protocols already described and widely used. and also its simple handling and its affordable acquisition.

In the last decades several gadgets have been developed with the objective of being able to reliably quantify the mobility of the first radius4, 5 although instruments to quantify the mobility of the fifth have not been described. Perhaps, the two most used in research published in the literature have been designed by Klaue and collaborators in 19946, and designed by Glasoe and collaborators in 19997. The design of Klaue and collaborators consists of a foot and ankle splint (AFO ) modified, to which an external structure is incorporated to suspend a micrometer directly above the head of the first metatarsal, and which in turn allows the measurement of dorsal mobility. The design of Glasoe et al. Consists of a kind of aluminum box in which the rearfoot and the leg are stabilized by a boot, open at the front, mounted on a wooden platform. A stainless steel structure, consisting of a part that immobilizes the forefoot of the fifth to the second metatarsal, and another part that moves the head of the first metatarsal towards the dorsal, is coupled to said box in front of the boot. In this case the data is obtained through a load cell and a variable linear differential transformer. Both instruments measure the only dorsal mobility of the first radius in discharge (not that of the fifth), stabilizing the minor metatarsals, both apply a dorsal force to the head of the first metatarsal and measure the dorsal displacement by means of an object placed on it. Also. these are large and heavy contraptions, difficult to handle for the daily clinical activity of podiatrists. since they were designed primarily for research purposes. On the contrary, the instrument that is proposed to be registered is capable of quantifying the mobility both upwards (dorsalflexion) and downwards (plantarflexion), both of the first and fifth radii, in decubitus on the examination table and in standing position supporting the weight of the body, besides being an instrument of easy manufacture, small, light and easy to use.

In 2005, Glasee and collaborators8 carried out a study with the objective of comparing the measurements of the two instruments on the same feet, and the conclusion was that the results did not show significant differences, therefore none of these instruments provides in a simple way the quantification of mobility in dorsalflexion and plantarflexion of the first radius, contrary to the instrument presented. Perhaps these contraptions are more useful for the development of research work than for the clinical exploration of the first radio.

Documentary sources

1. Root ML, Orien WP, Weed JH, Hughes RJ. Biomechanical Examination of the Foot, vol 1. Los Angeles: Clinical Biomechanics Corp; 1971.

2. Root ML, Orien WP, Weed JH. Normal and Abnormal Function of the Foot, vol 2. Los Angeles: Clinical Biomechanics Corp; 1977.

3. Ebisui JM. The First Ray Axis and the First Metatarsophalangeal Joint. An Anatomical and PathomechanicaL Study. J Am Podiatr Assoc 1968; 58 (4): 160-8.

4. Kelso SF, Richie Jr dH, Cohen IR, Weed JH, Root M. Direction and Range of Motion

of the First Ray J Am Podiatr Assoc 1982; 72 (12): 600-5.

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5. Munuera PV. Biomechanical exploration of the first radius and first metatarsophalangeal joint. In: Munuera PV (ed): The first radio. Biomechanics and Orthopodology. Santander: Exa Editores; 2009. Pp: 103-122.

6. Klaue K, Hansen MD, Masquelet AC. Clinical Quantitative Assessment of First Tarsometatarsal Mobility in the Sagital Plane and Its Relation to Hallux Valgus Deformity. Foot Ankle 1994; 15 (1): 9-13.

7. Glasoe WM, Yack HJ, Saltzman CL. Measuring First Ray Mobility With a New Device. Arch Phys Med Rehabil 1999, 80: 122-4.

8. Glasoe WM, Grebing BR, Beck S, Coughlin MJ, Saltzman CL. A Comparison of Device Measures of Dorsal First Ray Mobility. Foot Ankle Int 2005; 26 (11): 957-61.

9. General Council of Official Colleges of Podiatrists of Spain. Practical guide of protocols of exploration and biomechanics. Madrid, 2010. ISBN: 978-84-614-5980-3.

10. Kelso SF, Richie Jr OH. Cohen IR Weed JH. Root M. Direction and Range of Motion of the First Ray. J Am Podiatr Assoc 1982; 72 (12): 600-5.

Publications

-Title: Criterion-related validity of a clinical measure of dorsal first ray mobility. Author (s): Glasoe, WM (Glasoe, WM); Getsoian, S (Getsoian. S); Myers, M (Myers. M); Komnick M (Komnick, M); Kolkebeck, D (Kolkebeck, D); Oswald, W (Oswald, W); Liakos, P (Liakos, P). Source: JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY Volume: 35 Number: 9 Pages: 589-593 Publication date: SEP 2005.

-Title: Measurement of the first / second intermetatarsal angle following proximal oblique metatarsal osteotomy. Author (s): Allen, DM (AIIen, DM); Nunley, JA (Nunley, JA). Source: FOOT & ANKLE INTERNATIONAL Volume: 23 Number: 1 Pages: 64-67 Publication date: JAN 2002.

-Title: The reliability and validity of a first ray measurement device. Author (s): Glasoe, WM (Glasoe, WM); Yack, HJ (Yack, HJ); Saltzman, CL (Saltzman, CL). Source: FOOT & ANKLE INTERNATIONAL Volume: 21 Number: 3 Pages: 240-246 Publication date: MAR 2000.

-Title: Measurement of dorsal mobility in the first ray: Elimination of fat pad compression as a variable. Author (s): Glasoe, WM (Glasoe, WM); Allen, MK (Allen, MK); Yack, J (Yack, J). Source: FOOT & ANKLE INTERNATIONAL Volume: 19 Number: 8 Pages 542-546 Publication date: AUG 1998.

-Title: Radiographic assessment of the second metatarsal: Measure of first ray hypermobility. Author (s): Prieskorn, DW (Prieskorn, DW); Mann, RA (Mann, RA); Fritz, G (Fritz, G). Source: FOOT & ANKLE INTERNATIONAL Volume: 17 Number: 6 Pages: 331-333 Publication date: JUN 1996.

-Title: METATARSUS-ADDUCTUS AND SELECTED RADIOGRAPHIC

MEASUREMENTS OF THE 1ST RAY IN NORMAL FEET. Author (s): GRIFFITHS, TA (GRIFFITHS, TA); PALLADINO, SJ (PALLADINO, SJ). Source: JOURNAL OF THE

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AMERICAN PODIA TRIC MEDICAL ASSOCIATION Volume: 82 Number: 12 Pages: 616-622 Publication date: DEC 1992

References found

- SI201 0000027320100906, SI23136 (A), STA TIC SPLINT FOR MEASUREMENT OF PLANTAR YEAR DORSAL FLEXION I NT E NS ITYOF ANKLE JOINT. Inventor (s): NEJC SARABON [SI]; ANDREJ PANJAN [YES].

- CN20122462472U 20120912, CN202891935 (U), MEASUREMENT INSTRUMENT ON MOTION DEGREE OF FIRST METATARSAL BONE AND SECOND METATARSAL BONE OF SOLE.

- JP20100252447 20101111, JP2012100903 (A), ROTATION ANGLE DETECTION DEVICE AND METHOD USING FOOTFALL BY TOE GROUNDING METHOD.

Description of the invention

The existing instruments so far do not provide quantitative data on the total and real mobility of the first radius (not that of the fifth radius), since they only quantify dorsiflexion, and in a way that does not conform to reality, allowing only movement in the sagittal plane and discarding the movement in the frontal plane. Furthermore, due to the design of these instruments, the patient's foot must be without supporting the weight of the body, that is, in discharge. On the other hand, these are complex, large and heavy instruments, not suitable for the clinical exploration of the foot that is recommended in the biomechanical exploration protocols published by the General Council of Podiatry Colleges of Spain.

The device that is presented supplements these shortcomings, allowing to register both the sagittal and frontal movement of the first and fifth rays, whether dorsalflexion or plantarflexion, quickly, easily for the explorer, and comfortable for the patient. As a novelty, it also allows quantifying the position of the first and fifth rays when the foot is supporting the weight of the body, that is, with the patient standing, which provides an idea closer to the actual functioning of the foot during walking.

It is a measuring device consisting of two pieces made of methacrylate, with the shape of "L" (1) and inverted "L" (2), respectively, facing and joined by their vertical elements by means of two screws in the vertical of the "L" shaped part (3) that slide along two rails in the vertical part of the inverted "L" shaped part (11). The vertical elements of both pieces have a curvature towards the inverted "L" (4), to accommodate the combined movement in the sagittal plane and in the frontal plane, which has been quantified in previous investigations as follows: for each millimeter of movement in the sagittal plane, the first radius performs 0.77 degrees of movement in the frontal plane10. The vertical element of the inverted "L" carries a millimeter scale (5), and the vertical element of the "L" bears a unique mark (6), which should coincide with the center mark of the millimeter scale when the first radius is find in neutral zero position, that is, in the position from which the dorsalflexion and plantarflexion movements will be quantified.

The horizontal elements of both pieces in the form of "L" (7) are padded on their lower surface so that they do not disturb when pressed on the foot (8), and go

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joined by an elastic band (9) of the same width as the groove through which said band (10) passes, which allows the attachment of the instrument to the foot without the possibility of brothing it during measurement. This in turn allows the patient to be placed in standing position with the measuring instrument placed on the dorsal face of the first and second metatarsal heads (in case of measuring the mobility of the first radius), or those of the fifth metatarsals and fourth (in the case of measuring the fifth radius), with which you can record how much dorsiflexion the first or fifth radius experiences when the foot supports the body weight.

Description of the content of the figures

FIGURE 1. First and fifth foot radius meter. Anterior view, in the position it would have to measure the first radius of the right foot.

(1): "L" shaped element.

(2): inverted "L" shaped element

(3): screws to join the "L" shaped element to the inverted "L" shaped element.

(4): vertical parts of the pieces in the form of "L" and "L" inverted.

(5): millimeter scale on the vertical part of the piece in the form of an inverted "L".

(6): Unique mark on the vertical part of the piece in the form of "L".

(7): horizontal parts of the pieces in the form of "L" and "L" inverted.

(8): padding under the horizontal parts of the pieces in the form of "L" and "L" inverted.

(9): elastic band for attaching the instrument to the foot.

FIGURE 2. First and fifth foot radius meter. Top view, in the position you would have to measure the first radius of the right foot.

(10): slots through which the elastic band passes.

FIGURE 3. First and fifth foot radius meter. Side view, the two "Ls" being separated.

(11): rails in the vertical part of the piece in the form of an inverted "L" through which the screws that join both pieces run, allowing the sliding of one on the other.

Mode of realization of the invention

During the exploration of the joint mobility of the foot, after assessing the segments of the ankle, hindfoot and forefoot, and before the quantification of the mobility of the first finger, the mobility of the first and fifth rays should be explored. To do this, with the patient in supine position on the couch, the instrument that we present on the dorsal face is placed

of the foot, placing the horizontal part of the "L" (7 right) on the head of the first metatarsal (in case of measuring the first radius, for example), and the horizontal part of the inverted "L" (7 left) on the head of the second and third metatarsals. This meter is fixed and adjusted to the foot by means of the elastic band (9), which will hug the plantar face to the forefoot.

From here, the explorer holds with his fingers Index and middle of the left hand (if a right foot is explored) the horizontal part of the inverted "L" (7 left), and with the thumb of the same hand the face plantar of the second metatarsal. The index and middle 10 fingers of the right hand are placed on the horizontal part of the "L" (7) that is

on the head of the first metatarsal, and the thumb of the same hand is located on the plantar face of the head of this metatarsal. The scanner places the first radius in neutral position, making sure that the center mark of the millimeter scale coincides with the only mark of the vertical element of the "L" (6). That is when the clinician must move the first radius, first in dorsalflexion, sliding the parts

verticals of the "Ls" (1 and 2) one above the other, and recording the millimeters of movement towards the back that has occurred. Once this is done, it returns to the neutral position, and proceeds in the same way for the plantarflexion movement, that is, down. Having the millimeter scale (5) on both sides of the instrument (anterior and posterior), only turning the meter around we can use the same technique but this time to record the mobility of the fifth radius.

Once the exploration on the stretcher is finished. With the patient standing, the explorer can record the dorsal migration experienced by the first or fifth radius when the foot supports the weight of the body, since the instrument remains attached to the foot thanks to the elastic band (9).

Claims (9)

5 10 fifteen twenty 25 30 35 40 Four. Five fifty 1. Methacrylate device with a millimeter scale to measure the mobility of the first and fifth radii of the foot in loading and unloading, characterized by two pieces made of 3 mm thick methacrylate, with an "L" and an inverted "L" shape, respectively, facing and joined by its vertical elements by means of two screws, and by its horizontal elements by means of an elastic band that serves to hold the instrument to the foot. 2. Methacrylate device with millimeter scale to measure the mobility of the first and fifth foot radii in loading and unloading, according to previous claims, characterized in that the vertical piece of "L" inverted, has a millimeter scale and shows a curvature at a rate of 0.77 degrees of rotation in the frontal plane for every millimeter of movement in the sagittal plane. 3. Methacrylate device with millimeter scale to measure the mobility of the first and fifth foot radii in loading and unloading, according to previous claims, characterized in that the vertical piece of "L" also has a curvature at the rate of 0.77 degrees of rotation in the frontal plane for every millimeter of movement in the sagittal plane, adapting to the vertical piece of "L" inverted. 4. Methacrylate device with millimeter scale to measure the mobility of the first and fifth foot radii in loading and unloading, according to previous claims, characterized in that the vertical piece of "L" has a unique mark that indicates how much displacement has occurred in the first or fifth radii, both up and down. 5. Methacrylate device with millimeter scale to measure the mobility of the first and fifth foot radii in loading and unloading, according to previous claims, characterized in that the vertical piece of "L" inverted has two rails located in the piece of "L" inverted, so that the piece of "L" slides on it, following said curvature. 6. Methacrylate device with millimeter scale to measure the mobility of the first and fifth foot radii in loading and unloading, according to previous claims, characterized in that the horizontal part of the inverted "L" is straight and has a groove for the passage of an elastic band of about 1.5 cm. 7. Methacrylate device with millimeter scale to measure the mobility of the first and fifth foot radii in loading and unloading, according to previous claims, characterized in that the horizontal part of the "L" is curved to fit the head of the first or fifth metatarsal, and has a groove for the passage of an elastic band of about 1.5 cm. 8. Methacrylate device with millimeter scale to measure the mobility of the first and fifth foot radii in loading and unloading, according to previous claims characterized in that an elastic band passes through the grooves of both pieces in an "L" shape to fix the device to the foot and quantify the dorsal migration that the first radius experiences when the foot supports the weight of the body. 9. Methacrylate device with millimeter scale to measure the mobility of the first and fifth radii of the foot in loading and unloading, according to previous claims characterized in that both "L" shaped pieces are padded on their lower face with polyurethane foam. 5