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