First ray ‘insufficiency’/Hypermobile first ray

Wikis > Orthopaedics > Metatarsal Problems > First ray ‘insufficiency’/Hypermobile first ray

First ray ‘insufficiency’/Hypermobile first ray

Occurs when the first metatarsal does not bear its share of weight during dynamic function.

Due to:
1) Foot pronation  dorsiflexion of first ray  first metatarsal head does not take its full share of weightbearing
2) Ligamentous laxity
3) Short first ray (congenital or iatrogenic)
4) Elevated first metatarsal/metatarsus primus elevatus

Part of pathogenesis of hallux abducto valgus
Can have lateral forefoot pain, second metatarsophalangeal joint pain (capsulitis).
Callus is often on the plantarmedial aspect of the hallux and lateral forefoot

Loading of central metatarsals is correlated to the angle of hallux valgus .

Can produce dorsal metatarsal-cuneiform pain – excessive force of dorsiflexion of first ray  reactive hyperostosis from ‘jamming’ dorsally  painful from shoe pressure – treat with accommodative padding, shoe modifications, or surgical excision.

Cuneiform split  symptoms

Management:
Functional foot orthoses
Mortons extension
Surgical

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