1st ray

Comparison of Radiographic Parameters of the First Ray
Group Number of feet Metatarsus Primus
Elevatus
(mm ± SD)
1 st metatarsal
declination
(mm ± SD)
Difference, 1 st and 2 nd
metatarsal declination
(mm ± SD)
Hallux 100 7.8 ± 0.3 20.6 ± 0.3 3.7 ± 0.3
Rigidus
Neuroma 64 7.8 ± 0.3 20.9 ± 0.4 3.2 ± 0.3
Control 100 7.9 ± 0.2 20.2 ± 0.3 3.4 ± 0.2
• Analysis revealed no significant differences between groups for any of the
measurements examined (Table 1).3
• These results confirm that during mid-stance, elevation of the first ray seems to be a
normal radiographic finding.3
• Associations between metatarsus elevatus and hallux limitus have been previously
described in the literature, however it seems it is just as often refuted by others.2
• Coughlin and Shurnas examined the presence of first ray elevation in patients with
various grades of hallux rigidus after being treated with Cheilectomy or Arthrodesis.4
• Preoperatively, 120 (94%) of the 127 feet had <8 mm of elevation, which had been
determined as being the normal range.4
• This alone supports the argument that first ray elevation of up to the normal
expected amount does not strongly indicate a link to Hallux rigidus.4
• However there was a correlation between the postoperative grade of Hallux rigidus
and the amount of elevatus. The mean preoperative and postoperative
measurements of elevatus were 5.3 mm and 6.1 mm in the cheilectomy group. And
both before and following cheilectomy, an increased value for elevatus was
associated with a higher grade of hallux rigidus.4
• In summary, elevatus decreased postoperatively in patients with Grade-1 or 2 hallux
rigidus but it increased in those with Grade-3 or 4.4
• In contrast, the mean preoperative elevatus in the arthrodesis group was 5.6 mm,
and this was significantly reduced in those with Grade-3 or 4 hallux rigidus
postoperatively to 1.7 mm (difference in the means = 3.9 mm).4