title: Doppler imaging of vibrations as a tool for quantifying first tarsometatarsal joint stiffness.
abstract: OBJECTIVE
  To assess whether first tarsometatarsal joint stiffness can be measured by Doppler imaging of vibrations and if so, to assess reference values.
  
  
  METHODS
  Repeated in vivo Doppler imaging of vibrations measurements at the first tarsometatarsal joint in healthy persons.
  
  
  BACKGROUND
  Clinical hypermobility of the first tarsometatarsal joint is an important factor in a hallux valgus deformity. No objective and non-invasive test is available to quantify first tarsometatarsal joint mobility. Doppler imaging of vibrations, a technique recently developed to measure joint stiffness, might be an effective tool to quantify stiffness of this joint.
  
  
  METHODS
  Vibrations were applied to the head of the first metatarsal in 46 feet of 23 healthy subjects and picked up by a transducer at both sides of the first tarsometatarsal joint. A pilot study was performed on three patients with hypermobility of the first tarsometatarsal joint. Measurements are expressed in threshold units related to colour Doppler imaging.
  
  
  RESULTS
  The values of the threshold units were found to be very similar in healthy persons, with a good repeatibility; 95% of the healthy persons had a threshold unit below 3.4. No significant difference was found between the left and right foot, or between male and female subjects. Also there was no significant correlation with age or weight of the subjects. In the three patients with first tarsometatarsal hypermobility we found threshold units above 5.
  
  
  CONCLUSIONS
  With Doppler imaging of vibrations first tarsometatarsal joint stiffness can be measured in healthy persons in a non-invasive and objective way. In a pilot study, three patients with first tarsometatarsal hypermobility showed lower stiffness values than the healthy subjects. Relevance This study presents a new method for quantification of first tarsometatarsal joint stiffness and provides reference values in healthy persons. First measurements on patients gave promising results to future use of this method for assessment of clinical hypermobility in hallux valgus patients.
authors.affiliation: Department of Orthopaedic Surgery, Leyenburg Hospital, P.O. Box 40551, 2504 LN, The Hague, The Netherlands. frankfaber@netnet.nl
authors.forename: F W
authors.initials: FW
authors.lastname: Faber
authors.forename: G J
authors.initials: GJ
authors.lastname: Kleinrensink
authors.forename: H M
authors.initials: HM
authors.lastname: Buyruk
authors.forename: P G
authors.initials: PG
authors.lastname: Mulder
authors.forename: H J
authors.initials: HJ
authors.lastname: Stam
authors.forename: C J
authors.initials: CJ
authors.lastname: Snijders
authors.forename: R
authors.initials: R
authors.lastname: Stoeckart
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D001835:Body Weight; D005260:Female; D006215:Hallux Valgus / Q000503:physiopathology; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007596:Joints / Q000000981:diagnostic imaging* / Q000502:physiology; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging* / Q000502:physiology; D008875:Middle Aged; D010865:Pilot Projects; D018583:Pliability; D012015:Reference Standards; D015203:Reproducibility of Results; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013639:Tarsal Bones / Q000000981:diagnostic imaging* / Q000502:physiology; D014159:Transducers; D018615:Ultrasonography, Doppler, Color; D014732:Vibration