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Monday, January 7, 2013

Importance of the Positioning of the First Metatarsal

It is extremely important to know where the first metatarsal lies in relationship to the other metatarsals, especially the second. These photos to follow show the classic Root evaluation of the first metatarsal in relationship to the second metatarsal. Normally, the first metatarsal lies mainly plantar to the second metatarsal. In the first photo below see how the first metatarsal lies 3 mm above the first metatarsal, even though I have pushed it down as far as it can go!! This is called an elevated first metatarsal, producing a hypermobile first ray which does not bear weight well, allowing for more pronation to occur. 

The above photo shows the same observation of the first metatarsal in its most elevated position. When you see the 2 positions, maximally up and maximally down, you can tell this is elevated from the second--also called metatarsus primus elevatus (elevated first ray). 
The photo above shows the more normal right foot where the first metatarsal is 5 mm below the second when pushed down. It is so crucial to keep your thumbs parallel when doing this maneuver.

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