Ledbevægelse nr. 5 metatarsophalangealleddene.

Posted on 05. jan, 2016 by in Ikke kategoriseret

I dag skriver jeg om bevægelse i leddene mellem caput af metatarsen (1 – 5) og dens respektive proximale phalanx på digitus. Dorsalfleksion i disse led er nødvendig for afsæt.

Metatarsophalangealleddene.

Hvert af disse led har 2 adskilte og separate akser med bevægelse i det sagitale plan (dorsalfleksion/plantarfleksion) omkring en transvers akse og i det transverse plan (abduktion/adduktion) omkring en vertikal akse. Pga. disse aksers lokalisation er bevægelse i det frontale plan ikke mulig, og ethvert forsøg på at invertere eller evertere en normal tå vil føre til subluxation i metatarsophalangealleddet. Bevægelse i det sagitale plan er ekstremt vigtigt for normal bevægelse, mens bevægelse i det transverse plan er relativt lille og uden funktionel signifikans for gangcyklus.

Bevægelse af metatarsophalangealleddene i det transverse plan har givet anledning til kontroverser om terminologien for abduktion og adduktion, afhængig af om der refereres til en aksial referencelinje (linje fra hæl og ud gennem 2. digitus) eller en midtsagital linje (linje midt mellem fødderne). F.eks. blev abduktion tidligere beskrevet som en bevægelse af en tå væk fra den aksiale referencelinje og adduktion som en bevægelse af en tå mod denne linje. I den mere moderne litteratur beskrives abduktion og adduktion som bevægelse henholdsvis væk fra og imod det midtsagitale plan.

En anden grund til forvirring er brugen af termerne for varus og valgus position af en tå. Mange forfattere refererer til fejlstilling i det transverse plan som enten varus (repræsenterer adduktion) eller valgus (repræsenterer abduktion) hvilket ikke er korrekt, da varus og valgus referer til stillinger i det frontale plan. F.eks. er stillingen hallux abductovalgus en stilling, hvor hallux både er abduceret (det transverse plan) og i valgus (det frontale plan).

Udvikling af en større ledflade langs den dorsale del af 1. metatars var nøglesten i udviklingen frem mod effektiv gang på 2 ben fordi det gav stabilitet til 1. metatarsophalangealled, selvom det dorsalflekterer gennem en stor grad af bevægelse, mens den samtidig udsættes for signifikante grader af vertikale kræfter. Denne anatomiske forandring gjorde det muligt at udvikle gang fra at gå med bøjede knæ og hofter til en opret stilling, hvor acceleratonskræfter bliver tilført bag kroppens tyngdepunkt gennem de ekstenderede hofter.

Tidligere blev 1. metatarsophalangealled betragtet som et simpelt hængselsled, men nu klassificeres det som et glidende hængslesled, hvor transvers- og sagital-planbevægelse er mulig.

Den fulde grad af dorsalfleksion i 1. metatarsophalangealled er kun mulig, når proximale phalanx glider superiort på caput af 1. metatars. Dette glid fører til et dorsal-posterior skift i metatarsophalangealleddet transverse akse og hindrer dorsal kompression af caput af 1. metatars. Dorsalfleksion i 1. metatarsophalangealleddet begrænses af stramning af m. flexor hallucis brevis og fascia plantaris. Fakta er, at fascia plantaris har en så vigtig rolle, at hvis der opereres i fascia plantaris, så nedsættes dorsalfleksion i 1. metatarsophalangealleddet med 10 grader.

Næste gang afsluttes denne serie om ledbevægelse med højt- og lavtgearsafsæt.

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