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01-12-2014 | Research | Uitgave 1/2014 Open Access

Journal of Foot and Ankle Research 1/2014

Cardan angle rotation sequence effects on first-metatarsophalangeal joint kinematics: implications for measuring hallux valgus deformity

Journal of Foot and Ankle Research > Uitgave 1/2014
Ward M Glasoe, Fernando A Pena, Vandana Phadke
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1757-1146-7-29) contains supplementary material, which is available to authorized users.

Competing interests

The authors have no financial or personal conflicts that could influence the submitted work.

Authors’ contributions

WMG and FAP provided the concept and research design, and secured the funding support. WMG and VP performed data collection and data analysis. WMG wrote the manuscript while the other authors provided critical review. All authors read and approved the final manuscript.



There currently are no recommended standards for reporting kinematics of the first-metatarsophalangeal joint. This study compared 2 different rotation sequences of Cardan angles, with implications for understanding the measurement of hallux valgus deformity.


Thirty-one women (19 hallux valgus; 12 controls) participated. All were scanned in an open-upright magnetic resonance scanner, their foot posed to simulate the gait conditions of midstance, heel-off, and terminal stance. Using computer processes, selected tarsals were reconstructed into virtual bone models and embedded with principal-axes coordinate systems, from which the rotation matrix between the hallux and first metatarsal was decomposed into Cardan angles. Joint angles were then compared using a within factors (rotation sequence and gait condition) repeated-measures analysis of variance (ANOVA).


Only the transverse plane-first sequence consistently output incremental increases of dorsiflexion and abduction across gait events in both groups. There was an interaction (F ≥ 25.1; p < 0.001). Follow-up comparisons revealed angles were different (p < 0.05) at terminal stance.


Different rotation sequences yield different results. Extracting the first rotation in the transverse plane allows for the resting alignment of the hallux to deviate from the sagittal plane. Therefore, representing first-metatarsophalangeal joint kinematics with the transverse plane-first rotation sequence may be preferred, especially in cases of hallux valgus deformity.

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