An Operational Definition of First Ray Hypermobility

Background: The first ray (metatarsocuneiform) behaves as a load-bearing strut in supporting weight. Due to its functional importance, stress-testing techniques are used to assess the stability of the first ray and objectify evidence of hypermobility. The test and measurement of first ray hypermobility (FRH) is of interest to clinicians and researchers. The condition itself, however, has proven elusive to diagnose. This article defines FRH for the purpose of improving the consistency by which the diagnosis is made. Currently, the lack of a consensus definition prevents research from determining the incidence rates and prevalence of FRH, a commonly reported medical condition. The Definition: Symptomatic FRH presents as dorsal displacement that measures greater than 8 mm, accompanied with signs and symptoms consistent with loading insufficiency of the first ray. The operational definition is objective and if adopted across health care professions, the criterion could become the standard for identifying FRH in patients and research participants. Level of Evidence: Level V, expert opinion