A 45-year-old man undergoes amputation of the first ray including the great toe. Compared with amputation of a lesser toe ray, his gait will be affected most during which phase?

• A Initial contact (heel strike)
• B Mid stance
• C Swing phase clearance
• D Terminal stance and toe-off (push-off) ✓

Explanation

The great toe and first ray transmit the largest forefoot loads during terminal stance and generate most of the push-off power at toe-off, so first ray loss disproportionately impairs propulsion. Lesser toe rays contribute far less to push-off, and their loss is often well tolerated. Initial contact, mid stance and swing clearance depend mainly on heel function, foot alignment and dorsiflexor activity respectively.

Reference: Apley and Solomon's System of Orthopaedics and Trauma, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.