Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with insidious onset of localized pain in the left forefoot, specifically at the second metatarsal head. Pain is exacerbated by weight-bearing activities and impact sports. No history of acute trauma. Reports localized swelling and stiffness, particularly after periods of rest.
Clinical Examination Findings
Examination of the left foot reveals localized tenderness upon palpation of the second metatarsal head. Mild soft tissue swelling and limited range of motion at the second metatarsophalangeal (MTP) joint noted. Gait analysis demonstrates an antalgic pattern with avoidance of toe-off on the affected second ray. No erythema or neurovascular deficits noted.
Treatment Protocol
Conservative management initiated including offloading of the second metatarsal head via a metatarsal pad or orthotic insert. Activity modification to avoid high-impact loading. Short-term use of a stiff-soled shoe or walking boot if necessary. NSAIDs for pain management. Follow-up imaging in 6-8 weeks to monitor progression of osteonecrosis.