Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, localized pain in the forefoot, specifically at the [2nd/3rd/4th] metatarsal head. Pain is exacerbated by weight-bearing, prolonged standing, and physical activity. Reports localized swelling, stiffness, and occasional mechanical symptoms. No history of acute trauma. Symptoms have been progressive over [duration].
Clinical Examination Findings
Inspection reveals edema and erythema over the [2nd/3rd/4th] metatarsal head. Palpation elicits significant tenderness at the metatarsal head and distal shaft. Range of motion of the corresponding metatarsophalangeal (MTP) joint is restricted and painful, particularly with dorsiflexion. Crepitus may be noted. Gait analysis demonstrates an antalgic pattern with avoidance of toe-off on the affected side.
Treatment Protocol
Conservative management initiated: offloading via metatarsal pad or orthotic inserts, activity modification, and use of stiff-soled shoes or rocker-bottom footwear. NSAIDs prescribed for pain and inflammation management. Physical therapy focused on range of motion and strengthening. If conservative measures fail, consider surgical intervention (e.g., core decompression, osteotomy, or joint debridement).