Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic pain and stiffness localized to the first metatarsophalangeal (MTP) joint. Symptoms are exacerbated by dorsiflexion during the toe-off phase of gait and wearing rigid-soled footwear. Patient reports progressive loss of range of motion, localized swelling, and occasional dorsal osteophyte impingement. No history of acute trauma or gouty arthropathy.
Clinical Examination Findings
Physical exam reveals palpable dorsal exostosis at the first MTP joint with associated soft tissue thickening. Significant reduction in passive and active dorsiflexion noted compared to the contralateral side. Crepitus present upon joint manipulation. Gait analysis demonstrates an antalgic pattern with avoidance of terminal toe-off. Neurovascular status intact distally.
Treatment Protocol
Conservative management initiated including activity modification, use of stiff-soled shoes or rocker-bottom orthotics to limit MTP joint motion, and non-steroidal anti-inflammatory drugs (NSAIDs). Intra-articular corticosteroid injection discussed for symptomatic relief. Surgical consultation for cheilectomy or arthrodesis considered if conservative measures fail.