Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, progressive pain and stiffness in the left first MTP joint. Symptoms are exacerbated by dorsiflexion during the toe-off phase of gait and wearing rigid-soled footwear. Patient reports localized swelling, activity-related discomfort, and difficulty with activities requiring full hallux extension. No history of acute trauma or gouty flares.
Clinical Examination Findings
Left foot examination reveals dorsal osteophyte formation at the first MTP joint with palpable bony prominence. Range of motion is significantly restricted in dorsiflexion compared to the contralateral side. Tenderness to palpation noted at the dorsal joint line. No signs of erythema or warmth. Gait analysis demonstrates an antalgic pattern with avoidance of terminal stance phase on the left. Neurovascular status intact.
Treatment Protocol
Conservative management initiated: prescription of stiff-soled shoes or rocker-bottom footwear to reduce MTP joint excursion. Recommend orthotic inserts with a Mortonโs extension or carbon fiber plate. NSAIDs as needed for inflammation. Physical therapy for joint mobilization and gait training. Consider corticosteroid injection for refractory pain. Discussed potential for surgical intervention (cheilectomy or arthrodesis) if conservative measures fail.