Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, progressive pain localized to the left first metatarsophalangeal (MTP) joint. Symptoms exacerbated by dorsiflexion during gait, wearing tight-fitting footwear, and prolonged standing. Reports morning stiffness and occasional swelling at the dorsal aspect of the joint. Denies trauma, paresthesia, or constitutional symptoms.
Clinical Examination Findings
Left foot examination reveals dorsal exostosis at the first MTP joint with palpable osteophytes. Significant limitation of range of motion (ROM) noted, specifically in dorsiflexion. Pain elicited upon passive range of motion. No erythema or warmth. Neurovascular status intact with palpable dorsalis pedis pulse and normal capillary refill. Gait analysis demonstrates antalgic pattern with avoidance of toe-off phase on the left.
Treatment Protocol
Conservative management initiated: prescription of stiff-soled shoes or rocker-bottom footwear to reduce MTP joint excursion. Recommendation for orthotic inserts with Morton's extension. NSAIDs prescribed for pain and inflammation management. Referral for physical therapy to maintain joint mobility. Corticosteroid injection discussed as a secondary option if symptoms persist.