Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, progressive pain localized to the right first metatarsophalangeal (MTP) joint. Symptoms exacerbated by weight-bearing activities, dorsiflexion, and wearing rigid-soled footwear. Reports morning stiffness, localized swelling, and difficulty with push-off phase of gait. No history of acute trauma or infection.
Clinical Examination Findings
Right foot examination reveals dorsal bony prominence (osteophyte) at the first MTP joint. Palpation elicits tenderness over the dorsal aspect. Range of motion (ROM) is significantly restricted, particularly in dorsiflexion, with crepitus noted upon passive manipulation. Gait analysis demonstrates an antalgic pattern with avoidance of terminal stance push-off on the right side. Neurovascular status intact.
Treatment Protocol
Conservative management initiated: prescription of stiff-soled shoes or rocker-bottom orthotics to limit MTP joint excursion. Recommend NSAIDs for inflammation, activity modification, and physical therapy for joint mobilization. Consider corticosteroid injection if refractory to conservative measures. Surgical consultation for cheilectomy or arthrodesis discussed as potential long-term options.