Pathology

1. Painful loss of motion (esp dorisflexion) of 1st MTPJ secondary to degenerative joint disease
2. May be due to bony degeneration
   • Primary: OA
   • Secondary: degenerative conditions such as gout
3. May due due to capsular damage and contraction

Approach

• Expose both feet
• Describe any obvious deformities

1. Look

   

   • Likely to be unremarkable
   • May be complaining of pain in the big toe
2. Feel
   • 1st MTPJ tenderness, particularly on dorsal surface
   • Unilateral vs bilateral involvement
3. Move
   • Limited 1st MTPJ dorsiflexion
   • May be associated with crepitus

Completion

1. Watch patient walk
2. Examine shoes
3. Ask questions on how it affects life

Radiology

1. Initially normal
2. Later degenerative change

Treatment

1. Non-surgical
   • Appropriate footwear
   • NSAIDs / intra-articular steroid injections
2. Surgical
   • Early disease - cheilectomy: excision of dorsal segment of metatarsal head
   • Advanced disease - consider silastic interposition arthroplasty or arthrodesis
   • Optimal position of MTPJ in arthrodesis: 10-15' dorsiflexion, 15' valgus, neutral rotation