Epidemiology
1. Affects teens
2. Girls predominate by a factor of 3-4
Pathophysiology
1. Unknown etiology
2. Aseptic or avascular necrosis at one of metatarsal heads
3. Second metatarsal most commonly involved
Symptoms
1. Pain and swelling at the affected metarsal head
Signs
1. Metatarsal-phalangeal joint (MTP) inflammation
  1. Tenderness and swelling
  2. Restricted Range of motion
2. Metatarsal head palpably enlarged
XRay: Foot XRay
1. Widening and irregularity of metatarsal head
2. Flattening and collapse of MTP joint with cystic changes
3. Loose bodies sometimes present
Management
1. NSAIDs
2. Warm soaks
3. Local Corticosteroid Injection
4. Anterior metatarsal bar
  1. Shifts pressure from metatarsal head
5. Arthroplasty for persistent pain

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.