Etiology
1. Traumatic arthritis of first metatarsophalangeal joint
2. Occurs secondary to repeated dorsiflexion stress
3. Results in restricted range of motion of great toe
Epidemiology
1. Onset in ages 30 to 50 years old
Symptoms
1. Gradually increasing great toe pain and stiffness
2. Precipitated by minor injury
3. Provocative
  1. Ambulation
  2. Dorsiflexion
Signs
1. First metatarsal-phalangeal joint (MTP) inflammation
  1. Swelling
  2. Tenderness
  3. Restricted range of motion
2. Great toe held in slight flexion
3. Passive dorsiflexion painful
4. Adjusted gait
  1. Weight shifted to outer metatarsal heads
  2. Weight also shifted to lateral border of foot
Radiology: Foot XRay
1. Signs of Degenerative arthritis
  1. First metatarsal-phalangeal joint (MTP) narrowing
  2. Dorsal osteophyte (spur) formation
Management
1. Rest
2. Moist heat
3. NSAIDs
4. Morton's Extension Orthotic
  1. Rigid shank that supports length of toe
5. Intraarticular Corticosteroid Injection
  1. See Great Toe MTP Injection
6. Shoe with sufficient room in forefoot
  1. Anterior metatarsal bar in shoe
  2. Rockerbottom shoe may be tried
7. Surgery for refractory cases
  1. Arthroplasty or Arthrodesis

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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.