II. Imaging

  1. Plain Radiographs (AP, Lateral and Oblique): Preferred first-line test
  2. See Joint Imaging in Rheumatoid Arthritis
  3. See Joint Imaging in Osteoarthritis

III. Findings: Degenerative Arthritis (Osteoarthritis)

  1. First MTP joint commonly involved
    1. Associated with Hallux Valgus deformity
    2. Associated with Hallux Rigidus
  2. Rarely involves tarsal bones or ankle

IV. Findings: Rheumatoid Arthritis

  1. MTP joints commonly involved
  2. Bilateral ankles may be involved

V. Findings: Psoriatic Arthritis

  1. Foot commonly involved
  2. Sausage shaped toes may occur
  3. Classic psoriatic Plaque and Nail Pitting (60-80%)
  4. Ankle synovitis may be present

VI. Findings: Reiter's Syndrome

  1. Foot commonly involved
  2. Sausage shaped toes may occur

VII. Findings: Gout

  1. First MTP joint commonly involved (Podagra)

VIII. Findings: Pseudogout

  1. Occasionally involves Ankle Joint

IX. Differential Diagnosis: Other common conditions of the foot

  1. Morton's Neuroma (commonly seen in runners and joggers)
    1. Paresthesias at second and third MTP joint web space
    2. Pain reproduced on palpation
  2. Plantar Fasciitis
    1. Heel Pain worse at first steps in the morning
  3. Achilles Tendonitis
    1. Also seen in patients with Spondyloarthropathy

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