OA of the first MTPJ; can be primary (degenerative) or secondary to osteochondral injury
Clinical presentation
Symptoms
Painful 1st MTP joint
Stiffness
Pain increases with activity/aggrevated by shoes
Signs
Dorsal exostosis (bone spur)
IPJ hyperextension
Investigations
WB X-ray - AP/LAT and oblique
Management
Conservative treatment
Weight loss if appropriate
Analgesia, NSAIDs, activity modification
May involve the wearing of stiff soled shoe to limit motion at the MTPJ
A metal bar can be inserted into the sole of a shoe
Surgical management
In early cases where dorsal osteophytes impinge during dorsiflexion, removal of osteophytes (cheilectomy) may help
Gold standard surgical treatment is arthrodesis
Should alleviate pain, no movement of joint
Stops women wearing heels
1st MTP joint replacements are in use but failure rates are quite high and once failure occurs, salvage surgery is difficult and results are usually disappointing
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