PREFERRED PRACTICE PATTERN
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1
The patient is a 54-year-old female who presents with complaints of pain at the metatarsophalangeal (MTP) joint of the first toe. She reports that she is a nurse and on her feet all day for 12-hour shifts. She wears flats that are typically more pointed than rounded at the toe. She does have pain with toe-off when walking and redness at the MTP joint toe one after removing her shoes. She has been trying to find a more comfortable pair of shoes to wear but they all seem too tight at the first toe joint. She has noticed that the first toe seems to be drifting inwards toward the other toes.
Evaluation reveals hypermobility of the medial ligaments MTP joint toe one, joint redness and pain, depression of the second metatarsal, and shifting of the big toe laterally toward the other toes on the same foot. X-rays were negative for fracture. Weakness of the flexor hallucis longus (FHL) is also present.
Valgus deviation (lateral, abduction) of the great toe (hallux) and varus deviation of the first metatarsal.
Some rotation (valgus rotation) at the first metatarsal is also possible.
Static subluxation of first MTP.
Tissue surrounding first metatarsal joint may be inflamed and tender.
“Bump” on medial side of the first toe is partly due to
Inflammation of the bursal sac.
Osseous (bony) anomaly on the mesophalangeal joint (where first metatarsal bone and hallux meet).
Large part of the bump tends to be the head of the first metatarsal, as it deviates medially in relation to the phalange.
Severe hallux valgus. (From Imboden J, Hellmann DB, Stone JH. Current Diagnosis & Treatment in Rheumatology. 2nd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Diagnosis usually made by clinical examination or X-ray
Can be an independent diagnosis, not associated with disease process.
Most common in women: Male–female ratio is 1:92
22% to 36% of cases are in adolescents2
Poor footwear: Improper fit, pointed toe, narrow forefoot
Dancers at higher risk
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