Pain distal to the 2nd MTPJ

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Hi everyone, from a suffering Eagle supporter.

Just though I would start with a question.

I have a client that is complaining of pain distal to the 2nd MTPJ of the LF. Client complains of 1st step pain in this region, with a feeling of bruising and redness. The Plantar fascia on this foot is also much tighter.

I understand that the Plantar fascia attaches to the proximal Phalanges of each toe. I was wondering if people can get Plantar fasciitis at the distal attachment rather than the proximal as is normally the case???
Or am I reaching ?

Any Ddx

(Client has previously been treated for MTPJ Synovitis with metdome with great success and is back again, suggesting that this problem pre-dates the synovitis but is less painful.)

 

2nd MPJ stress syndrome (predislocation syndrome; plantar plate rupture):
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=534

 

Thanks for the Prompt reply Craig.

These were some of my differential diagnosis for the original Synovitis.

However I would have thought that these would elicit pain Plantar to the MTPJ not distal to it? As well as this Cross over taping had no effect.

 

Distal 2nd MTPJ pain.

I would look into patients history and determine if anything has happened that would simply cause more stress to the area. This may be corelated to the infrastructure of the bones (metatarsal protrusion, short first metatarsal, longer second metatarsal, dorsal displacement of the proximal phalanx of the second toe as noted in the previous post). I have seen this type of inflammatory problems in several patients and the often get relief with steriod injection, a short regimen of prednisone and/or anti-inflammatory medications in conjunction with the a metatarsal pad incorporated in the shoegear. Of course, sugical intervention is last.
DDx: Capsulitis of 2nd MTPJ.
Regarding the thought of plantar fasciitis in the distal portion of the structure, I would not recommended that diagnosis for your description of the scenario.
Good luck.

 

If there is that type of pain,another ddx could be a neuroma.Try for Mulder's sign and if you get a click,that may be what we are dealing with.