Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Painful 1st MTP Joint

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Ann PT, Jun 2, 2008.

  1. Ann PT

    Ann PT Active Member

    Members do not see these Ads. Sign Up.
    I'm looking for some thoughts about a patient I saw recently who was referred to me by our DPM for orthotics. He diagnosed pes cavus and hallux valgus.

    She is a 51 y.o. ER physician who complains of severe pain at her 1st MTP joint at the end of the work day. Her pain occurs with plantarflexion and dorsiflexion of the joint to the point that she has a hard time using her foot to step on the gas pedal after work because plantarflexion of the hallux is so painful. She generally wears an open dress casual shoe (like a Merry-Jane without the strap) but wore sneakers recently for 13 hours and had very little pain afterwards. Her x-ray was read as normal although clinically she appears to have some minor hypertrophic bone on the dorsolateral surface of her 1st MTP. As I recall she may have had a mild grade 2 (at most) hallux valgus (using the Manchester scale). Mechanically she has a large forefoot valgus in STJN and ambulates with a relatively "supinated" foot through the stance phase of gait (inadequate pronation coming into midstance). She has about 90 degrees of passive dorsiflexion at the 1st MTP joint.

    She has a clean joint with lots of available motion that hurts with plantarflexion as well as dorsiflexion when irritated. She is much better in sneakers than shoes.

    Any thoughts on what's happening here?

    Thank you very much!

  2. ives

    ives Member

    did you perform a Jack's test?
    is the supinated gait due to compensation to avoid the painful joint?
    does the Pt have a hypermobile 1st Ray?
  3. efuller

    efuller MVP

    Are you familiar with the concept of a functional hallux limitus. There are several threads on this site that go really deep into the theory of FnHL as well as treatment.


  4. Admin2

    Admin2 Administrator Staff Member

  5. Ann PT

    Ann PT Active Member

    Thank you for the responses.

    I am familiar with functional hallux limitus and she does not have it. She has excellent motion in weightbearing and NWB at the MTP joint. She also does not have a hypermobile first ray. I don't believe her gait pattern has changed to avoid pain because there is no significant difference between her right and left foot in terms of gait. I'm not familiar with the Jack's test but know there was a recent thread about it that I will look at.

    Thank you!
  6. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Perhaps a subtle osteochondral lesion on the metatarsal head is being overlooked here?

    If lucky (with narrow region of interest, thin slices through 1st MTPJ, using an extremity coil), an MRI may detect this, otherwise it may not be obvious until surgical exploration and debridement.

  7. efuller

    efuller MVP

    Does she have calluses? What impression is there in the shoe from the foot? Is there evidence of high load 1st met and hallux?

    What is the gait. Is there late stance phase pronation. Often people with lat dev STJ axis will have late stance phase pronation causing high medial load and high stress on 1st MPJ even though clinical exam shows no functional hallux limitus.

    The pain in the joint sounds exactly like what I get with my functional hallux limitus (when I don't wear my orthotics), but I do have a little dorsal osteophyte.



Share This Page