MPJ enlargement

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Hi everyone,

I have a 20year old pt with assymptomatic flatfoot. The thing that has me tricked is he has assymptomatic hypertrophy of the 1st metatarsal and metacarpal heads bilaterally. He has no significant medical or family history.
Is there some rhuematic changes going on?

Thanks
Bec

 

I am not aware of any typical rheumatological condition that could cause this. Is the hypertrophy recent or long history of it?

 

Hi Bec:
Can you clarify this?

20 year old (male or female) with non painful "hypertrophy" of the 1st MTP and MCP heads (only?)

Hypertrophy meaning - on radiograph or clinically?

Any erythema? Limited ROM? IPJs all normal?

Steve

 

Thanks for your quick replies, the pt is male and he has never noticed these findings before (I'm assuming chronic as he would of noticed if they had changed).
The hypertrophy was a clinical finding on physical examination and yes the MTP and MCP are the only joints visibly involved...? 1st MTPJ motion reaches 65deg bilaterally.

I have attached a photo of his right foot with the involved MTPJ. All IPJs seem unaffected.

Thanks
Bec

 

Hi Bec:
From what I can see the first Met area looks like a normal variant.
He appears to have early contraction of the IPJ hallux and 2nd digit. Hyperkeratosis medial hallux as well. Probably secondary to functional equinus.

Steve

ps

Does he chew his toenails? ( I know, not funny!)

 

G'day Bec,

I agree with Steve, looks to be a fnctional hallux limitus, evidenced by the HK developing over the interphalangeal joint, common wth hyperextension of the interphalangeal joint. This is probbaly due to the size of the joint. It doesn't appear to have any irregular extososis development in this picture. I have seen a few like this, and the non-pathological ones I just let go.

p.s. Does look liek he's had a bit of a chew doesn't it??