Painful 2nd toe

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Can anyone help me :45 yo women, 160cm, 60 kg has had a painful R and L foot for approx.8 years. R worse than L .The pain occurs when she bends the toes when walking, wearing high heels. ie dorsi/plantarflexion.
She used to, when sitting, plantarflex her toes-bending them under her feet until the MPJ's "clicked" . A kind of nervous habit. She did this a lot until one day it caused pain, (8 years ago) which is always there now with movement. The pain is noticeably less with the feet flat. The pain is worse in the Right foot on the dorsum of the 2,3,4, met heads and extending along the dorsum of the foot to the ankle at times.
BIomechanically-slight pronation, rearfoot varus, no limitation in joint movement. No other foot pathology than the above
X-rays taken 2001 and 2006. the latest one shows changes in the 2nd MPJ "mild to moderate OA had deveolped, a little degenerate subchondral sclerosis"
The dorsum R 2nd is lumpier than the L 2nd. On palpation the R 2nd MPJ "clicks/grates". No other foot deformities.
Footwear wears runners-one pair , an all terrain type, in particular is the most comfortable as it had a more rigid sole. Other runners are not as good

 

If there is flattening of the 2nd MT heads, I would suggest old Frieberg's/traumatic OA - in which case maybe cheilectomy of the joint wouldbe worth considering.

Can you post the xrays on the forum?

LL

 

From the info given, Freibergs and partial plantar plate rupture would be at the top of my list. Is the first ray functioning normally??

Don't forget to rule out neuroma as well.

Nick