OA of the first MTPJ; can be primary (degenerative) or secondary to osteochondral injury

Clinical features

Symptoms

• Painful 1st MTP joint
• Stiffness
• Pain increases with activity/aggregated by shoes

Signs

• Dorsal exostosis (bone spur)
• IPJ hyperextension

Investigations

• Imaging:
  • WB X-ray - AP/LAT and oblique

Management

Conservative treatment

• Weight loss if appropriate
• Analgesia, NSAIDs, activity modification
• May involve the wearing of stiff soled shoe to limit motion at the MTPJ
  • A metal bar can be inserted into the sole of a shoe

Surgical management

• In early cases where dorsal osteophytes impinge during dorsiflexion, removal of osteophytes (cheilectomy) may help
• Gold standard surgical treatment is arthrodesis
  • Should alleviate pain, no movement of joint
  • Stops women wearing heels
• 1st MTP joint replacements are in use but failure rates are quite high and once failure occurs, salvage surgery is difficult and results are usually disappointing