Metatarsalgia—first ray Case for small group discussion AOTrauma—Foot & Ankle Module 14: The great toe Juan B Gerstner, CO

Case description 42-year-old woman Fell from a ladder and hit her hallux Immobilized in a walking boot for 3 weeks After 3 months she still had pain in the first metatarsophalangeal joint Range of motion was reduced to 50% X-rays were normal What are possible diagnoses? Additional investigation necessary? Possible diagnoses: hallux rigidus, sesamoid disorders, osteochondral lesions, turf toe, traumatic hallux valgus Additional investigation: CT? MRI? Arthroscopy?

MRI

Discussion Diagnosis Natural history Nonoperative treatment Surgical treatment options

Arthroscopic debridement and microfractures Arthroscopic technique Portals Microfractures X osteochondral transplantation

Take-home messages Persistent pain in posttraumatic hallux needs diagnostic investigation Besides osteochondral lesion, turf toe, traumatic hallux valgus, sesamoid disorders, and hallux rigidus are possible diagnoses MRI is the main diagnostic tool Microfractures are useful in the treatment of first metatarsal head osteochondral lesions Arthroscopy may be used