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Great Toe Pain: An Unexpected Finding

Great Toe Pain: An Unexpected Finding. Kennieth McCollough, MD American Sports Medicine Institute SEACSM February 10, 2012. History. 17 year old female cross country runner Swelling of medial aspect of right great toe for two months

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Great Toe Pain: An Unexpected Finding

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  1. Great Toe Pain:An Unexpected Finding Kennieth McCollough, MD American Sports Medicine Institute SEACSM February 10, 2012

  2. History • 17 year old female cross country runner • Swelling of medial aspect of right great toe for two months • Localizes pain to medial side of right first metatarsal phalangeal joint • Now having pain upon movement of the toe and with palpation • Interfering with running • Activity modification has not helped

  3. History • No medications or allergies • No past medical history • No past surgical history • Lives with family, NS/ND • Family history unremarkable • ROS otherwise negative

  4. Physical Exam • Swelling noted over medial aspect of right first MTP • Swelling and tenderness on palpation • Active and passive range of motion severely limited by pain. • Strength of right great toe was 4/5 secondary to pain. Normal strength in foot and ankle • Calcaneal valgus and pronation of bilateral feet on standing, but lateralizes on right to avoid toe-off • Normal alignment of 1st ray, MTP and proximal phalynx

  5. Questions?

  6. Differential Diagnosis • First MTP sprain • Stress Reaction/Fracture • Arthritis(OA, Septic, Gouty) • Sesamoiditis • Tendinitis(Flexor, Extensor tendons of great toe) • Bursitis • Neoplasm

  7. Imaging • Initial Radiographs • Working Diganosis: Calicific Peri-arthritis

  8. Initial Treatment • Placed in Cam Boot,started NSAIDS and restricted from running • Became acutely more inflamed and swollen over the next five days • Consult was made to Foot and Ankle specialist • MRI was performed

  9. Magnetic Resonance Imaging Radiology report read as focus of calcification medial to the first metatarsal with surrounding soft tissue edema

  10. Treatment • Surgical resection of soft tissue mass on medical aspect of right first metatarsal joint secondary to worsening clinical picture and poor response to conservative management

  11. Pathology • Described as fibrous tissue with dystrophic calcification

  12. Final Diagnosis and Outcome • Acute Calcific Peri-arthritis • Un-remarkable post operative course • Resumed running in six weeks

  13. Questions?

  14. Thank You

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