musculoskeletal and connective tissue disorders
Metatarsophalangeal Joint Pain
Treatment of Metatarsophalangeal Joint Pain
Orthoses If present, treatment of underlying systemic rheumatic disease Foot orthoses with metatarsal pads may help redistribute and relieve pressure from the noninflamed joints. With excess subtalar eversion or when the feet are highly arched, an orthotic that corrects these abnormal alignments should be prescribed. Shoes with rocker sole modifications may also help. For hallux limitus or rigidus, orthosis modifications may further help to plantarflex the first ray to improve metatarsophalangeal joint motion and reduce pain. If the first ray elevation cannot be reduced by these means, an extended first ray elevation pad may be helpful. For more severe limitation of first metatarsophalangeal motion or pain, the use of rigid orthoses, carbon fiber plates, or external shoe bars or rocker soles may be necessary to reduce motion at the joint. If inflammation (synovitis) is present, medications to treat the underlying inflammatory condition (eg, rheumatoid arthritis) are indicated. An injection of a local corticosteroid/anesthetic mixture may be useful for immediate pain relief (see Considerations for Using Corticosteroid Injections ). Surgery may be needed if conservative therapies are ineffective. 