II. Epidemiology
- Affects teens
- Girls predominate by a factor of 3-4
- Most associated with ballet and dance
III. Pathophysiology
- Unknown etiology, but presumed due to microtrauma, decreased vascular supply or systemic conditions
- Disordered ossification of the Metatarsal head (most often the second Metatarsal)
- Avascular necrosis (or aseptic necrosis) of the seccond Metatarsal head (other toes may be involved)
IV. Risk Factors
- Trauma
- Repetitive stress
- Improper shoes
- Decreased blood supply to the affected area
V. Symptoms
- Pain and swelling localized to the affected metarsal head
- Typically unilateral (90% of cases)
- Worse with weight bearing or walking
VI. Signs
-
Metatarsal-phalangeal joint (MTP) inflammation
- Tenderness and swelling over the involved Metatarsal head
- Restricted Range of motion
- Metatarsal head palpably enlarged
VII. Imaging
- Weight-Bearing Foot XRay
- XRay Findings may lag symptom onset by 3-6 weeks
- Sclerosis and flattening of the involved articular surface of the Metatarsal head
- Widening and irregularity of Metatarsal head
- Flattening and collapse of MTP joint with cystic changes
- Loose bodies sometimes present
- MRI
- Consider when serial XRays fail to make the diagnosis
VIII. Management
- NSAIDs
- Warm soaks
- Local Corticosteroid Injection
- Well padded shoes
- Stiff soled shoe or walking boot
- Anterior Metatarsal bar or pad
- Shifts pressure from Metatarsal head
- Surgery indications
- Loose bodies
- Significantly deformed Metatarsal head