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

2. 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?

3. MRI

4. Discussion Diagnosis Natural history Nonoperative treatment
Surgical treatment options

5. Arthroscopic debridement and microfractures
Arthroscopic technique
Portals
Microfractures X osteochondral transplantation

6. 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