Forefoot problems

• pain to 1^st MTPJ area or generalised forefoot pain
• increase pain and stiffness to 1^st MTPJ
• gradual onset of pain
• swelling
• bony prominence/deformity
• loss of function
• crepitus of joint mobilisation
• parasethesia/pins and needles to lesser digits
• painful callus
• daylight sign
• family history
• limping
• inability to carry out normal sporting activity or walk long distances

• Hallux-Abducto Valgus, Hallux Limitus, Hallux rigidus
• Morton's neuroma
• Plantar plate tear
• Capsulitis
• Lesser toe deformities
• Gout
• Osteoarthritic changes

Evidence suggests that 80% of MSK problems are self limiting and will recover within 12-18 months. It is important to rule out serious pathology or any problem that warrants escalation but for all other cases a period of initial self directed rehabilitation should be given before any further intervention is considered.

• Footwear advice
• POLICE (Protect, Optimal Loading, Ice, Compression, Elevate)
• Sign post to NHS Inform - www.nhsinform.scot
• Sign post to NHS Doing More – www.dgdoingmore.co.uk

Issue condition specific leaflet

• Hallux valgus (Bunions)
• Hallus limits or rigidus
• Morton's neuroma

If symptoms persist following 12 weeks of self management

Refer via SAP/appropriate referrers to MSK pathway

Triaged into appropriate service i.e. Physiotherapy, Orthotist or Podiatrist.