Warning

Presentation

  • Unable to wear heeled footwear
  • Initiated by a single traumatic event
  • Increased pain after a period of activity
  • Symptoms exacerbated by footwear
  • Difficulty with footwear accommodation

Symptoms/signs

  • pain to 1st MTPJ area or generalised forefoot pain
  • increase pain and stiffness to 1st 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

Differential diagnosis

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

Primary care management

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.

 

Issue condition specific leaflet

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

Refer

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.

Editorial Information

Last reviewed: 05/07/2024

Next review date: 06/07/2026

Reviewer name(s): Lynne Drennan.