Friday, November 7, 2008

Case Study: Toe Pain

Patient: 45 year old male construction worker
Complaint: Right first toe pain, especially with running.

The patient presents with a chronic, intermittent complain of right first toe pain. He reports that the toe does not hurt if he avoids running, but that when he does go for a run the toe pain comes on in the first few minutes of the run and will last for several days afterward. The pain is local, and he denies and sharp, shooting or electrical pain.

Upon examination, observation reveals the right first toe's metatarsal to be hypertrophic, with excessive bone formation at the proximal end. This causes a bump on the dorsal surface of the patient's foot. Palpation of the joints and muscles reveal a hypertonic adductor pollicus and decreased joint motion at the metatarso-cuneiform joint.

Discussion: This patient is suffering from a very common condition: Osteoarthritis. Through no real fault of the patient, his joint has begun to degrade with the forces of time and stress. This causes his toe's joints to not move as well, which in turn causes muscles to become tense and painful. When he runs, he aggravates the condition by putting further stress on an already-stressed joint.

Treatment: We will focus on pain control. The current deformation of bone from the arthritis is nearly impossible to reverse, but we can slow any further progression of the disease. We will massage the adductor pollicus muscle to help it relax and then adjust the toes, foot, knee and hip as needed to make sure the entire limb is moving as best it can. Then, we will make sure the patient's sure are providing the proper foot support. In this case, the patient's high arches need to be considered and orthotics are recommended.

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