| Questions to guide assessment of non-trauma-related forefoot pain: |
- Are there localized findings?
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- Findings isolated to the great toe?
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- Valgus deviation. — Bunion (hallux valgus).
- Varus deviation. — Hallux varus.
- Irregularity and enlargement of first MTP. — Suggests osteoarthritis, gout, or other degenerative condition of first MTP joint.
- Limited passive extension of first toe. — Hallux limitus or hallux rigidus.
- Redness and swelling with intense pain and tenderness of acute onset. — Suggests gout, or less commonly, pseudogout or septic joint.
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- Changes in lesser toes?
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- Dorsiflexion of proximal phalanx at the MTP joint, flexion of PIP joint and a neutral DIP joint. — Hammertoe.
- Dorsiflexion of proximal phalanx on MTP and plantar flexion of PIP and DIP. — Claw toe.
- Rotation and prominence of the fifth toe and MTP. — Bunionette.
- Flexion contracture of the DIP joint. — Mallet toe.
- Flexion of the MTP, PIP, and DIP joints. — Curly toes.
- Toes that rotate over or under other toes. — Crossover toes.
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- Does one or more of the toes appear significantly shortened?*
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- Is there first MT brachymetatarsia?
- Is there fourth MT brachymetatarsia?¶
- With multiple involved toes, is there evidence of a congenital injury or complex genetic disorder?Δ
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- Are there changes to the skin or nails in the forefoot?
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- Large callus over the plantar surface of the second MT head. — Suggests Morton callus indicating likely metatarsalgia.
- Multiple calluses over plantar surfaces of MT heads. — Suggests metatarsalgia with drop of transverse arch or neurogenic conditions causing peripheral neuropathy.
- Callus that appears to have a central core. — Suggests a corn.
- Callus on the dorsum of the PIP. — Suggests friction from shoe surface in patient with hammer toe or curly toe.
- Callus-like skin changes with dark dots after shaving surface. — Plantar wart.
- Inflammatory reaction along lateral nail bed. — Suggests ingrown toenail.
- Abnormal nail appearance. — Nail dystrophy (multiple causes).
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- Are there generalized changes to the MTP or PIP joints?
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- Is there evidence of rheumatoid arthritis?
- Is there evidence of osteoarthritis?
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- Is there forefoot pain without obvious changes in the appearance of the foot?
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- Pain over the distal MT shafts. — Suggests metatarsalgia.
- Pain localized to the area between MTs, or worse when the sides of the foot are squeezed together. — Suggests Morton neuroma.
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