Diagnosis and treatment of First Metatarsophalangeal Joint Disorders. Section 6: Other disorders ☆ ☆☆

If clinical examination and radiographs allow for definitive diagnosis, treatment should be directed accordingly. Nondisplaced or mildly displaced fractures, symptomatic partitions, and avascular necrosis may be initially treated with immobilization and offloading techniques. If these measures fail, or if a markedly displaced fracture is encountered, excision of the affected sesamoid(s) may be indicated. Degenerative/arthritic changes may be treated with offloading techniques, orthotics, anti-inflammatory nonsteroidal drugs, or localized injection. Surgery may be indicated if nonsurgical care is unsuccessful (2,14). Excision of a sesamoid(s) may result in a variety of postoperative problems including hallux varus, valgus, hammertoe, and/or extensus; the patient must be evaluated carefully (15).