title: Nonoperative treatment of metatarsophalangeal joint synovitis.
abstract: The results of nonoperative treatment of metatarsophalangeal (MP) joint synovitis in 13 patients without known rheumatologic conditions (15 joints) were reviewed. Average duration of forefoot pain was 4 +/- 3 months (range 0.5-12 months), except for one patient who had pain for 30 months. The second MP joint was involved in nine cases (60%), and the third was involved in six cases (40%). Examination revealed tenderness and palpable fullness of the MP joint in all cases; painful dorsal drawer sign was present in 10 cases (67%), adjacent interdigital tenderness in six cases (40%), and hammertoe deformity in eight cases (53%). Treatment included intra-articular corticosteroid injection and rocker-sole show modification to limit MP joint dorsiflexion. At follow-up evaluation (18 +/- 9 months, range 4-26 months), the involved MP joint was asymptomatic in nine joints (60%), improved or almost asymptomatic in five joints (33%), and operated in one (7%) joint. Two of seven (29%) joints not initially associated with hammertoe developed a mild hammertoe deformity from time of diagnosis to follow-up. In conclusion, nonoperative treatment can be effective for MP joint synovitis, and the incidence of progressive hammertoe deformity in successfully treated cases is low.
authors: Boston Foot and Ankle Center, New England Baptist Hospital, Massachusetts, USA.
authors: E
authors: E
authors: Trepman
authors: S J
authors: SJ
authors: Yeo
mesh_terms: D000328:Adult; D000368:Aged; D002045:Bupivacaine / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007270:Injections, Intra-Articular; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular / Q000187:drug effects; D012775:Shoes; D013585:Synovitis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000534:rehabilitation*; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*
chemical_list: D014221:Triamcinolone; D003907:Dexamethasone; D008012:Lidocaine; D002045:Bupivacaine