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All copyrights are reserved by the Academy of Ambulatory Foot and Ankle Surgery. Pathway 3 DETERIORATES AFTER INITIAL IMPROVEMENT * Re-Evaluate & / or Refer IMPROVED * Continue Initial Treatment CLINICAL RESPONSE IMPROVED CONDITION DETERIORATES NO Improvement REFER TO PODIATRIC FOOT & ANKLE SURGEON Figure 13: Surgical Treatment Associated Findings * Central Metatarsalgia * IPJ Plantar Callous Radiographic Findings * Disorder is one of Progressive Degenerative Changes at 1st MTP Joint * See Figure 2: Classification & Radiographic Findings INITIAL TREATMENT OPTIONS * NSAIDs * Corticosteroid Injections * Orthoses * Shoe Modifications * Operative Treatment Significant Findings: * Dorsal "Bump" / Prominence * Hallux Equinus * IPJ Hyperextension * +/- Abnormal ROM 1st MTP Joint Significant History: * Painful 1st MTP Joint * 1st MTP Joint Stiffness * Pain Increases with Activity * Pain Aggravated by Shoes * Suprastructural Musculoskeletal Complaints * Insidious Onset c/s 1st MTP Joint Trauma * Arthritis Hallux Rigidus Source: Clinical Practice Guideline First Metatarsophalangeal Joint Disorders Panel. Diagnosis and treatment of first metatarsophalangeal joint disorders. J Foot Ankle Surg 2003 May-Jun;42(3):112-54.