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All copyrights are reserved by the Academy of Ambulatory Foot and Ankle Surgery. Pathway 5 CLINICAL RESPONSE NO IMPROVEMENT * Re-Evaluate * Consider Imaging - Tc Scan - MR - CT IMPROVEMENT * Continue Treatment until Symptoms Resolve * Fracture (acute, stress) * Avascular Necrosis * Arthritic Changes * Soft Tissue Swelling Diagnose & Treat Appropriately RADIOGRAPHS * Capsuloligamentous Injury (Acute "Turf Toe") * Chondromalacia * Flexor Hallucis Tendinopathy Period of Symptomatic Treatment Re-Evaluate after period of Observation and Treatment Significant Findings: * +/- Swelling, Effusion, Dislocation * Pain on 1st MPJ ROM * Localized Pain c Weight-Bearing Sesamoid Disorders 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.