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All copyrights are reserved by the Academy of Ambulatory Foot and Ankle Surgery. Pathway 6 NO IMPROVEMENT * Re-Evaluate * Consider Imaging - Tc Scan - MR - CT CLINICAL RESPONSE IMPROVEMENT * Continue Treatment until Symptoms Resolve * Fracture or Dislocation * Soft Tissue Swelling Diagnose & Treat Appropriately * Period of Symptomatic Treatment Re-Evaluate after period of Observation RADIOGRAPHS Significant Findings: * Pain on ROM * +/- Presence of Deformity * Localized Pain c/s Wt-Bearing * Soft Tissue Damage or Vascular Embarrassment Significant History * History of Trauma * Acute or Later Onset of Symptoms * +/- Pain or Disability 1st MTP Joint Trauma 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.