How To Handle Second MTPJ Stress Syndrome

By Joshua Gerbert, DPM

   Second MTPJ stress syndrome has become a catch-all term for patients who complain of chronic pain involving the second MTPJ. While it is important to differentiate this entity from a neuroma, intermetatarsal bursitis or a stress fracture of a metatarsal, it is even more important for the practitioner to determine an accurate etiology or etiologies for the second MTPJ stress syndrome. Only by understanding the cause of the problem can one develop an effective treatment plan.    When a patient has second MTPJ stress syndrome, he or she may have the following typical signs and symptoms:    • pain with pressure to the second MTPJ;    • a positive modified Lachman’s test (manual subluxation of the MTPJ that creates pain);    • pain in the sub-second metatarsal head with standing and/or ambulation;    • pain with the second MTPJ area that is well localized;    • edema of the second MTPJ area;    • painful second hammertoe (flexible or rigid depending on the amount of time since the onset of symptoms);    • possible dorsal dislocation of the second digit at the MTPJ;    • possible adduction (splaying) of the second digit when the foot is loaded;    • possible hyperkeratotic lesion of the sub-second metatarsal head;    • hallux abductus with bunion deformity, which may be symptomatic; and/or    • a hypermobile first ray with abnormal pronation.    The longer the problem has been present, the more digital deformity one will usually see. Possible etiologies of second MTPJ stress syndrome include:    • chronic overload of the second MTPJ which may be due to hypermobility of the first ray, longstanding hallux abductus with bunion deformity, negative metatarsal protrusion distance or chronic digital deformity;    • inflammatory disease affecting the second MTPJ;    • multiple steroid injections into the second MTPJ as a treatment for MTPJ stress syndrome; and/or    • a traumatic event affecting the second MTPJ.

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