Pertinent Pearls On Treating First MPJ Injuries In Athletes

A. Douglas Spitalny, DPM, FACFAS

Pinpointing The Source Of Cartilage Injuries

Cartilage injuries to the first MPJ can be difficult to diagnose acutely and may not become evident on X-rays for eight to 10 months. Bone bruising can be visible on MRI acutely or not at all.

   All of this can be frustrating to the athlete and surgeon. Despite having essentially a normal exam, normal X-rays and often normal MRIs, the athlete is unable to perform. The minute athletes bear weight, they are in extreme pain. They cannot tolerate any pressure on the hallux. Athletes will often grow desperate and frustrated because we cannot provide them with immediate answers. We need to prove that the joint is the source of their pain.

   One option to consider is performing a diagnostic injection. If that relieves pain, a diagnostic arthroscopy of the first MPJ can be beneficial. Many times, I have found a full thickness cartilage flap to be helpful. More often, these isolated cartilage flaps, tears or full thickness defects can go unnoticed diagnostically until we see subchondral damage on X-ray. All the while, the athlete is playing in pain. Over time, these injuries will predispose the athlete to arthritis.

In Summary

Metatarsophalangeal joint injuries can become very debilitating for athletes. Although the mechanism of injury may seem minor, the extent of the injury may not be apparent. The use of MRI has helped to better define these injuries but ultimately treatment has remained the same: rest and immobilization. No matter the injury, these athletes can often have long-term symptoms and be predisposed to post-traumatic arthritis.

   Dr. Spitalny is a staff podiatrist at General Leonard Wood Army Community Hospital at Ft. Leonard Wood, Mo. He is a Fellow of the American College of Foot and Ankle Surgeons.


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