719.27 (villonodular synovitis of the ankle and foot)
MTP Synovitis Etiology / Epidemiology / Natural History
Inflammatory synovitis of an isolated MTP joint
MTP Synovitis Anatomy
MTP Synovitis Clinical Evaluation
Pain in the MTP joint, accompanied by palpable fullness, warmth, and tenderness
Toe may be thickened; more curled than the adjacent toes; may have hammer-toe deformity.
Anterior drawer test: hold the metatarsal head between the index finger and thumb; grasp the base of the proximal phalanx with the other hand and apply a dorsally directed force. Dorsal displacement and pain indicate metatarsophalangeal joint instability or MTP synovitis.
ROM most notable plantar flexion, is decreased.
Evaluate for Mortons Neuroma (common associated finding)
MTP Synovitis Diagnositc Tests
A/P and lateral views of foot. A/P view may show MTP joint widening. No joint erosions or polyarticular disease.
Severe disease may cause MTP subluxation with base of the proximal phalanx overlapping the metatarsal head on the A/P view.
Rheumatologic workup to rule out systemic causes is indicated.
MTP Synovitis Classification / Treatment
Initial Treatment: NSAIDs, shoe modifications and a rheumatologic workup to rule out systemic causes. Shoe modifications = wide toe box, soft shoes with a metatarsal support or metatarsal bar, consider a hard soled shoe with rocker bottom.
Secondary treatment: intra-articular corticosteroid injection combined with a hard soled shoe (Mizel MS, Foot Ankle 1993;14:305)
Surgical treatment: MTP joint exploration via a dorsal approach with debridement, synovectomy and MTP joint reduction. May require release of the collateral ligaments and the extensor digitorum longus tendon for MTP joint reduction. Any concomitant intermetarsal neuralgia should be treated concomitantly.