This lady presented with marked shooting pain in the right dorsal medial 1st MTPJ.
She has endured this pain for approximately 12 months, with little relief from anti-inflammatory medication (both orally and topically), orthotics, deflective pads and corticosteroid injection.
On examination, the pain was reproducible specifically over the dorsal medial bony prominence of the 1st MTPJ. This corresponds to the region of an early bunion with a very associated small dorsal spur.
I suspect the prominence is leading to irritation of the overlying nerve.
There is now the option to try an ultrasound-guided low-dose corticosteroid injection with local anaesthetic subdermally in an attempt to free up the nerve. If there is no success and the pain persists, modern bunion surgery to eradicate the prominence and allow the nerve irritation to settle could be contemplated.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
Also read:
Juvenile hallux valgus (bunion)
Gout deposits (not bunions)
Biomechanics of a pathology (bunions and pes planus)
(This content is intended for healthcare professionals only)