This patient presented recently with a long-standing markedly painful left 2nd MTPJ. Conservative care has been unsuccessful and hence she was referred for a surgical consultation. On examination, a firm, “lump” was noted on the dorsal aspect of this joint.
This firm “lump” with a step-down prominence was palpated and deemed to be a dislocated joint. These dislocations are hard to control non-surgically, however, a wide and large metatarsal dome with possible defection and a wide, cushioned shoe may help. No amount of strapping or manipulation will suffice, as the plantar plate is torn and the phalanx is now sitting on the metatarsal head.
When you feel these “lumps” ensure you X-ray. She is booked for surgery, I will keep you posted with some post-operative images soon.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.