Friday's Patient Problem of the Week: Measuring Range of Motion 2nd Metatarsal Phalangeal Joint

A patient presented post operative 2nd metatarsal phalangeal joint. The joint was very stiff and painful and she wanted advice on increasing the range of motion and minimizing the pain. As she walked, she felt that the bottom of the base of the toe would stay against the ground and cause pain. She felt that the toe would not move up as she walked through her foot. Even though the pain was on the bottom of the toe at the MPJ, she felt that the restriction to bending the joint was in the top of the joint. 

2nd MPJ with healed surgical scars, but too much restriction at the top of the joint. Patient started on joint mobilization (like with Hallux Limitus) and cross frictional massage with a Blaine Scar Treatment Kit.

http://youtu.be/bdRuO0QERpI

Tin Foil is used to give the patient a reference point before and then after treatment. With the toe bent upwards as much as possible, the tin foil is massaged into the skin to represent that area. About a 6 inch strip of tin foil is used and folded on itself to get some rigidity. 

Once the tin foil is removed for the skin, the patient can observe the angular relationship to the toe to the metatarsal (here before mob and massage). I can measure this as a 19 degree angle. 

After mobilization and massage, the angular relationship is remeasured and the patient can see how their treatment is working. Doing this multiple times a day (2-3) for several months (3-6) can give a consistent improvement. Remember no pain in this treatment. Here I measured the same patient at 40 degrees post mobilization and gentle cross frictional massage of 2 minutes. 

Friday's Patient Problem of the Week: Dislocating 2nd Toe

This nice patient had her 2nd toe going over the first slightly after injuring the area playing soccer. The pain was isolated to the 2nd metatarsal-phalangeal joint for several months before the 2nd toe started to noticeably drift towards the first toe. Taping of the second to the third (sometimes even to the 4th) toe and using a medium gel toe separator has held the toe joint in the right position and allowed a dramatic reduction of pain. MRI has documented a ligamentous tear under the 2nd met/toe joint and the patient is discussing surgical options with several podiatrists on my recommendation. She may however stabilize this area over the next 6-12 months and do well without surgery for now. I have also added Hapad metatarsal arch pads to off weight the sore area and she ices for 10 minutes 3-5 times a day when she can sit still long enough. Eventually she will need to be able to do metatarsal doming exercises to rebuild the toe and metatarsal strength.