Working Diagnosis:
Osteochondral defect of the proximal phalanx of the right great toe with mild degenerative changes at the right first MTP with moderate underlying subchondral cystic change and edema

Treatment:
Orthopedics performed a right 1st MTP capsulotomy and debridement with a great toe proximal phalangeal curettage and local bone grafting.

Author's Comments:
Providers should be aware that x-rays may be normal in patients with an osteochondral defect. If pain continues after conservative treatment and there is a high index of suspicion for an osteochondral defect an MRI is the study of choice for further evaluation and staging.

Editor's Comments:
This is an interesting and uncommon cause of forefoot pain after trauma, and it is important to note that first MTP osteocondral defect may be a risk factor for hallux rigidus later in life.

References:
DeLee JC, Drez Jr D, Miller MD. DeLee &
Drez's Orthopaedic Sports Medicine
Principles and Practice, 2nd Ed, Elsevier
Science, Philadelphia 2003.

Chambers HG, Shea KG, Carey JL. AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg 2011; 19:307.

Perumal V, Wall E, Babekir N. Juvenile osteochondritis dissecans of the talus. J Pediatr Orthop 2007; 27:821.

Care of the Young Athlete, 2nd ed, Anderson SJ, Harris SS, Gregory AJM (Eds), American Academy of Pediatrics, Elk Grove Village 2010.

Moktassi A, Popkin CA, White LM, Murnaghan ML. Imaging of osteochondritis dissecans. Orthop Clin North Am 2012; 43:201.

Polousky JD. Juvenile osteochondritis dissecans. Sports Med Arthrosc 2011; 19:56.

Harvey BS, Herngenroeder AC. Management of osteochondritis dissecans. UpToDate. Retrieved from http://www.uptodate.com/contents/management-of-osteochondritis-dissecans-ocd?search=osteochondritis+dissecans&source=search_result&selectedTitle=1~27 2017.

Return To The Case Studies List.