Osteoarthritis Of The Second Metatarsophalangeal Joint

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Osteoarthritis Of The Second Metatarsophalangeal Joint

Authors, Editors, Case Information Author: Tamzid Hassan, DO Affiliation: Inspira Health / Rowan-Virtua School of Osteopathic Medicine Co Author(s): Michael Serra-Jovenich, DO; Altamash Raja, DO, RMSK Senior Editor: Nicholas Moore, MD Clinical Vignette: A 68-year-old male presented with pain in the right second toe. He had a remote history of a second toe fracture, and an x-ray revealed a questionable right second phalangeal loose body. Type of Probe Used: 15-4 MHz Linear Transducer Unlabeled Long Axis View of the 2nd MTP Joint Unlabeled Long axis view of the right second metatarsophalangeal joint. Labeled Long Axis View of the 2nd MTP Joint Labeled Long axis view of the right second metatarsophalangeal joint demonstrating a prominent osteophyte along with distension of the capsule and synovial thickening Unlabeled Long Axis View of the 2nd MTP with Power Doppler Unlabeled long axis view of the right second metatarsophalangeal joint with Power Doppler placed over a hypoechoic area. Labeled Long Axis View of the 2nd MTP with Power Doppler Labeled long axis view of the right second metatarsophalangeal joint. Power doppler is placed over a hypoechoic area surrounding the osteophyte (likely representing a joint effusion). There is no hyperemia or neovascularization. Unlabeled Short Axis View of the 2nd Metatarsal Unlabeled short axis view of the second metatarsal, just proximal to the MTP joint. Labeled Short Axis View of the 2nd Metatarsal Labeled short axis view of the second metatarsal demonstrating several cortical irregularities. #7 - Video View Video Long axis cine of the right 2nd MTP joint from medial to lateral. Osteophytes are present at the distal end of the metatarsus. Effusion is appreciated at the joint space and around the osteophytes. #8 - Video View Video Short axis cine of the right 2nd MTP joint from proximal to distal. Several cortical irregularities are appreciated. Interpretation Image Interpretation: The right second metatarsophalangeal joint recess is distended. Several hyperechoic, irregularly shaped bodies are noted which likely represent osteophytic changes. In the presence of prior trauma, these findings are suggestive of osteoarthritis. Teaching Pearl: Ultrasound can be useful for detecting arthritic changes in small joints of the foot, including MTP joint recess distension, synovitis, osteophytes, cortical irregularity, and loose bodies. These findings can be clinically important even when radiographs do not fully explain the patient's focal pain. Conservative care often remains first-line, including footwear modification, activity modification, offloading, orthoses, and symptom-guided rehabilitation. Ultrasound can also guide injection when the joint is confirmed as the pain generator. References: 1. Molyneux P, Bowen C, Ellis R, et al. Development of an ultrasound imaging atlas for grading osteoarthritis in the first metatarsophalangeal joint. Arthritis Care Res (Hoboken). 2024;76(11):1501-1510. doi:10.1002/acr.25407 2. Roukis TS, Piraino JA, Hollawell S, et al. ACFAS clinical consensus statements: hallux rigidus. J Foot Ankle Surg. 2024;63(6):624-630. doi:10.1053/j.jfas.2024.07.006 3. Ruiz Santiago F, Moraleda Cabrera B, Láinez Ramos-Bossini AJ. Ultrasound guided injections in ankle and foot. J Ultrasound. 2024;27(1):153-159. doi:10.1007/s40477-023-00808-1
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Authors, Editors, Case Information

Unlabeled Long Axis View of the 2nd MTP Joint

Labeled Long Axis View of the 2nd MTP Joint

Unlabeled Long Axis View of the 2nd MTP with Power Doppler

Labeled Long Axis View of the 2nd MTP with Power Doppler

Unlabeled Short Axis View of the 2nd Metatarsal

Labeled Short Axis View of the 2nd Metatarsal

#7 - Video

#8 - Video

Interpretation

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