I’m a first time post-er, but a long time reader!
I have a 6 year old boy who presented complaining of pain in dorsal interphalangeal joints of both halluces, left worse than right.
There was pain in the interphalangeal joint on plantarflexion of both halluces and on palpation of dorsal interphalangeal joint, left worse than right.
No pain on dorsiflexion of interphalangeal joint.
Normal range of motion of interphalangeal joint both first digits.
Pain levels are 8-9 out of 10 on palpation and on plantarflexion, keeping in mind this is a 6 yr old boy.
Painful when walking and especially when on standing on tip-toes.
History of pain has been present for around 6 months, progressively getting worse, however only in the last month has it become an issue, especially after exercise which most recently has been after Karate (barefoot exercise).
No history of trauma or injury to either foot in this particular area.
He has bilateral moderate rearfoot pronation (approximately 6-7 degrees everted) and mild intoeing of both feet.
Treatment has consisted of rest from offending activities (sports/Karate), icing twice daily to the area and sent for x-rays of foot.
Treatment also consisted of orthoses which will aim to correct excessive pronation and intoeing, these orthoses are yet to be issued (issue date in 1 week).
The x-rays are attached, focusing in on the left medial interphalangeal joint of the great toe.
Xray report reads as follows:
There is a dysmorphic interphalangeal joint of the great toe which demonstrates a spur at the head of the great toe proximal phalanx medially and joint space narrowing, possibly due to a partial fibrous union between the phalanges of this joint medially. It is uncertain, whether this is due to developmental abnormality or related to previous injury. No other joint nor bone pathology demonstrated. No evidence of fracture.
The bones and joints appear normal. This is no evidence of fracture.
Any suggestions, is this something that warrants examination from a surgeon?
Your help would be greatly appreciated. Thank you.