Module 16, Pediatric Orthopaedist Level

A 15 year and 4 month old female presented to the office with a complaint of left foot pain near the fourth toe for one year. She had no antecedent trauma. She described her pain as a constant, dull ache which had been getting progressively worse. She complained of exquisite tenderness with flexion and extension of her left fourth toe. She was tender to palpation over the dorsum of the fourth metatarsal phalangeal joint. She was unable to toe walk without inverting her foot to relieve pressure from the fourth metatarsal head. For six months she has been treated with orthotics, casts, injections, and therapeutic doses naprosyn. During any substantial ambulation there is severe, limiting pain.

Question 16A

The most appropriate treatment is switching her to ibuprofen 2400 MG a day and make her non-weight bearing.

Question 16B

The etiology of this condition is unknown.

Question 16C

Surgical treatment should now be considered.

Question 16D

Insertion of silastic prosthesis is expected to provide the best long term result.

Question 16E

Metatarsal head resection is another reasonable alternative if surgical treatment is to be considered.