Non-surgical Early treatment for mild cases of<unk>  may include prescription foot orthotics, shoe modifications (such as a pad under the joint, and/or a deeper toe box to take the pressure off the toe and/or facilitate walking), specialized footwear ('rocker-sole' shoes), medications (anti-inflammatory drugs) or injection therapy (corticosteroids to reduce inflammation and pain). Physical therapy programs may be recommended, although there is very limited evidence that they provide benefit for reducing pain and improving function of the joint. Surgical The goal of surgery is to eliminate or reduce pain. There are several types of surgery for treatment of<unk> . The type of surgery is based on the stage of<unk> . According to the Coughlin and Shurnas Clinical Radiographic Scale: Stage 1<unk>  involves some loss of range of motion of the big toe joint or first MTP joint and is often treated conservatively with prescription foot orthotics. Stage 2<unk>  involves greater loss of range of motion and cartilage and may be treated via cheilectomy in which the metatarsal head is reshaped and bone spurs reduced. Stage 3<unk>  often involves significant cartilage loss and may be treated by an osteotomy in which cartilage on the first metatarsal head is repositioned, possibly coupled with a hemi-implant in which the base of the proximal phalanx (base of the big toe) is resurfaced. Stage 4<unk> , also known as end stage<unk> , involves severe loss of range of motion of the big toe joint and cartilage loss. Stage 4<unk>  may be treated via fusion of the joint (arthrodesis) or implant arthroplasty in which both sides of the joint are resurfaced or a hinged implant is used. Fusion of the joint is often viewed as more definitive but may lead to significant alteration of gait causing postural symptomatology. The implants termed "two part unconstrained" implants in which a "ball" type device is placed on the first metatarsal head and "socket" portion on the base of the big toe do not have a good long term track record. The hinged implants have been in existence since the 1970s, have been continually improved and have the best record of improving long term function. Another example of MTP joint implant is "Roto-glide" which is designed to restore optimum anatomical movement whilst preserving as much primary bone stock as possible. Cartilage replacement may be the first step before considering Fusion ( Arthrodesis- stiff toe joint) or arthroplasty. Cartilage repair for focal osteochondral defects of the first MTP may be a strategy before fusion or arthroplasty. Osteochondral plugs and resurfacing both have advocates. Although still at the case report stage, the experience is improving in the literature.
Hallux rigidus
Bunion
Klumpke paralysis
Periodic paralysis
Myoclonic dystonia
Torsion dystonia
Monomelic amyotrophy
Holmes tremor