Differential Diagnosis for Pain over 1st Metatarsal, Worse with Dorsiflexion

• Single Most Likely Diagnosis
  • Sesamoiditis: This condition involves inflammation of the sesamoid bones or the tendons surrounding them, located under the first metatarsal bone. Dorsiflexion increases pressure on these bones, exacerbating the pain.
• Other Likely Diagnoses
  • Hallux limitus/rigidus: A condition where the big toe's range of motion is limited, often due to arthritis. Dorsiflexion can be particularly painful as it puts additional stress on the already compromised joint.
  • Bursitis of the first metatarsophalangeal joint: Inflammation of the bursa around the joint can cause pain, especially with movement such as dorsiflexion.
  • Morton's neuroma: Although typically associated with pain between the toes, a neuroma affecting the nerve supply to the first toe could potentially cause pain in the area of the first metatarsal, worsened by dorsiflexion.
• Do Not Miss Diagnoses
  • Osteonecrosis of the first metatarsal or sesamoid bones: A condition where the bone tissue dies due to lack of blood supply. It's crucial to identify this condition early to prevent further bone collapse and to initiate appropriate treatment.
  • Infection (osteomyelitis or septic arthritis): Infections in the bone or joint can present with pain and need to be identified and treated promptly to avoid serious complications.
  • Gout: Although gout typically affects the base of the big toe, it can sometimes present in other areas of the foot and can be extremely painful, requiring immediate treatment.
• Rare Diagnoses
  • Freiberg's disease: A rare condition involving avascular necrosis of the metatarsal head, more commonly affecting the second metatarsal but can occur in the first.
  • Kohler's disease: A rare bone disorder causing pain and swelling in the foot, typically affecting children and involving the navicular bone, but could potentially cause referred pain to the area of the first metatarsal.