Dorsal first metatarsocuneiform exostosis

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Dorsal first metatarsocuneiform exostosis

Common.

Due to:
• dorsal ‘humping’ of midfoot in those with pes cavus (especially if anterior cavus)
• proliferation of bone from dorsal hypermobility of first ray (due to ‘jamming’)
• trauma

Clinical features:
Prominence of base of first metatarsal and medial cuneiform
Discomfort and erythema from shoe pressure
May have parathesias, tingling, numbness (due to compression of medial dorsal cutaneous nerve)
On x-ray – dorsal prominence visible; may be plantar gap in metatarsocuneiform joint.

Classification:
Type 1 Local dorsal exostosis
Type 2 Dorsal exostosis with osteoarthritis of joint
Type 3 Dorsal exostosis with angular deformity
Type 4 Exostosis extends across other metatarsocuneiform joints
Type 5 Pseudoexostosis of dorsal humping of anterior pes cavus

Management:
Initially – avoid footwear
Padding on underside of tongue to accommodate prominence
Surgical excision or arthrodesis of joint.

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