CASE
The patient is a 31-year-old female with pain near the great toe of the left foot. The pain had been present for 5 years. The patient had experienced no antecedent trauma. She described the pain as a constant, dull ache and said it had been getting progressively worse, which was why she was seeking treatment. She was being treated for bilateral plantar fasciitis with corticosteroid injections administered by a podiatrist, and that condition was resolving. Screening for rheumatoid arthritis was unremarkable.
On physical examination, the patient complained of exquisite tenderness with flexion and extension of her left great toe. She had tenderness to palpation over the dorsum of the first metatarsophalangeal (MTP) joint. She had 40 degrees of dorsiflexion and 20 degrees of plantar flexion of her first MTP joint. She was unable to toe walk without inverting her foot to relieve pressure on the first metatarsal head. A radiograph was ordered (see Figure 1). What did the radiograph show?
