First Metatarsophalangeal Joint Dorsal Soft-Tissue Impingement in Athletes: Case Report

Athletes may experience persistent pain during dorsiflexion of the first metatarsophalangeal (MTP) joint after trauma, resembling anterior ankle impingement. Although MTP joint arthroscopy was first reported in 1985, reports of dorsal soft-tissue impingement in the first MTP joint are lacking. We describe three cases in which athletes with posttraumatic dorsal soft-tissue impingement in the first MTP joint underwent arthroscopic treatment. Diagnostic criteria included pain and snapping during passive dorsiflexion of the MTP joint, with minimal or no abnormalities on radiographs or magnetic resonance imaging. Arthroscopy was performed using dorsomedial and dorsolateral portals and a 1.9-mm 30° arthroscope. Impinged synovial and scar-like tissue was debrided using a small joint-shaver system. Weight-bearing was allowed immediately postoperatively, and sports-specific exercises were resumed 1 month after surgery. Case 1 involved an 18-year-old male karate athlete with pain during 5° dorsiflexion after a toe injury. Case 2 involved a 21-year-old female sprinter with pain and snapping at 10° dorsiflexion after a foot sprain. Case 3 involved a 16-year-old female ballet dancer with pain at 45° dorsiflexion 2 years after a toe sprain. In all cases, intra-articular lidocaine and dexamethasone injections provided only temporary pain relief. Arthroscopy revealed dorsal impingement of synovial and scar-like tissue during dorsiflexion. All patients returned to their sports within 2–3 months postoperatively. The findings suggest that trauma-induced dorsal soft-tissue impingement in the first MTP joint, resembling anterior ankle impingement, can be present even when imaging is inconclusive. Temporary relief from steroid injections may indicate scar tissue impingement rather than active synovitis. Arthroscopy allows both definitive diagnosis and simultaneous treatment. Dorsal soft-tissue impingement should be considered in athletes with posttraumatic first MTP joint pain during dorsiflexion. Arthroscopic debridement is effective for both diagnosis and management, enabling an early return to sports activities.