The condition is defined as a limitation or loss of motion of the joint connecting the great first toe to the metatarsal. The condition may be referred to as osteoarthritis of the 1st metatarsophalangeal joint. (See Diagnostic Code: 5003 Arthritis, degenerative)

Repetitive stress or overuse, injuries to the joint, inflammatory conditions such as gout, rheumatoid arthritis, metabolic conditions, damage to the joint due to osteoarthris, and structural factors.

A manifestation of the condition is pain upon walking. There may also be slight swelling of the joint, limited joint movement, tenderness, and exostosis formation. As the condition progresses, there may be increased heat at the joint site which represents secondary irritation of the synovial membrane. The condition is also aggravated by the wearing of shoes.

Diagnostic measures include x-rays, a complete history, and physical examination.

Nonsurgical treatment may include physical therapy to include passive exercises, drug therapy ( nonsteroidal anti-inflammatories, injection of local anesthetics, and/or a corticosteroid), and an orthotic device or special footwear to decrease pain and increase motion of the joint.

Surgical intervention may be necessary when conservative management fails.

Residuals may include pain, deformity, reduced joint mobility, and a change in gait. The condition may be chronic requiring long-term drug therapy for pain.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• When multiple foot disabilities are present, but the etiology of the symptoms cannot be separated, assign a single disability evaluation for the predominant symptoms. If the etiology of the symptoms can be delineated, separate disability evaluation may be assigned under multiple DCs for foot disabilities provided that the principles of 38 CFR 4.14 have not been violated.

• Not to be combined with clawfoot ratings.