X-Ray Findings - Both Feet

1. First MTP Joint (Big Toe) - Most Prominent Finding

• Severe osteoarthritis / Hallux Rigidus at the first metatarsophalangeal joint:
  • Marked joint space narrowing
  • Subchondral sclerosis (increased bone density around the joint)
  • Osteophyte formation (bone spurs)
  • Irregular, fragmented bony margins at the joint
• The sesamoid bones beneath the first metatarsal head appear displaced/hypertrophied
• Mild hallux valgus (lateral deviation of the great toe) is also present, though the arthritic changes are the dominant feature

2. Midfoot (Tarsometatarsal / Lisfranc Joints)

• Moderate joint space narrowing and irregularity around the tarsometatarsal and intercuneiform joints
• Consistent with midfoot osteoarthritis

3. Lesser Toes (2nd-5th)

• Alignment of lesser metatarsals is relatively well-preserved
• No obvious acute dislocation of lesser MTP joints

4. Acute Fractures

• No clearly defined acute fracture is visible
• However, the severe remodeling at the 1st MTP joint can obscure chronic changes

Summary

Clinical Recommendation

• Orthopedic / Podiatry referral is advised
• Correlate with symptoms: pain on dorsiflexion of big toe, midfoot pain on weight-bearing
• Consider gout workup (serum uric acid) - the irregular bony erosions can also be seen in tophaceous gout at this age
• Conservative options: stiff-soled footwear, custom orthotics, NSAIDs
• Surgical options (if conservative fails): 1st MTP fusion (arthrodesis) for hallux rigidus

Disclaimer: This is an AI-assisted radiological interpretation and should be reviewed and confirmed by a qualified radiologist or orthopedic specialist before clinical decisions are made.