Acute Calcific Tendinitis of the Forefoot in Young Women- A Presentation of Two Cases

Case Report

Foot Ankle Stud. 2021; 3(1): 1022.

Acute Calcific Tendinitis of the Forefoot in Young Women- A Presentation of Two Cases

Hession E* and Ryan J

Department of Emergency Medicine, St. Vincent’s University Hospital, Ireland

*Corresponding author: Hession E, Department of Emergency Medicine, Elm Park, Dublin 4, Ireland

Received: April 19, 2021; Accepted: May 05, 2021; Published: May 12, 2021


Introduction: Calcific tendinitis is an uncommon presentation in the forefoot with relatively few cases reported in the medical literature. It is commonly overlooked and should form part of a differential diagnosis when assessing patients presenting with acute pain of the forefoot localised to a single joint or tendon. We present two cases of young women involved in amateur running and martial arts respectively who presented with acute pain of their forefoot.

Case Description: These 2 cases describe a 44 year old amateur female runner and 23 year old female martial arts athlete who presented with acute onset of pain affecting the dorsal aspect of their great toe interphalangeal joint and base of 1st metatarsal respectively. Both patients had tender erythematous swellings at the site of pain and difficulty weightbearing. Plain radiography revealed areas of calcification at the respective sites which was confirmed with ultrasound. Both patients underwent US guided corticosteroid injections with significant symptom improvement within 48 hours of injections and rapid return to sport.

Discussion: These two cases demonstrate an atypical presentation of acute calcific tendinitis affecting the forefoot and add two more cases to the reported literature. Combining the characteristic clinical presentation of acute pain affecting a tendon or joint with a tender erythematous swelling on examination with the typical radiographic features of calcification can promptly diagnose this often misdiagnosed condition and avoid unnecessary investigations. Conservative treatment and intralesional injection with corticosteroids can lead to rapid resolution and favourable patient outcomes.

Keywords: Calcific tendinitis; Calcific periarthritis; Foot


Calcific tendinitis is a disorder of uncertain aetiology characterised by the deposition of calcium hydroxyapatite crystals in any tendon of the body [1-2]. The rotator cuff tendons are most commonly affected with the prevalence of radiographic calcific tendinitis in the shoulder being 2.7% [2]. The majority of patients are healthy and middle aged with case collections demonstrating twice as many women as men being affected [4]. Foot involvement is relatively uncommon. It typically affects the tendons around the plantar aspect of the first metatarsophalangeal joint with young women predominantly affected [5]. It less commonly affects the peroneus longus or tibialis posterior tendon.

A comprehensive literature review revealed relatively few cases of forefoot calcific tendinitis [6-12]. There has only been one published case in the English literature to the best of our knowledge of calcific tendinitis affecting the extensor aspect of the great toe [13]. In this case series, we present two cases of young women who presented with acute calcific tendinitis of the forefoot affecting the dorsal aspect of the great toe and base of 1st metatarsal respectively.

Case Presentation

Case 1

A 44-year-old woman with no known medical problems presented to the emergency department with a 24-hour history of sudden onset pain and swelling affecting the dorsal aspect of her right great toe interphalangeal joint. The pain and swelling came on suddenly following a run the previous day. She was an otherwise healthy patient with no previous history of pain, surgery or injury to the foot. She was an avid amateur athlete running on average 50km weekly. She was unable to weight bear on her foot in the emergency department.

On clinical examination there was notable erythema and swelling extending from the dorsal aspect of her first MTP joint along her great toe to the distal phalanx. It was associated with pain on palpation and passive extension and flexion of her great toe MTP joint and interphalangeal joint elicited pain.

A plain radiograph of the foot (Figure 1) demonstrated an area of calcification medial to the first interphalangeal joint which was confirmed as calcific periarthritis on US (Figure 2). The patient underwent US guided injection with 10mg Depo-Medrol mixed with 0.25% Marcaine. She reported significant improvement in symptoms within 48 hours and returned to light running 7 days later and normal activities at 14 days. A repeat x-ray 3 months later revealed complete resolution of the area of calcification (Figure 3) and the patient remained asymptomatic.