Review Question - QID 218565

Figure A is the radiograph of a 55-year-old male who presents to your office for 6 week's follow-up for his right great toe. Last you saw him, he was diagnosed with degenerative disease of the first MTP joint. At that time you prescribed a Morton extension insole that extended just under the great toe. The patient continues to report pain in the first MTP joint that is worse with walking. He works as a construction manager and is constantly walking job sites at work. On exam, his pain remains on the dorsum of the hallux with pain during extreme dorsiflexion. He has no mid-range pain. Which of the following is the best next step in treatment?