A 70-year-old woman is evaluated for pain in the left great toe that has been present for 5 years and has steadily worsened. The pain is exacerbated by standing for long periods and wearing shoes with higher heels. At times the toe becomes inflamed, and throbbing pain may persist throughout the day and night. Oral and topical NSAIDs do not help. She is otherwise well and takes no medications. Findings on physical examination are shown. No palpable masses or interdigital clicks are observed when the foot is compressed.

Which of the following is the most likely diagnosis?

A Avascular necrosis of the metatarsal head

B Bunion

C Morton neuroma

D Stress fracture

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