Metatarsalgia
Differential Diagnosis
Stress fracture
Interdigital neuroma
MTP joint synovitis
Plantar wart
Plantar keratosis
Make a diagnosis!
Interdigital Neuroma (Syn. Morton's Neuroma)
Fibrosis of the digital nerve in the 3,4 interspace - not truly a neuroma
Typical history
Characteristic site of pain
Sensory abnormalities on the adjacent toes
Mulder's click unreliable
Diagnostic Injection
Interdigital Neuroma - Treatment
- Insole – three quarter length with metatarsal dome
- Injection steroid and local - 12% cure rate (Kitaoka)
- Surgery 85% success (Johnson)
Stress Fractures of the Foot and Ankle
Long history since described in 1855 Prussian soldiers before x-Ray
Most common in metatarsals 2,3,4 because of lack of mobility
History and examination characteristic
Plain x-rays usually normal
The defining moment of the bone scan
Stress Fractures - Stages
- Stress response (Pre-failure)
- Microfracture (Symptoms)
- Infraction (x-ray changes)
Stress Fractures Of The Foot And Ankle - Treatment
Protected weight-bearing is important
I prefer the patient to non-weight bear initially
Question of underlying bone density arises in menopausal females
Advice regarding surfaces and shoes