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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

  1. Insole – three quarter length with metatarsal dome
  2. Injection steroid and local - 12% cure rate (Kitaoka)
  3. 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
  1. Stress response (Pre-failure)
  2. Microfracture (Symptoms)
  3. 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

 

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