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-wieght bear initially
Question of underlying bone density arises in menopausal females
Advice regarding surfaces and shoes