metatarsalgia(redirected from Mortons metatarsalgia Mortons neuroma)
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metatarsalgia/meta·tar·sal·gia/ (-tahr-sal´jah) pain and tenderness in the metatarsal region.
tailor’s bunionInflammation of the 5th metatarsal at the base of the little toe; named after the seated position of tailors who sat cross-legged, compressing a pressure point of the little toe that corresponded to the site of inflammation.
• Intrinsic—due to congenital bone defects, which is distinctly rare.
• Extrinsi—caused by footwear that puts pressure on the 5th metatarsal.
Pain over the lateral base of the fifth toe; if extreme and prolonged, the skin may ulcerate.
Padded and/or wider shoes; surgery is a last resort.
metatarsalgiaOrthopedics Pain of the forefoot at the plantar aspect of the metatarsal head DiffDx Neuroma, intermetatarsal bursitis Defects causing excess local pressure Depressed metatarsal, elongated metatarsal with abnormal metatarsal parabola, ↓ plantar fat pad, accessory sesamoids, overpronation with hypermobile first ray Management ↓ pressure under affected metatarsal head, metatarsal pads to unload metatarsal, arch supports or orthotics, Spenco insoles to ↓ shear forces and pad, thick, curved midsole–rocker-bottom–shoes to ↓ forces under the metatarsals
metatarsalgiaPain in the long bones of the foot (METATARSALS).
metatarsalgiapain under the metatarsal heads in the foot as a result of abnormal foot shape, intense training or overuse, altered biomechanics or poorly fitting shoes. Stress fracture should be excluded by X-ray, though this can be negative initially. Treatment initially is with rest and analgesia but aims to reverse the cause, avoid overweight and encourage good well-fitting supportive shoes. orthoses can be helpful. Morton's metatarsalgia (Morton's neuroma) painful neuralgia caused by a neuroma on a digital nerve, most commonly that supplying the third toe cleft. Symptoms include pain and tingling in the two adjacent toes. In sport, most common in those where repetitive weight-bearing is a feature. The condition is exacerbated by ill-fitting shoes, so treatment is targeted to assess footwear and relieve pressure locally. Surgery may be required in resistant cases. (Named after the American surgeon who described it in 1876.)
metatarsalgia; M non-specific term denoting forefoot pain, in the metatarsal area (Table 1)
exercise-related metatarsalgia athletics-induced M, associated with pes cavus, forefoot equinus or a protracted propulsive phase of gait (compensatory foot movements cause forefoot overload, and resultant bone and soft-tissue stress)
greater metatarsalgia first-ray M
lesser metatarsalgia lesser-rays (2-5) M
|Form of metatarsalgia||Type/characteristics|
|Functional metatarsalgia (forefoot pain due to inherent local structural defect)||• Unusual metatarsal formula|
• Loss of normal forefoot joint mobility
• Local metatarsus equinus ± associated toe deformity (hammer, claw, retraction, trigger deformity)
• Iatrogenic change (e.g. hallux abductovalgus/foot surgery)
• Loss/atrophy of plantar fibrofat pad
• Rigid pes cavus
• Fixed plantarflexed ray
• Fixed-toe deformity
• Subluxation of a metatarsophalangeal joint
• Localized metatarsal equinus
• Generalized joint hypermobility
|Non-functional metatarsalgia (forefoot pain due to forefoot, foot or limb pathology or systemic disease)||Soft-tissue pathologies|
• Focal plantar hyperkeratosis
• Connective tissue pathology, e.g. plantar fibromatosis, plantar plate rupture
• Synovial pathology, e.g. ganglion, adventitious bursitis, capsulitis, gouty tophus, rheumatoid bursae and nodules
• Vascular pathology, e.g. ischaemia, venous and lymphatic insufficiency
• Neurological problems, e.g. sensory dysfunction, nerve entrapment, Morton's neuroma/neuritis (see Table 2)
• Muscular pathology
• Stress/march fracture
• Osteochondritis (Freiberg's infraction; sesamoid osteochondritis)
• Sesamoid pathologies
• Rheumatoid disease
• Autoimmune disease
• Ankylosing spondylitis
• Connective tissue diseases
• Reactive arthritides
• Sero-negative arthritides
• Back pain
• Paget's disease
|Proximal tarsal tunnel syndrome||Branches of the posterior tibial nerve||Medial ankle area|
|Distal tarsal tunnel syndrome Jogger's foot||Medial plantar nerve||Between navicular tuberosity and belly of abductor hallucis|
|Distal tarsal tunnel syndrome Baxter's neuritis||Lateral plantar nerve||Between bellies of abductor hallucis, quadratus plantae and abductor digiti quinti minimi|
|Joplin's neuroma||Medial plantar nerve proper||Medial area of first metatarsal head|
|Houser's neuroma||First plantar intermetatarsal nerve||Between 1 and 2 metatarsals|
|Heuter's neuroma||Second plantar intermetatarsal nerve||Between 2 and 3 metatarsals|
|Morton's neuroma||Third plantar intermetatarsal nerve||Between 3 and 4 metatarsals|
|Islen's neuroma||Fourth plantar intermetatarsal nerve||Between 4 and 5 metatarsals|