lesser metatarsalgia

lesser metatarsalgia

pain (due to a range of causes) in lesser metatarsals area, affecting any tissue within that area (see Table 1)
Table 1: Presentations of metatarsalgia
Form of metatarsalgiaType/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
• Neoplasm
Bone pathologies
• Stress/march fracture
• Osteochondritis (Freiberg's infraction; sesamoid osteochondritis)
• Sesamoid pathologies
Systemic disease
• Rheumatoid disease
• Autoimmune disease
• Osteoarthritis
• Ankylosing spondylitis
• Connective tissue diseases
• Reactive arthritides
• Sero-negative arthritides
Others
• Back pain
• Paget's disease
• Obesity
• Infection
• Neoplasm
Table 2: Presentations of nerve trunk irritation in the foot
Neuroma/lesionInvolved nerveLocation
Proximal tarsal tunnel syndromeBranches of the posterior tibial nerveMedial ankle area
Distal tarsal tunnel syndrome Jogger's footMedial plantar nerveBetween navicular tuberosity and belly of abductor hallucis
Distal tarsal tunnel syndrome Baxter's neuritisLateral plantar nerveBetween bellies of abductor hallucis, quadratus plantae and abductor digiti quinti minimi
Joplin's neuromaMedial plantar nerve properMedial area of first metatarsal head
Houser's neuromaFirst plantar intermetatarsal nerveBetween 1 and 2 metatarsals
Heuter's neuromaSecond plantar intermetatarsal nerveBetween 2 and 3 metatarsals
Morton's neuromaThird plantar intermetatarsal nerveBetween 3 and 4 metatarsals
Islen's neuromaFourth plantar intermetatarsal nerveBetween 4 and 5 metatarsals
Mentioned in ?