Forefoot symptoms



Digital deformities

  • Congenital or acquired (± painful)
  • Medially = hammertoe and crossover toe (painful and contribute to pain from secondary corns / calluses)
  • Other toes = hammertoe, claw toe, and mallet toe.
  • Hammertoe = contractures causing - extension at MPJ, flexion at PIPJ, hyperextension at DIPJ
  • Crossover toe = contractures causing - extension & medial subluxation at 2nd MPJ.

Initial treatment = non-surgical

  • Sensible footwear padding, orthotics, shoe insoles,
  • Occasionally debridement of assoc. hyperkeratosis, steroid injection if bursitis
  • Rarely ortho referral for - tenotomy / tendon lengthening / capsular release / phalangeal head resection etc (GP to refer )

Metatarsalgia (pain in the ball of the foot)

  • Pain in the ball of the foot, ± swelling ± discoloration
  • DDx - MT stress #, capsulitis (arthritic), avascular necrosis, tumour, foreign body, or infection.

Treatment

  • Metatarsal padding, orthotics, NSAIDs
  • Surgery (GP referral) very rarely

Morton's neuroma.

This frequently encountered form of nerve compression is often described by patients as a "lump" on the bottom of the foot or as the sensation of walking on a rolled-up or wrinkled sock.

  • Compression neuropathy of the common digital nerve (usually 3rd)
  • Sensation of lump under sole of foot
  • Clinical Dx
  • Treat to reduce pressure on nerve - wider shoes, no stilettos, metatarsal pads
  • Occasionally local steroid or B12 injection around neuroma

Bunionettes (tailors bunion)

Although most bunions (hallux valgus) affect the big toe, a similar joint deformity may affect the little toe.

  • Clinical diagnosis
  • Plantar lateral prominent head little MT
  • Pain worse wearing shoes
  • Treat with proper footwear, padding, NSAIDs, steroid injection

Traumatic injury

  • Significant force (e.g. crush) = X-rays indicated.
  • Undisplaced fractures = immobilization (most displaced fractures / dislocations need Orthopaedic intervention)
  • Beware compartment syndrome
    • High energy or crush with pain ++
    • Swelling ++
    • Mottled skin ± altered sensation)


Content by Dr Íomhar O' Sullivan 29/03/2009. Last reviewed Dr ÍOS 16/12/19.