Other Causes of Forefoot Pain
Here are some other conditions that can generate foot pain symptoms very similar to those of Mortonís neuroma, and sometimes these conditions can be mistaken for Mortonís neuroma.
- Metatarsalgia - (pain and inflammation of the metatarsal bones and their soft tissue sheath)
Pain is often felt when the metatarsal shaft is gently palpated. Metatarsalgia can be associated with over training and increasing your running mileage too soon, and can be a sign of impending metatarsal stress fracture.
- Metatarsal Stress Fracture - Patients with metatarsal stress fracture experience sharp intense pain on palpation of the metatarsal shaft, rather than the metatarsal interspace.
- Capsulitis - (pain and inflammation of the joints between the metatarsal bones and toes)
Pain is often experienced on the underside of the ball of the foot when the metatarsal head is gently palpated. Capsulitis is now thought by some to be strongly implicated in the formation of Mortonís neuroma. This is because the inflamed swollen joint capsules impinge and compress the interdigital nerves thus leading to the formation of neuroma.
- Radiculopathy - A term used to describe a problem with nerves where the problem is at or near the root of the nerve in the spine but symptoms are often felt further away at the other end of the nerve through a process called referred pain. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot. Often when radiculopathy is present a simple test known as a straight leg raise will reproduce neuroma like symptoms in the foot. If you have a history of back pain you should ask your clinician to consider radiculopathy as a potential cause of your foot pain.
- Tarsal Tunnel Syndrome - One of the main nerves of the foot can become compressed as it passes through a anatomical tunnel in the ankle. In such cases patients can experience symptoms similar to Mortonís neuroma, such as burning and tingling in the forefoot. A simple clinical test called the Tinelís test can be used to evaluate for tarsal tunnel syndrome. The test involves tapping the tibial nerve below the ankle, a positive test produces tingling in the forefoot.
- Tendonitis - inflammation of the tendons which run along the top of the foot.
- Dislocation - of a joint between a metatarsal and a toe (metatarsal-phalangeal joint)
- Severe Plantar Callus - (hard skin known as callus on bottom of the foot)
The hard skin or callus can exert pressure onto the nerve above causing neuroma like symptoms. Such patients should see a Podiatrist and have the callus removed. If the callus is causing the pain the relief should be instant.
- Bursitis - A Bursa is an inflamed fluid-filled sack, often between a bone and an area of pressure, or between the metatarsal heads. Interdigital bursa can often compress the interdigital nerve, generating similar symptoms to Mortonís neuroma. Frequently, bursa are seen wrapped around a Mortonís neuroma, in such cases Cryosurgery will treat the bursa as well as the neuroma.