Intermetatarsal Neuromas are associated with acute sharp pain to the bottom of the foot and are most commonly seen between the 2nd and 3rd metatarsal bones or between 3rd and 4th metatarsal bones.
A classic cause of forefoot pain is the inner metatarsal neuroma a neuroma means tumor of the nerve it’s not a nerve tumor but what happens between the metatarsals is that the common digital nerve will become scarred and inflamed causing symptoms of radiation tingling burning sharp shooting knife-like or lacinating pain very classically what we see is neuroma in a
Location between the third and the fourth metatarsal as well as the second and the third metatarsal the classic morton’s neuroma is pain that occurs between the third and fourth metatarsal or what we call the third inner space as we’re identifying important anatomy what we’re actually seeing is this is identification of the fourth metatarsal this is identification
Of the third metatarsal and the pain that originates in between those metatarsals up into the web space is very classic so when we squeeze the metatarsals oftentimes we’ll get a clicking or popping which is called a molder’s click but definitely pain will radiate in between the toes or back from the foot as we do this palpation maneuver this classic change in
The toe position is considered sullivan sign not everyone with the neuroma will actually have a change in the position but what we see is we see this split between the third and the fourth toe for this third inner space neuroma and we can compare this split to the uninvolved side on the right foot to show the difference why people develop neuroma has a lot to
Do with the mechanics of the foot during walking or heel and the ball of the foot are the high load bearing areas of the foot the heel which is one bone takes the impact during walking the ball of the foot essentially has five contact points we’ve got the fifth fourth third second and first metatarsal so direct pressure as we lead our foot into propulsion where
We’re lifting our heels off the ground can increase pressure causing nerve damage side to side pressure or narrowness of the shoes can create pinching of the metatarsals and then intrinsic motion that occurs or the sharing motion that occurs between the metatarsals is the third component or potential source of irritation and trauma to the nerve how we treat
People with inner metatarsal neuroma is to really reduce pressure through the ball of the foot and we use a condition specific orthotic which is an arch support with built-in intrinsic padding and we see this plastic shell orthotic with this poron metatarsal padding and what that does is it’ll displace or reduce pressure through the ball of the foot and the
Metatarsal padding itself will actually help separate the metatarsals which will decrease pressure through the nerve other forms of treatment for inner metatarsal neuroma is in fact anti-inflammatory ice oral anti-inflammatories and cortisone cortisone generally is considered a gold standard of care to help decrease the inflammation of the nerve if cortisone
Fails oftentimes we’ll use dilute alcohol injections to create scarring and create dysfunction to the nerve to help relieve pain outside of conservative measures we also look at surgery as an option for people who failed this but classic treatment is using a shoe and orthotic to help reduce pressure as well as decreasing that side to side pressure on the nerve
Again inner metatarsal neuroma is definitely pain in between the metatarsals and not pain directly on the metatarsals and it’s not associated with swelling on top of the foot
Transcribed from video
Intermetatarsal Neuroma: Causes, Diagnosis, and Treatment By SLO Motion Shoes