If it’s not Morton’s neuroma, then what could it be?
Differential diagnosis for Morton’s neuroma
The vast majority of referrals that I get from primary care for evaluation of forefoot pain are referred for a suspected Morton’s neuroma. Interestingly, not many of these referrals actually have Morton’s neuroma. So if it’s not Morton’s neuroma, what could the source of the pain be? Let’s take a look at the differential diagnosis for Morton’s neuroma.
First, we have to qualify this patient and rule out a history of lumbar pain or peripheral vascular disease. Referred pain from lumbar disc disease and critical limb ischemia (poor circulation) can also contribute to forefoot pain. But in this case, we’re referring to a young and otherwise healthy individual. And the pain that we’re referring to does not involve the great toe joint. We’re talking pain behind the 2-5th toes.
Other than Morton’s neuroma, what foot conditions can be the source of forefoot pain? Here’s a list of possible problems.
- Fat pad atrophy
- Foreign body injury
- Forefoot callus
- Tarsal tunnel syndrome
- Plantar plate tear
- Freiberg’s infraction
By far, the most common problem that I see in the office that causes forefoot pain is capsulitis. Capsulitis will usually be found in the ball of the foot under the second toe. The symptoms of capsulitis increase when going barefoot and are relieved with the use of a shoe.
The other conditions listed should be ruled out when evaluating forefoot pain. Be sure to follow the link for more information on each condition.