History
The primary symptom of metatarsalgia is pain at 1 or more of the metatarsal heads. [6, 7, 8, 9] Diffuse forefoot pain and midfoot pain are often present in athletes with combinations of high-impact inflammatory conditions. [2, 3]
The pain is typically aggravated during the mid-stance and propulsion phases of walking or running.
A history of a gradual, chronic onset is more common than an acute presentation. Chronic symptoms may be of gradual onset over 6 months.
A Morton neuroma (interdigital neuroma) produces symptoms of metatarsalgia due to irritation and inflammation of the digital nerve located in the web space between the metatarsal heads. Patients with a Morton neuroma may complain of toe numbness in addition to pain in the forefoot. The term Morton neuroma is a misnomer because no neuroma truly exists. Rather, the lesion results from a mechanical entrapment neuropathy. (See also the Medscape Reference articles Physical Medicine and Rehabilitation for Morton Neuroma and Surgery for Morton Neuroma.)
Physical Examination
Palpable point tenderness at the distal end of the plantar metatarsal fat pad is a typical finding.
Pain and tenderness are experienced on the plantar surface of the metatarsal head, which is often accompanied by the development of a callus formation (plantar keratosis). (See also the Medscape Reference article Intractable Plantar Keratosis.)
Absence of pain in the interdigital space helps the clinician assess for the presence of a neuroma.
Patients with an interdigital neuroma have maximal tenderness between the web spaces.
Loss of sensation may be present in the adjacent toes.
In patients with interdigital neuromas, the pain is usually aggravated by the metatarsal squeeze test. Compression between the metatarsal heads may produce a painful click, known as a Mulder sign.
