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)
J Foot Ankle Surg. 2009;48:230-272.
