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  • Intermetatarsal disorder
  • Morton’s metatarsalgia
  • Plantar nerve lesion

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  • 355.6 Lesion of plantar nerve

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  • G57.6 Lesion of plantar nerve
  • G57.60 Lesion of plantar nerve, unspecified lower limb

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

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Description

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  • Painful condition that affects the ball of the foot
  • Growth of scar tissue from chronic irritation of compression
  • Most common area is between the 3rd and 4th toes, but also can be in between the 2nd and 3rd toes
  • Involves a thickening of the tissues (neuroma) around one of the intermetatarsal plantar nerves
  • Branches from the medial and lateral plantar nerves
  • May alter mechanics during the push-off phase of gait

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Essentials of Diagnosis

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  • Can be an independent diagnosis and not associated with a disease process
  • Characterized by numbness, burning, and pain
  • Sometimes relieved by removing shoes
  • No visible deformity
  • Higher risk for individuals with bunions and flat feet

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General Considerations

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  • Feeling like you are stepping on something like a pebble
  • A burning pain in the ball of the foot that radiates to the toes
  • Tingling or numbness in the toes
  • Titled a neuroma, but is not a tumor formation as “oma”

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Demographics

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  • Ladies wearing high heels
  • Rock climbers with repetitive forefoot pressure

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Signs and Symptoms

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  • Burning pain in the ball of the foot
  • Numbness and tingling in the toes, especially between the 3rd and 4th toes
  • Difficulty wearing/finding shoes, especially pointy ones
  • Limited motion of the MTP joint

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Functional Implications

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  • Pain with standing
  • Pain with ambulation at the toe
  • Inability to wear regular shoes
  • Need to wear larger shoes with a larger toe box
  • Alteration of gait pattern and mechanical issues of the forefoot

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Possible Contributing Causes

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  • Poor footwear: improper fit
    • Toe comes to a point (boots)
    • Narrow forefoot (high heels)
  • Certain sports
    • Repetitive trauma from high-impact activities, such as jogging or running
    • Those requiring tight shoes, such as snow skiing or rock climbing
  • Foot deformities: bunions, hammer toes, flat feet, excessive flexibility

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Differential Diagnoses

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  • Metatarsalgia
  • Metatarsal stress fracture
  • Capsulitis
  • Synovitis
  • Stress fracture
  • Tendinitis
  • Degenerative arthritis
  • Bursitis
  • Lumbar radiculopathy
  • Freiburg’s disease: osteochondritis of the metatarsal head

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Imaging

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  • X-ray
  • Diagnostic ultrasound
  • MRI

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Diagnostic Procedures

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  • Mulder’s Sign (Pinch Test)2: Lateral squeezing of the forefoot with one hand and the opposite hand pushing up on the nerve

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  • Rule out fracture
  • Reveal soft tissue abnormalities
  • Mulder’s Sign2: A positive test is a click or snap at the nerve with severe pain

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Medication

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  • Anti-inflammatories
  • Corticosteroid injection

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