Hi,
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I have a 34yo woman with left forefoot pain at area of 3/4MTP joints.
Assesment shows bilateral pronation L>R. Left HAV. Good ROM of lesser MTP joints -no pain on joint movement. Minor lateral deviation of 4th digit. "Click" elicited on compression and traction of 3rd digit.
I have been treating this as mortons neuroma including orthotic therapy for improving medial and transverse arches.
Follow up 4 weeks later showed no improvement to pain levels. Orthotics were comfortable and pt was compliant with treatment. Small increase in 4th digit deviation on weight bearing. No increase on pain on palpation.
I sent for ultrasound which found ' no evidence of morton's neuroma', 'no evidence of bursitis', 'flexor tendons and sheaths are normal', 'Small joint effusion at the 3rd MTP joint may indicate the presence of some synovitis'.
Any ideas on further treatment or references would be appreciated. I haven't seen this before.
Thanks
SRD
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