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Hi I have a patient who develops excruciating pain (sharp, sounds like nerve pain) in the medial side left 4th digit when wearing skiing boots or hiking boots so much so he has to remove the boots during activity. He is OK in everyday fooware.
The Skiing boots are bespoke, as he thought that this might resolve the problem. On palpation there is discomfort in the soft tssue on the dorsum of the foot at the 3rd and 4th tendon space. There is no pain on the planter aspect. Am I to treat this like a neuroma and use a mortons dome to open the space up. The ski boots come with a bespoke orthotic and would be simple to modify.
Please does anybody have any suggestions
Thankyou
PodsDog​

 

I would start by treating it as a Mortons Nuerome.
Get some imaging done.

 

Hi Craig Thankyou for that! What do you think a differential diagnosis could be? Have you come across this yourself?

 

I also stick a toe spacer or a piece of adhesive scf 6 mm between the 3/4 toes to make some more space. Neuroma / neuritis / bursitis.

 

Hey without pain ! Neuritis bursitis of course! thanks for that. Pt has gone on trip but will definately look into that as af ollow up! Thanks