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A sixty six year old lady has been complaining of metatarsal pain which is helped by enclosing the foot in lace up shoes and on examination does not seem to be a Morton's neuroma. A metatarsal pad seems to offer no relief. There is swelling and pain on palpation but not when the toes are pressed together. Do you think that Ibuprofen gel might help? What could I do to resolve her problem?

 

Could you possibly give some more info? E.g.
Which metatarsal (s) are effected? Bilateral? Any history of trauma or an increase of activity? Does it hurt all the time? Any relevant medical history?

 

The pain is more towards the first metatarsal, only in one foot and it comes on suddenly as a searing pain at rest, e.g. when in bed or in the evening when sitting. It is a sharp pain that makes her want to rub the foot and it lasts 15-20 seconds. There has been no trauma or increased activity. It is better if she wears lace up supportive shoes and she now thinks that the met support might be helping a little.
It is a mystery. Can you solve it?
I suspect a nerve pain. But what can be done about it if it is?

 

hi sorry for the long reply, only just read this blog.
You may well now have dx but my opinion is nerve pain from the symptoms you describe. However being close to the 1st met I would order a x-ray AP and a axial sesamoid view and see what is happening around this joint to cause the nerve irritation.
cheers

 

I have seen a 1/2 met neuroma. Try ultrasound examination as well as X-ray.

All the best

Bill