A 30 year old presented with complaints of pain on the ball of the right foot. There was no trauma to the area and the pain had progressively been getting worse.
There was greater discomfort and pain with prolonged standing and when walking.
They had long feet and the right 2nd toe was dorsiflexed and dislocated. The pain was worse when wearing tight shoes.
Performing an ultrasound of the forefoot indicted a large 2nd intermetatarsal neuroma as well as a second plantar plate tear.
Ultrasound image of a normal plantar plate (left side) and a plantar plate with a tear (right side)
Ultrasound image of the neuroma in the 2nd intermetatarsal space
For the plantar plate treatment options include:
- Digital taping to hold the toe straight
- Budin Loop Splints to hold the toe straight
- Metatarsal domes to offload the forefoot (reduced pressure on the plantar plate.
- Custom made Orthotics with a metatarsal dome incorporated into the design to offload the forefoot (reducing the pressure on the plantar plate)
- Shoe stretching and modification
For the neuroma treatment options include:
- Reducing the size of the mass
- Injection therapy (alcohol or cortisone)
- Radiofrequency Nerve Ablation (RFA)
- Offloading the forefoot to prevent irritation of the nerve
- Orthotics with a metatarsal dome
- Shoes with a stiffer forefoot
A trial injection of the neuroma with local anaesthetic completely eliminated the pain, it was determined that the neuroma was the main cause of the discomfort. The neuroma was reinjected with cortisone and orthotics were made to offload the forefoot. This completely resolved the pain.
If there was no resolution or the pain remained a small concentration of 100% alcohol can be injected for the neuroma.