Differential Diagnosis for Pain in the Second Metatarsal

Single Most Likely Diagnosis

• Morton's Neuroma: This condition is characterized by a benign neuroma of an intermetatarsal plantar nerve, most commonly between the third and fourth metatarsals but can also occur between the second and third. It causes pain, numbness, and tingling in the forefoot, especially with pressure or weight-bearing activities. The second metatarsal area is a common location for this condition due to the high pressure and stress it endures during walking and running.

Other Likely Diagnoses

• Stress Fracture: A stress fracture in the second metatarsal bone can cause pain in this area. Stress fractures are small cracks in a bone, often caused by overuse and repetitive stress. The second metatarsal is one of the most common sites for stress fractures in the foot due to its role in bearing weight and facilitating movement.
• Metatarsalgia: This term refers to pain in the ball of the foot, which can be caused by various factors including poor foot mechanics, overuse, or ill-fitting shoes. The second metatarsal head is a common area for metatarsalgia due to its prominent position and the pressure it receives during activities.
• Capsulitis of the Second Metatarsophalangeal Joint: Inflammation of the joint capsule surrounding the second metatarsophalangeal joint can cause pain and stiffness in the area. This condition is often related to overuse, poor foot mechanics, or trauma.

Do Not Miss Diagnoses

• Osteomyelitis or Septic Arthritis: Although less common, infections such as osteomyelitis (bone infection) or septic arthritis (joint infection) in the area of the second metatarsal can present with pain and require urgent medical attention to prevent serious complications.
• Tumor: Both benign and malignant tumors can occur in the bones of the foot, including the second metatarsal. While rare, it's crucial to consider this possibility to ensure timely diagnosis and treatment.

Rare Diagnoses

• Freiberg's Disease: A rare condition characterized by avascular necrosis of the metatarsal head, most commonly the second. It typically affects adolescents and can cause pain in the forefoot.
• Kohler's Disease: A rare bone disorder causing pain and swelling in the foot, typically affecting the navicular bone but can occasionally involve other bones including the metatarsals. It's more common in children.