Differential Diagnosis for Metatarsalgia and Morton's Neuroma

When differentiating between metatarsalgia and Morton's neuroma, it's crucial to consider a range of potential diagnoses to ensure accurate treatment and management. The following categories help organize the differential diagnosis:

• Single Most Likely Diagnosis
  • Morton's neuroma: This condition is characterized by a thickening of the tissue around the nerve leading to the toes, often causing pain, numbness, or tingling, particularly between the third and fourth toes. The symptoms can mimic metatarsalgia, making it a primary consideration in the differential diagnosis.
• Other Likely Diagnoses
  • Metatarsalgia: This refers to pain in the ball of the foot, which can be caused by various factors including overuse, poor foot mechanics, or footwear issues. It's essential to distinguish between metatarsalgia and Morton's neuroma, as treatments may differ.
  • Plantar fasciitis: Inflammation of the plantar fascia can cause pain in the heel and the ball of the foot, potentially mimicking the symptoms of metatarsalgia or Morton's neuroma.
  • Sesamoiditis: Inflammation of the tendons surrounding the sesamoid bones can cause pain under the first metatarsal bone, which might be confused with metatarsalgia.
• Do Not Miss Diagnoses
  • Stress fracture: A fracture in one of the metatarsal bones can cause severe pain in the ball of the foot, similar to metatarsalgia or Morton's neuroma. Missing this diagnosis could lead to further injury or complications.
  • Infection (e.g., osteomyelitis or septic arthritis): Infections in the foot can cause severe pain and require immediate medical attention to prevent serious complications.
  • Tumor: Although rare, a tumor in the foot could cause pain and other symptoms similar to metatarsalgia or Morton's neuroma, making it a critical diagnosis not to miss.
• Rare Diagnoses
  • Freiberg's disease: A rare condition causing avascular necrosis of the metatarsal head, leading to pain in the ball of the foot.
  • Kohler's disease: A rare bone disorder causing pain and swelling in the foot, typically affecting children.
  • Peripheral neuropathy: Damage to the peripheral nerves can cause a variety of symptoms, including pain, numbness, or tingling in the feet, which might be mistaken for metatarsalgia or Morton's neuroma.

Each of these diagnoses has distinct characteristics and requires careful consideration to ensure an accurate diagnosis and appropriate treatment plan.