Differential Diagnosis for Pain over the Plantar Aspect of the Head of the First Metatarsal
- Single most likely diagnosis
- Sesamoiditis: This condition is characterized by inflammation of the sesamoid bones or the tendons surrounding them, located under the first metatarsal head. It is a common cause of pain in this area, especially with activities that put pressure on the ball of the foot, such as walking.
- Other Likely diagnoses
- Morton's neuroma: Although more commonly associated with pain between the toes, a neuroma can sometimes cause pain that radiates to the plantar aspect of the foot, including the area over the first metatarsal head.
- Bursitis: Inflammation of the bursae around the first metatarsal head can cause pain in this area, especially with pressure or walking.
- Metatarsalgia: This is a general term for pain in the ball of the foot, which can be caused by various factors including poor foot mechanics, overuse, or ill-fitting shoes.
- Do Not Miss diagnoses
- Osteomyelitis or septic arthritis: Although less common, infections in the bones or joints of the foot can cause severe pain and have serious consequences if not promptly treated.
- Gout: Acute gouty arthritis can cause intense pain in the foot, often starting in the big toe and potentially radiating to adjacent areas.
- Deep vein thrombosis (DVT): While DVT typically presents with swelling and pain in the calf, in rare cases, it can cause pain in the foot, especially if the clot is located more distally.
- Rare diagnoses
- Freiberg's disease: A rare condition characterized by avascular necrosis of the metatarsal head, which can cause pain in the ball of the foot.
- Kohler's disease: A rare bone disorder causing pain and swelling in the foot, typically affecting the navicular bone but potentially causing referred pain to the area over the first metatarsal head.
- Tarsal tunnel syndrome: Compression of the posterior tibial nerve can cause pain, numbness, and tingling in the foot, including the area over the first metatarsal head, although this is less common.