Neuromas may form in a plantar digital nerve, usually proximal to its bifurcation. These neuromas may occur in any of the digital nerves but are most common in the third interspace. The cause of these lesions is thought to be local irritation of the nerve due to entrapment, usually from tight-fitting shoes. Women between the ages of 25 and 50 years are the most commonly affected group. Patients present with pain located in the area of the metatarsal head. The pain is described as burning, cramping, or aching. Pain is worsened by ambulation and resolved by rest and removal of shoes. The pain may radiate to the affected toes, and patients may note numbness in the toes. Pain is usually easily reproduced upon palpation of the area, and at times a mass is felt. Diagnosis is usually made clinically, but nerve conduction studies, electromyograms, ultrasound studies, and MRI may be helpful at times. Conservative treatment consists of wearing wide shoes with good metatarsal head supports and metatarsal head off-loading inserts. Local glucocorticoid injections can be curative. Conservative therapy is often unsuccessful, and patients may ultimately require neurolysis or surgical intervention. 2 32
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