Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, sharp, burning pain in the left forefoot, specifically localized to the third intermetatarsal space. Symptoms are exacerbated by weight-bearing and wearing narrow, tight-fitting footwear. Patient reports a sensation of "walking on a pebble" or "wrinkled sock" under the foot. No history of acute trauma. Pain is relieved by removing footwear and massaging the forefoot.
Clinical Examination Findings
Physical examination of the left foot reveals localized tenderness at the third intermetatarsal space. Mulderโs click is positive upon lateral compression of the metatarsal heads. No erythema, edema, or skin lesions noted. Sensation is intact in the toes, though paresthesia is elicited with direct palpation of the intermetatarsal space. Gait analysis shows antalgic pattern favoring the lateral aspect of the foot.
Treatment Protocol
Conservative management initiated: recommendation for wider toe-box footwear and metatarsal pad placement to offload the intermetatarsal space. Prescription of NSAIDs for inflammation control as needed. Discussion regarding corticosteroid injection if symptoms persist. Referral for orthotic consultation to address biomechanical factors.