Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with localized burning pain, paresthesia, and a sensation of "walking on a pebble" in the right 3rd intermetatarsal space. Symptoms are exacerbated by tight-fitting footwear and weight-bearing activities, and are relieved by rest and removal of shoes. No history of trauma or systemic neuropathy.
Clinical Examination Findings
Right foot examination reveals positive Mulderโs click upon lateral compression of the 3rd and 4th metatarsal heads. Tenderness is elicited upon direct palpation of the 3rd intermetatarsal space. No erythema, edema, or skin lesions noted. Distal neurovascular status is intact with normal capillary refill and palpable pedal pulses.
Treatment Protocol
Conservative management initiated: transition to wide-toe-box footwear, metatarsal pad application for offloading, and activity modification. NSAIDs prescribed for pain management. If refractory, consider corticosteroid injection or referral for surgical excision.