Advanced Foot And Ankle Center Of San Diego

Experienced Medical and Surgical Care Of The Foot And Ankle

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Offices in La Jolla and Poway - View Locations

It is Not a Neuroma

So You have been treated for a neuroma for a year now. You have had injections and spent money on orthotics and even went for physical therapy. You ask why am I not getting better. Because it is NOT a neuroma.

There are other causes of pain in the forefoot. Too often all forefoot pain is categorized as neuroma. Other conditions to consider are capsulitis, which is an inflammation of ligaments that surrounds two bones, at the level of the joint. In this case it would be the ligaments that attach the phalanx (bone of the toe) to the metatarsal bone. Inflammation from this condition will put pressure on an otherwise healthy nerve and give neuroma type symptoms. Additionally, an intermetatarsal bursitis between the third and fourth metatarsal bones will also give neuroma type symptoms because it too puts pressure on the nerve. Freiberg’s disease, which is anosteochondritis of the metatarsal head, causes pain on weight bearing or compression. And last but not least the most common missed diagnosis a Plantar plate capsule tear.

PLANTAR PLATE CAPSULE TEAR

The best way to diagnose this problem is with a special MRI called an MR arthrogram. I have worked closley with radiologists in San Diego developing the best technique for this exam.

Plantar plate dislocation

Plantar plate dislocation

Arthrogram with MRI

Arthrogram with MRI

Notice the dye leaking out of the joint

Notice the dye leaking out of the joint

MRI showing Plantar plate tear

MRI showing Plantar plate tear

SURGICAL REPAIR OF THE PLANTAR PLATE

plantar approach

plantar approach

Dorsal Approach

Dorsal Approach

Dorsal Approach

Dorsal Approach

Dorsal Approach

Dorsal Approach