Forefoot pain

Red Flag

• If red/hot distal foot with or without collapse which cannot be explained by gout or superficial skin infection > refer to on call surgeons urgently

 

Management

• Screen for neuropathy, especially if diabetic
• Conservative measures

o        1/3 of patients improve with footwear & calf stretch exercises.

o        Referral to podiatry may help those not responding

• Steroid injection (blind / USS guided) for mortons neuroma – trial of 1 injection

o        Further 1/3 of patients respond to this

• USS request on usual USS form direct to RCHT radiology department
• If no or minimal response to injection and significant pain refer to surgeons

Mortons neuroma is not always seen on USS, equally it can be an incidental finding. If unsure about the diagnosis and patient has pain referral may be appropriate.

 

 

The routine excision of simple ganglia is not indicated

Surgery for ganglion of the will only be funded for patients who have:

• Persistent pain (i.e. pain without spontaneous resolution within 1 to 2 years) or
• SFI* or
• Evidence of nerve compression."

*Significant functional impairment is defined as a loss or absence of an individual’s capacity to meet personal, social or occupational demands. Please provide examples of the impairment the individual is experiencing.’