Table 1 The expert derived clinical assessment protocol for the diagnosis of forefoot neuroma
Theme | Delphi Recommendation | Number of Votes (out of 16) |
|---|---|---|
Location of Pain | Pain located in the 2nd or 3rd inter metatarsal space | 9 |
Forefoot pain reported by patient | 7 | |
Patient Reported Symptoms | Paraesthesia radiating distally in the toes. | 14 |
Pins and needles reported by the patient | 12 | |
Shooting pain reported by the patient | 12 | |
Burning sensations reported by the patient | 15 | |
Clicking reported by the patient | 5 | |
Weight Bearing Sensation | Walking on pebbles/lump/stone reported by the patient | 9 |
Separating the metatarsal heads e.g. met dome, padding, off the shelf insoles ease symptoms | 7 | |
Shoe style: tight fitting/narrow aggravate pain symptoms reported by the patient | 10 | |
Observations | On palpation of joint margins no pain reported by the patient | 6 |
Diastasis of toes | 5 | |
No pain on movement of joint | 6 | |
No swelling | 5 | |
Tests | Diagnostic LA (plus/minus steroid injection) | 8 |
Tenderness/pain reported by patient on palpation of inter metatarsal space (usually 2nd/3rd) | 12 | |
Mulders Click (One hand is clasped around the foot at the level of the metatarsal heads. Whilst compression of the hand around the metatarsal heads the thumb of the contralateral hand exerts firm pressure on the sole of the foot at the site of the suspected forefoot neuroma. The test is considered positive if a palpable click was felt) | 15 | |
Pain reported by patient on lateral compression of the forefoot | 11 | |
Pain on squeezing metatarsal heads (lateral and direct compression) | 11 | |
Imaging | Ultrasound | 16 |
X-ray (rule out other pathology) | 11 |