Last evidence check April 2010

Look for evidence of systemic disease especially:

Examination must begin proximally

Always screen the patient for diabetes - a urine test is usually enough

This will usually indicate one or more possible factors which may be contibuting to forefoot pain. Differential injections around interdigital nerves and into MTP joints may help distinguish between MTP synovitis and interdigital neuralgia (although at least 10% of patients with each of these conditons also has the other) (Miller 2001). In the end it often requires experience-based judgement to decide which factors should be tackled and in what order.