In a case of foot pain worsened by shoes, which diagnosis is indicated by tenderness between the third and fourth metatarsal heads?

Tenderness between the third and fourth metatarsal heads is a classic finding associated with Morton's neuroma, which is a compression neuropathy of the digital nerves that can occur between the metatarsal bones, most commonly affecting the nerve between the third and fourth toes. Patients often report worsening pain when wearing tight shoes or engaging in activities that place pressure on the forefoot.

The intense pain can also lead to a sensation of burning or tingling in the associated toes. The diagnosis is often confirmed by palpation of the affected area, which reproduces the symptoms, and potentially by imaging studies or ultrasound that may reveal a thickened nerve, though the clinical presentation alone is usually sufficient for a diagnosis.

While options like plantar fasciitis and metatarsal fractures can cause foot pain, their specific presentations and mechanisms differ. Plantar fasciitis typically presents with heel pain that is worse in the morning, and fingertip tenderness is not localized to the metatarsal heads but rather along the arch of the foot. A metatarsal fracture would usually show localized swelling and possible deformity, as well as acute painful response to motion or weight-bearing. Interdigital neuroma might suggest a broader range of nerve involvement,