The London Podiatry Centre would agree with the consensus of opinion that a neuroma between the 1st and 2nd or the 4th and 5th metatarsals/toes is rare. This is because the space between these toes and adjacent metatarsals is fairly large and there is therefore less chance of nerve entrapment. However, whilst there is little to no published literature on the presence of such neuromas, they can and do occur!

The London Podiatry Centre has encountered at least two instances where neuromas have formed between the 4th and 5th metatarsals/toes. This was prior to the introduction of cryosurgery and the neuromas were treated successfully through surgical excision. The diagnosis was confirmed by means of histopathology.

The Centre has also seen patients with interdigital neuromas between the 1st and 2nd metatarsals/toes. In a more recent case the diagnosis was confirmed by means of ultrasound and MRI scan and the patient responded very positively to cryosurgery. In previous cases the author has encountered neuroma formation from specific activities which can cause a shearing stress between the 1st and 2nd metatarsals/toes and in one particular instance this was caused by surfing.

In conclusion, patients should be aware that interdigital neuromas can form between less frequent locations such as the 4th and 5th or 1st and 2nd metatarsals/toes. The symptoms would be similar to that of other neuromas but the distribution of pain will be the effected toes.