Tennis Player with Forefoot Pain (Neuroma)

I. Athlete & Injury Overview:

• Athlete: 32-year-old high-level tennis player (competitive amateur).

• Injury: Morton's neuroma (3rd intermetatarsal space), chronic forefoot pain.

• Biomechanics: Excessive pronation, forefoot loading, rapid lateral movements, repetitive impact.

• Footwear: High-performance tennis shoes (clay/hard court).

II. Podiatric Assessment & Treatment:

• Assessment: Palpable tenderness and Mulder's click in the 3rd intermetatarsal space, splaying of the forefoot, gait analysis showing increased forefoot pressure. Mild fat pad atrophy in forefoot with heavy callus pattern sub 1stMTPJ and pinch calluses on the hallux. Ultrasound: confirmed neuroma.

• Treatment: Corticosteroid injection, physical therapy (stretching, strengthening), custom orthotics, footwear modification.

• Timeline: 2 weeks relative rest, gradual return to court with modified training and orthotics.

III. Product Innovation & Recommendations:

• Footwear: Wider toe box tennis shoes with reinforced toe box, metatarsal relief padding within the shoe.

• Orthotics:

  • Custom orthotics with a metatarsal pad positioned proximal to the neuroma, deep heel cup, and forefoot cushioning. Poron or similar shock-absorbing material for the forefoot, rigid polypropylene shell for stability. EVA top cover for low friction.

• Management: Targeted exercises to improve foot intrinsic muscle strength and flexibility, biomechanical analysis of court movement patterns to reduce forefoot stress. Gradual return to training, modified court surfaces, proper warm-up and cool-down routines.

IV. Performance & Prevention:

• Return: Gradual return to play, monitoring pain levels.

• Prevention: Regular foot stretching and strengthening, proper footwear selection, orthotic use, biomechanical analysis of movement.

• Performance: Orthotics and footwear modifications to reduce pain and improve court agility

• Longterm: Great potential. Avoid barefoot and flipflops.