High-Resolution Ultrasound of the Forefoot and Common Pathologies

Abstract

Forefoot pain is common in clinical practice. Careful history taking and routine physical examination are initially performed for diagnosis, but imaging can confirm the clinical suspicion and play a key role in management. Ultrasound (US) can provide a visualization of the fine anatomy of the forefoot and is a useful method for evaluating various lesions causing forefoot pain. In this review, we provide the detailed anatomical structures of the forefoot and their normal appearances on US. We also focus on the most common pathologies affecting the forefoot, including plantar plate tear, sesamoiditis, bone fracture, synovitis, tenosynovitis, bursitis, Morton’s neuromas, and foreign bodies.

First Metatarsophalangeal Joint Pain in Athletes: Diagnosis, Management, and Return to Play Considerations

“…Ultrasonography of turf toe will demonstrate a hypoechoic defect in the plantar plate and may be better visualized during dynamic testing. Figure by Chen et al (8) is licensed under Creative Commons BY.…”

“…Stress fractures can appear as cortical buckling with a surrounding hypoechoic callus (17) (Fig. 3) (8). Ultrasound is not the best modality for evaluating osteonecrosis, but later stages with collapse of bone may demonstrate discontinuity of the subchondral bone (18).…”

“…Ultrasonography can demonstrate interruption of the cortex (arrows) of the sesamoid and soft tissue swelling (arrowheads), which is suggestive of a sesamoid stress fracture. Figure by Chen et al (8) is licensed under Creative Commons BY.…”

Top 15 musculoskeletal lesions in the aging recreational sporter: a pictorial review

“…Morton's fibroma consists of a perineural thickening surrounding the digital nerve of the foot typically occurring at the third web space and more rarely at the second web space, usually in response to irritation, trauma, or excessive pressure. Although Morton's fibroma is often designated as an interdigital neuroma, this is a misnomer as the lesion does not represent a true neuroma but a pseudotumoral reactive fibrous lesion around the interdigital nerve (40).…”

“…The presence of continuity with the plantar digital nerve can improve diagnostic confidence (40). On MRI, the lesion is most often isointense to muscle on T1-WI and hypointense to mixed on T2-WI.…”