Imaging of the Painful Forefoot

Abstract

Imaging of the painful forefoot has advanced rapidly in the previous 20 years, with the development of magnetic resonance (MR) imaging and dynamic musculoskeletal ultrasound (MSKUS). Each modality has its strengths and weaknesses, as outlined later. Diagnoses are made at the time of the MSKUS scan and images are taken to demonstrate any abnormality, whereas MR diagnoses are made from a predetermined series of image sequences. Musculoskeletal ultrasound has the advantage of clinical input, whereas MR images are more anatomical and show areas MSKUS cannot, such as joints and bone marrow. Whatever the modality used, a comprehensive request form with all relevant clinical information will aid radiologists in their assessment. Plain x-rays are also considered mandatory for all patients being imaged.

Diagnostic Value of Elastography in the Diagnosis of Intermetatarsal Neuroma

“…2). Previous studies have reported interdigital nerves within neuromas (39); however, we could not visualize nerves using US. Edema, axonal degeneration, and fibrosis can affect echogenicity and elasticity.…”

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“…In cases of interdigital neuroma, an increased transverse relaxation time (T2) signal, greater calibration, and increased contrast uptake may be seen on MRI due to the affected interdigital nerve. Some authors have also reported a relationship between neuroma and the interdigital nerve (Simmons, 2008;Waizy et al, 2010). The term "target sign" is used for central hypointense and peripheral hyperintense-looking round tumors derived from neural tissue (Bhargava et al, 1997).…”

Role of imaging methods in diagnosis and treatment of Morton’s neuroma

“…The extruding content may be formed by the MN and/or the bursa. It is theorized that the click will only happen when there is a MN because a thickened bursa is much more pliable than a neuroma[ 16 ]. As both entities may coexist, we can complete the US scan with another maneuver that will help in differentiating between MN and bursal tissue.…”