MR Imaging of the Forefoot: Morton Neuroma and Differential Diagnoses

ABSTRACT

Magnetic resonance (MR) imaging of Morton neuromas is highly accurate. Morton neuromas are more conspicuous when the patient is prone positioned and the foot is plantar flexed than in the supine position with the toes pointing upward. MR imaging of Morton neuromas has a large influence on the diagnostic thinking and treatment plan of orthopedic foot surgeons. The most common differential diagnoses include intermetatarsal bursitis, stress fractures, and stress reactions. Some diagnoses (nodules associated with rheumatoid arthritis, synovial cyst, soft tissue chondroma, and plantar fibromatosis) are rare and can be diagnosed with histologic correlation only.

KEYWORDS

MR imaging - forefoot; neuroma - bursitis - stress fracture

REFERENCES

• 1 Morton T. A peculiar and painful affection of the fourth metatarsal-phalangeal articulation.  Am J Med Sci. 1876;  71 37-45
• 2 Rubin D A, Towers J D, Britton C A. MR imaging of the foot: utility of complex oblique imaging planes.  AJR Am J Roentgenol. 1996;  166 1079-1084
• 3 Erickson S J, Rosengarten J L. MR imaging of the forefoot: normal anatomic findings.  AJR Am J Roentgenol. 1993;  160 565-571
• 4 Mann R A, Baxter D E. Diseases of the nerves. In: Mann RA, Coughlin MJ Surgery of the Foot and Ankle. Vol 1. St. Louis; Mosby-Year Book 1993: 543-573
• 5 Theumann N H, Pfirrmann C W, Chung C B et al.. Intermetatarsal spaces: analysis with MR bursography, anatomic correlation, and histopathology in cadavers.  Radiology. 2001;  221 478-484
• 6 Zanetti M, Ledermann T, Zollinger H, Hodler J. Efficacy of MR imaging in patients suspected of having Morton's neuroma.  AJR Am J Roentgenol. 1997;  168 529-532
• 7 Zanetti M, Strehle J K, Kundert H-P, Zollinger H, Hodler J. MR imaging for suspected Morton's neuroma: effect on diagnostic thinking and therapeutic decisions.  Radiology. 1999;  213 583-588
• 8 Amis J A. Primary interdigital neuroma resection. In: Johnson KA The Foot and Ankle. New York; Raven Press 1994: 163-177
• 9 Beskin J L. Primary and salvage procedures for Morton's interdigital neuroma. In: Myerson M Current Therapy in Foot and Ankle surgery. St. Louis; Mosby-Year Book 1994: 183-187
• 10 Sharp R J, Wade C M, Hennessy M S, Saxby T S. The role of MRI and ultrasound imaging in Morton's neuroma and the effect of size of lesion on symptoms.  J Bone Joint Surg Br. 2003;  85 999-1005
• 11 Frank P W, Bakkum B W, Darby S A. The communicating branch of the lateral plantar nerve: a descriptive anatomic study.  Clin Anat. 1996;  9 237-243
• 12 Viladot A. The metatarsals. In: Jahss MH Disorders of the Foot and Ankle. Vol 2. Philadelphia; WB Saunders 1991: 1229-1268
• 13 Biasca N, Zanetti M, Zollinger H. Outcomes after partial neurectomy of Morton's neuroma related to preoperative case histories, clinical findings, and findings on magnetic resonance imaging scans.  Foot Ankle Int. 1999;  20 568-575
• 14 Zanetti M, Strehle J, Zollinger H, Hodler J. Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers.  Radiology. 1997;  203 516-520
• 15 Redd R A, Peters V J, Emery A F, Branch H M, Rifkin M D. Morton neuroma: sonographic evaluation.  Radiology. 1989;  171 415-417
• 16 Bencardino J, Rosenberg Z S, Beltran J, Liu X, Marty-Delfaut E. Morton's neuroma: is it always symptomatic?.  AJR Am J Roentgenol. 2000;  175 649-653
• 17 Weishaupt D, Treiber K, Kundert H P et al.. Morton neuroma: MR imaging in prone, supine, and upright weight-bearing body positions.  Radiology. 2003;  226 849-856
• 18 Bossley C J, Cairney P C. The intermetatarsophalangeal bursa-its significance in Morton's metatarsalgia.  J Bone Joint Surg Br. 1980;  62-B 184-187
• 19 Chauveaux D, Le Huec J C, Midy D. The supra-transverse intermetatarsocapital bursa: a description and its relation to painful syndromes of the forefoot.  Surg Radiol Anat. 1987;  9 13-18
• 20 Awerbuch M S, Shephard E, Vernon-Roberts B. Morton's metatarsalgia due to intermetatarsophalangeal bursitis as an early manifestation of rheumatoid arthritis.  Clin Orthop Relat Res. 1982;  167 214-221
• 21 Erickson S J, Canale P B, Carrera G F et al.. Interdigital (Morton) neuroma: high-resolution MR imaging with a solenoid coil.  Radiology. 1991;  181 833-836
• 22 Ashman C J, Klecker R J, Yu J S. Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging.  Radiographics. 2001;  21 1425-1440
• 23 Weinfeld S B, Haddad S L, Myerson M S. Metatarsal stress fractures.  Clin Sports Med. 1997;  16 319-338
• 24 Chowchuen P, Resnick D. Stress fractures of the metatarsal heads.  Skeletal Radiol. 1998;  27 22-25
• 25 Schweitzer M E, White L M. Does altered biomechanics cause marrow edema?.  Radiology. 1996;  198 851-853
• 26 Haller J, Sartoris D J, Resnick D et al.. Spontaneous osteonecrosis of the tarsal navicular in adults: imaging findings.  AJR Am J Roentgenol. 1988;  151 355-358
• 27 Zanetti M, Steiner C L, Seifert B, Hodler J. Clinical outcome of edema-like bone marrow abnormalities of the foot.  Radiology. 2002;  222 184-188
• 28 Yamamoto T, Bullough P G. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture.  J Bone Joint Surg Am. 2000;  82 858-866
• 29 el-Noueam K I, Giuliano V, Schweitzer M E, O'Hara B J. Rheumatoid nodules: MR/pathological correlation.  J Comput Assist Tomogr. 1997;  21 796-799
• 30 De Beuckeleer L, De Schepper A, De Belder F et al.. Magnetic resonance imaging of localized giant cell tumour of the tendon sheath (MRI of localized GCTTS).  Eur Radiol. 1997;  7 198-201
• 31 Jelinek J S, Kransdorf M J, Shmookler B M, Aboulafia A A, Malawer M M. Giant cell tumor of the tendon sheath: MR findings in nine cases.  AJR Am J Roentgenol. 1994;  162 919-922
• 32 Sherry C S, Harms S E. MR evaluation of giant cell tumors of the tendon sheath.  Magn Reson Imaging. 1989;  7 195-201
• 33 Wicke C, Grober J, Pereira P L, Adler C P, Maurer F. Soft tissue chondromatosis of the foot: diagnosis and therapy [in German].  Chirurg. 2001;  72 193-195
• 34 Bansal M, Goldman A B, DiCarlo E F, McCormack R. Soft tissue chondromas: diagnosis and differential diagnosis.  Skeletal Radiol. 1993;  22 309-315
• 35 Zlatkin M B, Lander P H, Begin L R, Hadjipavlou A. Soft-tissue chondromas.  AJR Am J Roentgenol. 1985;  144 1263-1267
• 36 Robbin M R, Murphey M D, Temple H T, Kransdorf M J, Choi J J. Imaging of musculoskeletal fibromatosis.  Radiographics. 2001;  21 585-600
• 37 Yoshida S, Shidoh M. Plantar fibromatosis.  Postgrad Med J. 2003;  79 158