PDF herunterladen
Semin Musculoskelet Radiol 2023; 27(03): 337-350
DOI: 10.1055/s-0043-1764388
Review Article

Differential Diagnosis of Metatarsalgia

P. Diana Afonso
1   Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
2   Radiology Department, Hospital Particular da Madeira, Grupo HPA, Funchal, Portugal
,
Sabrina Veras Britto
3   Radiology Department, Clinica Radiológica Luiz Felippe Mattoso, Gupo Fleury, Rio de Janeiro, Brazil
,
Charles E. Spritzer
4   MSK Division, Radiology Department, Duke University Medical Center, Durham, North Carolina
,
Patrícia Martins e Souza
3   Radiology Department, Clinica Radiológica Luiz Felippe Mattoso, Gupo Fleury, Rio de Janeiro, Brazil
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Lesser (or central) metatarsalgia is defined as pain in the forefoot under or around the lesser metatarsals and their respective metatarsophalangeal joints. Two common causes of central metatarsalgia are Morton's neuroma (MN) and plantar plate (PP) injury. Because both clinical and imaging features overlap, establishing the correct differential diagnosis may be challenging. Imaging has a pivotal role in the detection and characterization of metatarsalgia. Different radiologic modalities are available to assess the common causes of forefoot pain, so the strengths and weakness of these imaging tools should be kept in mind. It is crucial to be aware of the pitfalls that can be encountered in daily clinical practice when dealing with these disorders. This review describes two main causes of lesser metatarsalgia, MN and PP injury, and their differential diagnoses.

Keywords

plantar plate - Morton's neuroma - magnetic resonance imaging - ultrasonography - metatarsophalangeal joints

Supplementary Material



Publikationsverlauf

Artikel online veröffentlicht:
25. Mai 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Hodes A, Umans H. Metatarsalgia. Radiol Clin North Am 2018; 56 (06) 877-892
    CrossrefPubMedGoogle Scholar
  • 2 Umans RL, Umans BD, Umans H, Elsinger E. Predictive MRI correlates of lesser metatarsophalangeal joint plantar plate tear. Skeletal Radiol 2016; 45 (07) 969-975
    CrossrefPubMedGoogle Scholar
  • 3 Besse JL. Metatarsalgia. Orthop Traumatol Surg Res 2017; 103 (1S): S29-S39
    CrossrefPubMedGoogle Scholar
  • 4 Ganguly A, Warner J, Aniq H. Central metatarsalgia and walking on pebbles: beyond Morton neuroma. AJR Am J Roentgenol 2018; 210 (04) 821-833
    CrossrefPubMedGoogle Scholar
  • 5 Umans H, Srinivasan R, Elsinger E, Wilde GE. MRI of lesser metatarsophalangeal joint plantar plate tears and associated adjacent interspace lesions. Skeletal Radiol 2014; 43 (10) 1361-1368
    CrossrefPubMedGoogle Scholar
  • 6 Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. J Am Acad Orthop Surg 2010; 18 (08) 474-485
    CrossrefPubMedGoogle Scholar
  • 7 Mann TS, Nery CAS, Baumfeld D, Fernandes EÁ. Degenerative injuries of the metatarsophalangeal plantar plate on magnetic resonance imaging: a new perspective. Einstein (Sao Paulo) 2022; 20: eAO6543
    CrossrefPubMedGoogle Scholar
  • 8 McCarthy CL, Thompson GV. Ultrasound findings of plantar plate tears of the lesser metatarsophalangeal joints. Skeletal Radiol 2021; 50 (08) 1513-1525
    CrossrefPubMedGoogle Scholar
  • 9 Park CH, Chang MC. Forefoot disorders and conservative treatment. Yeungnam Univ J Med 2019; 36 (02) 92-98
    CrossrefPubMedGoogle Scholar
  • 10 Mainard D. The second ray syndrome: detailed pathological, clinical and therapeutic aspects. Eur J Orthop Surg Traumatol 1997; 7: 159-164
    CrossrefPubMedGoogle Scholar
  • 11 Son HM, Chai JW, Kim YH. et al. A problem-based approach in musculoskeletal ultrasonography: central metatarsalgia. Ultrasonography 2022; 41 (02) 225-242
    CrossrefPubMedGoogle Scholar
  • 12 Nery C, Coughlin MJ, Baumfeld D, Mann TS, Yamada AF, Fernandes EA. MRI evaluation of the MTP plantar plates compared with arthroscopic findings: a prospective study. Foot Ankle Int 2013; 34 (03) 315-322
    CrossrefPubMedGoogle Scholar
  • 13 Nery C, Umans H, Baumfeld D. Etiology, clinical assessment, and surgical repair of plantar plate tears. Semin Musculoskelet Radiol 2016; 20 (02) 205-213
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 14 Bhatia D, Myerson MS, Curtis MJ, Cunningham BW, Jinnah RH. Anatomical restraints to dislocation of the second metatarsophalangeal joint and assessment of a repair technique. J Bone Joint Surg Am 1994; 76 (09) 1371-1375
    CrossrefPubMedGoogle Scholar
  • 15 Duan X, Li L, Wei DQ. et al. Role of magnetic resonance imaging versus ultrasound for detection of plantar plate tear. J Orthop Surg Res 2017; 12 (01) 14
    CrossrefPubMedGoogle Scholar
  • 16 Linklater JM, Bird SJ. Imaging of lesser metatarsophalangeal joint plantar plate degeneration, tear, and repair. Semin Musculoskelet Radiol 2016; 20 (02) 192-204
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 17 Fernandes EA, Mann TS, Puchnick A. et al. Can ultrasound of plantar plate have normal appearance with a positive drawer test?. Eur J Radiol 2015; 84 (03) 443-449
    CrossrefPubMedGoogle Scholar
  • 18 Coughlin MJ, Schutt SA, Hirose CB. et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int 2012; 33 (02) 133-140
    CrossrefPubMedGoogle Scholar
  • 19 Galley J, Sutter R, Germann C, Pfirrmann CWA. The Vulcan salute sign: a non-sensitive but specific sign for Morton's neuroma on radiographs. Skeletal Radiol 2022; 51 (03) 581-586
    CrossrefPubMedGoogle Scholar
  • 20 Mann TS, Nery C, Baumfeld D, Fernandes EA. Is second metatarsal protrusion related to metatarsophalangeal plantar plate rupture?. AJR Am J Roentgenol 2021; 216 (01) 132-140
    CrossrefPubMedGoogle Scholar
  • 21 Albright RH, Brooks BM, Chingre M, Klein EE, Weil Jr LS, Fleischer AE. Diagnostic accuracy of magnetic resonance imaging (MRI) versus dynamic ultrasound for plantar plate injuries: a systematic review and meta-analysis. Eur J Radiol 2022; 152: 110315
    CrossrefPubMedGoogle Scholar
  • 22 Bignotti B, Signori A, Sormani MP, Molfetta L, Martinoli C, Tagliafico A. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol 2015; 25 (08) 2254-2262
    CrossrefPubMedGoogle Scholar
  • 23 Lee MJ, Kim S, Huh YM. et al. Morton neuroma: evaluated with ultrasonography and MR imaging. Korean J Radiol 2007; 8 (02) 148-155
    CrossrefPubMedGoogle Scholar
  • 24 Santiago FR, Muñoz PT, Pryest P, Martínez AM, Olleta NP. Role of imaging methods in diagnosis and treatment of Morton's neuroma. World J Radiol 2018; 10 (09) 91-99
    CrossrefPubMedGoogle Scholar
  • 25 Nery C, Baumfeld D, Umans H, Yamada AF. MR imaging of the plantar plate: normal anatomy, turf toe, and other injuries. Magn Reson Imaging Clin N Am 2017; 25 (01) 127-144
    CrossrefPubMedGoogle Scholar
  • 26 Mohana-Borges AV, Theumann NH, Pfirrmann CW, Chung CB, Resnick DL, Trudell DJ. Lesser metatarsophalangeal joints: standard MR imaging, MR arthrography, and MR bursography--initial results in 48 cadaveric joints. Radiology 2003; 227 (01) 175-182
    CrossrefPubMedGoogle Scholar
  • 27 Mendicino RW, Statler TK, Saltrick KR, Catanzariti AR. Predislocation syndrome: a review and retrospective analysis of eight patients. J Foot Ankle Surg 2001; 40 (04) 214-224
    CrossrefPubMedGoogle Scholar
  • 28 Gregg J, Silberstein M, Schneider T, Marks P. Sonographic and MRI evaluation of the plantar plate: a prospective study. Eur Radiol 2006; 16 (12) 2661-2669
    CrossrefPubMedGoogle Scholar
  • 29 Klontzas ME, Koltsakis E, Kakkos GA, Karantanas AH. Ultrasound-guided treatment of Morton's neuroma. J Ultrason 2021; 21 (85) e134-e138
    CrossrefPubMedGoogle Scholar
  • 30 Di Caprio F, Meringolo R, Shehab Eddine M, Ponziani L. Morton's interdigital neuroma of the foot: a literature review. Foot Ankle Surg 2018; 24 (02) 92-98
    CrossrefPubMedGoogle Scholar
  • 31 Bhatia M, Thomson L. Morton's neuroma—current concepts review. J Clin Orthop Trauma 2020; 11 (03) 406-409
    CrossrefPubMedGoogle Scholar
  • 32 Zanetti M, Weishaupt D. MR imaging of the forefoot: Morton neuroma and differential diagnoses. Semin Musculoskelet Radiol 2005; 9 (03) 175-186
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 33 Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E. Morton's neuroma: is it always symptomatic?. AJR Am J Roentgenol 2000; 175 (03) 649-653
    CrossrefPubMedGoogle Scholar
  • 34 Xu Z, Duan X, Yu X, Wang H, Dong X, Xiang Z. The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton's neuroma: a systematic review. Clin Radiol 2015; 70 (04) 351-358
    CrossrefPubMedGoogle Scholar
  • 35 Mak MS, Chowdhury R, Johnson R. Morton's neuroma: review of anatomy, pathomechanism, and imaging. Clin Radiol 2021; 76 (03) 235.e15-235.e23
    CrossrefPubMedGoogle Scholar
  • 36 Puri A. Morton's neuroma. J Foot Ankle Surg 2020; 7 (02) 46-49
    PubMedGoogle Scholar
  • 37 Frank PW, Bakkum BW, Darby SA. The communicating branch of the lateral plantar nerve: a descriptive anatomic study. Clin Anat 1996; 9 (04) 237-243
    CrossrefPubMedGoogle Scholar
  • 38 Claassen L, Bock K, Ettinger M, Waizy H, Stukenborg-Colsman C, Plaass C. Role of MRI in detection of Morton's neuroma. Foot Ankle Int 2014; 35 (10) 1002-1005
    CrossrefPubMedGoogle Scholar
  • 39 Weishaupt D, Treiber K, Kundert HP. et al. Morton neuroma: MR imaging in prone, supine, and upright weight-bearing body positions. Radiology 2003; 226 (03) 849-856
    CrossrefPubMedGoogle Scholar
  • 40 Thomson CE, Beggs I, Martin DJ. et al. Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. J Bone Joint Surg Am 2013; 95 (09) 790-798 , S1
    CrossrefPubMedGoogle Scholar
  • 41 Mahadevan D, Attwal M, Bhatt R, Bhatia M. Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial. Bone Joint J 2016; 98-B (04) 498-503
    CrossrefPubMedGoogle Scholar
  • 42 Makki D, Haddad BZ, Mahmood Z, Shahid MS, Pathak S, Garnham I. Efficacy of corticosteroid injection versus size of plantar interdigital neuroma. Foot Ankle Int 2012; 33 (09) 722-726
    CrossrefPubMedGoogle Scholar
  • 43 Deutsch AL, Coel MN, Mink JH. Imaging of stress injuries to bone. Radiography, scintigraphy, and MR imaging. Clin Sports Med 1997; 16 (02) 275-290
    CrossrefPubMedGoogle Scholar
  • 44 Zanetti M, Strehle JK, Zollinger H, Hodler J. Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers. Radiology 1997; 203 (02) 516-520
    CrossrefPubMedGoogle Scholar
  • 45 Ashman CJ, Klecker RJ, Yu JS. Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging. Radiographics 2001; 21 (06) 1425-1440
    CrossrefPubMedGoogle Scholar
  • 46 Dakkak YJ, Niemantsverdriet E, van der Helm-van Mil AHM, Reijnierse M. Increased frequency of intermetatarsal and submetatarsal bursitis in early rheumatoid arthritis: a large case-controlled MRI study. Arthritis Res Ther 2020; 22 (01) 277
    CrossrefPubMedGoogle Scholar
  • 47 Rosskopf AB, Loupatatzis C, Pfirrmann CWA, Böni T, Berli MC. The Charcot foot: a pictorial review. Insights Imaging 2019; 10 (01) 77
    CrossrefPubMedGoogle Scholar
  • 48 Van Hul E, Vanhoenacker F, Van Dyck P, De Schepper A, Parizel PM. Pseudotumoural soft tissue lesions of the foot and ankle: a pictorial review. Insights Imaging 2011; 2 (04) 439-452
    CrossrefPubMedGoogle Scholar
  • 49 Giard MC, Pineda C. Ganglion cyst versus synovial cyst? Ultrasound characteristics through a review of the literature. Rheumatol Int 2015; 35 (04) 597-605
    CrossrefPubMedGoogle Scholar
  • 50 Weishaupt D, Schweitzer ME, Morrison WB, Haims AH, Wapner K, Kahn M. MRI of the foot and ankle: prevalence and distribution of occult and palpable ganglia. J Magn Reson Imaging 2001; 14 (04) 464-471
    CrossrefPubMedGoogle Scholar
  • 51 Barros MV, Labropoulos N. Plantar vein thrombosis—evaluation by ultrasound and clinical outcome. Angiology 2010; 61 (01) 82-85
    CrossrefPubMedGoogle Scholar
  • 52 Bernathova M, Bein E, Bendix N, Bodner G. Sonographic diagnosis of plantar vein thrombosis: report of 3 cases. J Ultrasound Med 2005; 24 (01) 101-103
    CrossrefPubMedGoogle Scholar