Intermetatarsal Bursitis - MSK Radiology
Imaging Findings:
• T2-hyperintense fluid-like signal and T1-hypointense signal between the first and second metatarsal heads.
• The fluid-like signal is dorsal to the INTERMETATARSAL LIGAMENT along the plantar surface. This signal does not extend into the plantar surface.
Case description:
• This patient had chronic plantar pain which is exacerbated during training for marathon and localized to the first and second metatarsal heads.
• Clinical concern was for stress fracture.
• Has peripheral enhancement not shown (neuromas centrally enhance). If <3mm could be physiologic.
• The MRI shows fluid-like signal within the first intermetatarsal space which DOES NOT extend plantar to the intermetatarsal ligament (orange arrows).
Differential diagnosis:
• Morton neuroma
- Isointense to slightly hyperintense relative to muscle on T1-weighted MR images.
- Iso- or hypointense to fat on T2-weighted images with poor conspicuity.
- Contrast useful! Will intensely enhance increasing conspicuity of the lesion.
• Metatarsal stress fracture
- Band of low-signal intensity on both T1- and T2-weighted sequences with surrounding marrow edema-like signal.
• Plantar plate injury
- Most commonly 2nd MTP joint. Increased signal in/around the plantar plate on T2-sequence or a focal defect.
Dr. Donald von Borstel @DrvonBorstel
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