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Foot and ankle radiology
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
US is the imaging modality of choice in identifying Morton's neuroma, which has an equal sensitivity to MRI (22). Morton's neuroma appears as a hypoechoic well-defined lesion that is seen along the expected course of the plantar interdigitial nerve. Sonographic Mulder sign can be elicited by compressing the metatarsal heads whilst the US probe is placed along the plantar surface of the symptomatic webspace (Figure 22.29). When metatarsal heads are compressed, Morton's neuroma is displaced towards the US probe with the characteristic click and this may reproduce the symptoms.
Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Intermetatarsal (Morton’s) neuroma – is an inflammatory swelling between the metatarsal heads that produces pain on walking, which can often be replicated by lateral compression of the distal foot (Mulder’s sign). The diagnosis can be confirmed by ultrasound with lateral or dorsal compression of the foot, demonstrating an ill-defined hypoechoic lesion between the metatarsal heads that pops out on the plantar surface during pressure. Ultrasound-guided steroid injection can be administered once the diagnosis is confirmed. Alternative diagnoses such as intermetatarsal bursitis may also be suggested. MRI with contrast can achieve the same results but is a more complex test and cannot be used to guide injection.
Management of acute lesser toe pain
Published in Postgraduate Medicine, 2021
Jessyca Ray, Nicholas A. Andrews, Aseel Dib, Whitt M. Harrelson, Ankit Khurana, Maninder Shah Singh, Ashish Shah
Pain associated with interdigital neuroma is not located under the metatarsal heads like metatarsalgia, but instead it is found in the interdigital space [24]. Various provocative maneuvers can be performed to attempt to illicit or recreate the patient’s pain. Mulder’s sign is the most specific provocative test for interdigital neuroma. This maneuver involves compressing the forefoot and intermetatarsal space at the same time. Mulder’s sign is positive if the interdigital neuroma is forced out of the intermetatarsal space with a click and elicits pain [8,22,24].