Plantar Fasciitis/Nodular Fasciitis Morton Neuroma/Bursa Plantar ...

Plantar Foot Pathology:
Plantar Fasciitis/Nodular Fasciitis
Morton Neuroma/Bursa
David Fessell, MD
University of Michigan
Ann Arbor, Michigan, USA
• Plantar Fasciitis
• Plantar Fibromatosis
• Morton’s Neuroma/Bursa
• Foreign bodies
Recommend: Jeswani T, Morlese J, McNally EG,
Clinical Radiology 2009, 64:931-39
Plantar Fasciitis:
Plantar Fasciitis:
• Overuse
– seronegative arthritis
• > 4 mm, hypoechoic
• Tender on palpation
• +/- Hyperemia
Fasciitis
• Versus MRI:
– Sensitivity 80%
– Specificity 89%
Fasciitis
Sabir N, J US Med 24:1041
Jeswani T, Clin Rad 64:931
Sabir N, J US Med 24:1041
normal
Plantar Fibromatosis:
--Usually hypoechoic
-- +/- hyperemia
Plantar Fibromatosis:
Solid mass in continuity with the plantar fascia:
From C. Brandon, MD
1

Plantar Fibromatosis:
Plantar Fibromatosis:
calcaneus
Differential Diagnosis:
– Muscle/fat lesions
– Foreign body
– Xanthoma (Achilles)
– Plantar fascial tear
• Hx trauma and tear/fluid
at US
transverse
-- Assess for: location/surrounding infiltration further eval.
Associations: Palmar and superficial fibromatosis
Men > women
Griffith JF, AJR 179:1167
Jeswani T, Clin Rad 64:931
Morton’s Neuroma
• Often a clinical Dx
• US helpful in:
– Atypical cases
– Multiple neuromas
– Bursitis vs. neuroma
• Location: most
common 2d and 3d web
space
Morton’s Neuroma
• US appearance:
hypoechoic/anechoic
• Assess for continuity
with interdigital nerve
• US/MR comparable
accuracy
Khoury V, Sem Mus Rad 11:149
trv
long
Khoury V, Sem Mus Rad 11:149
Images from M. Brigido, MD
Intermetatarsal Bursitis
Intermetatarsal Bursitis
• Compresses with transducer pressure
• Anechoic
• Can occur with Morton’s over
estimate size of Morton’s
• Physiologic bursal fluid: up to 3 mm
(first-third web spaces)
No Compression
With Compression
Khoury V, Sem Mus Rad 11:149
2

Morton’s Neuroma & Bursa:
Morton’s and Bursa
--Entering nerve root visualized
--3d web space neuroma
--Associated intermetatarsal bursa
US of Morton’s Neuroma
Technique:
1. Probe plantar/finger
dorsal
2. Probe dorsal/finger
plantar
3. Mulder’s maneuver:
probe plantar/squeeze
US of Morton’s Neuroma
Technique:
1. Probe plantar/finger
dorsal
2. Probe dorsal/finger
plantar
3. Mulder’s maneuver:
probe plantar/squeeze
US of Morton’s Neuroma
Technique:
1. Probe plantar/finger
dorsal
2. Probe dorsal/finger
plantar
3. Mulder’s maneuver:
probe plantar/squeeze
Morton’s: Mulder’s Maneuver
3

Foreign Bodies: 4 Key Points
Wood Foreign Body:
1. FBs are echogenic
2. Hypoechoic halo,
+ shadowing/reverb.
trv
Horton, L. K. et al. Am. J. Roentgenol. 2001;176:1155-1159
Plantar Foreign Bodies:
Foreign Bodies: 4 Key Points
metal
64 y.o. stepped on needle
3. Use Doppler
Evaluation
– Aids detection of FB
– Fluid vs. phlegmon
plastic
16 y.o. plantar mass
Boyse T D et al. Radiographics 2001;21:1251-1256
Summary: 4 Key Points:
4. Assess for associated
complications
--Abscess; tenosynovitis;
--Septic Joint; osteomyelitis
--Tendon, vessel, nerve injury
14 y.o. stepped on glass:
long
• Glass removed in the emergency department
• Clinical Impression: possible tendon tear
US: FHL rupture due to foreign body
4

56 y.o. stepped on glass:
US of the Plantar Foot:
Glass FB
1. Plantar Fasciitis
2. Plantar Fibromatosis
3. Morton’s Neuroma
4. Foreign bodies
PPT laceration
Boyse T D et al. Radiographics 2001;21:1251-1256
5