Ultrasound in foot lesion diagnosis (Morton’s neuroma, lipofibroma)

Objective: To assess the value of ultrasound in the diagnosis of metatarsal region lesions, in particular, Morton’s neuroma and lipofibroma. Material and methods: The main group consisted of 144 patients with metatarsal pain radiating into the toes and metatarsal mass on ultrasound. Exclusion criteria were: the poor visualization of region of interest, previous surgery of Morton’s neuroma, an acute foot injury, the absence of morphological verification. The control group consisted of 25 patients with absence of symptoms and history of foot pathology. According to the morphological data main group was subdivided to subgroup of Morton’s neuroma (132 patients, 148 lesions) and subgroup of lipofibroma (12 patients, 12 lesions). In most cases masses occurred in females (92.4% of patients with Morton’s neuroma and 83.3% of patients with lipofibroma). In subgroup of Morton’s neuroma 55.3% of patients were aged 40-59 years. Ultrasound examination was performed with the use of iU22 scanner (Philips, Netherlands) with a 5-12 MHz linear probe and Logiq P-5 scanner (GE Healthcare, USA) with a 3-10 MHz linear probe. Numeric Rating Scale for Pain (NRS Pain) was used to assess the correlation between the size of lesion and pain severity. Results: In subgroup of Morton’s neuroma 64.9% of lesions were localized in the third intermetatarsal space, 31.1% in the second intermetatarsal space, and 4.1% in the first intermetatarsal space. In subgroup of lipofibroma 66.7% of lesions were localized in the second intermetatarsal space, 25.0% in the third intermetatarsal space, and 8.3% in the fourth intermetatarsal space. In B-mode ultrasound the hypoechogenicity of the lesion was the main diagnostic criterion of Morton’s neuroma (100.0%). In Doppler ultrasound the main diagnostic criterion for lipofibroma was the presence of vascularization (100.0%), whereas Morton’s neuroma was completely avascular in 100.0% of cases. There were no statistical differences of linear dimensions, area, and volume of lesions between subgroups (P > 0.05 for all comparisons). There were no significant differences between linear dimensions, area, and volume of lesions assessed by ultrasound and intraoperatively (P > 0.05 for all comparisons). The thickness of common plantar digital nerves proximal to the lesion location in the main group was significantly higher compared to the control group (P < 0.05). No significant correlation was found between the severity of pain and the maximal size of lesions (r_S = 0.1, P > 0.05 for both ultrasound and intraoperative size assessment). Conclusion: Ultrasound allows differential diagnosis of Morton’s neuroma and such a rare tumor as lipofibroma, against the background of similar symptoms.

nerve ultrasound, common plantar digital nerve, Morton’s neuroma, lipofibroma, metatarsalgia, foot

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