Abstract
Disorders affecting the forefoot are common in the clinical practice. Accurate history and physical examination are the mainstays of diagnosis but imaging modalities are frequently obtained to confirm the clinical suspicion and plan appropriate treatment. In this article we will present the ultrasound (US) technique of examination of the forefoot followed by a brief description of the normal US anatomy and of US appearance of the most frequent forefoot disorders; rheumatoid arthritis, osteoarthritis, overuse arthropathy, Morton neuromas, bursitis, mucoid cysts, foreign bodies, bone disorders.
Riassunto
Le patologie che interessano l’avampiede sono frequenti nella pratica clinica. L’anamnesi accurata e l’esame fisico sono i pilastri della diagnosi, ma le modalità di imaging sono spesso necessarie per confermare il sospetto clinico e pianificare un trattamento appropriato. In questo articolo presenteremo la tecnica dell’esame ecografico dell’avampiede, seguita da una breve descrizione dell’anatomia ecografica e delle caratteristiche delle lesioni più frequenti nell’avampiede: artrite reumatoide, osteoartrosi, artropatia da sovraccarico, neuroma di Morton, borsite, cisti mucoide, corpi estranei, lesioni ossee.
Similar content being viewed by others
References
Morvan G, Wybier M, Mathieu P, Vuillemin V, Guérini H, Stérin P et al (2010) Foot imaging. Rev Prat 60:335–341
Bianchi S, Martinoli C (2007) Ultrasound of the musculoskeletal system. Springer, Heidelberg
Ansede G, Lee JC, Healy JC (2010) Musculoskeletal sonography of the normal foot. Skeletal Radiol 39:225–242. doi:10.1007/s00256-009-0697-7
Brasseur JL, Morvan G, Godoc B (2005) Dynamic ultrasonography. J Radiol 86:1904–1910
Bianchi S, Martinoli C (2007) Foot. In: Bianchi S, Martinoli C (eds) Ultrasound of the musculoskeletal system. Springer, Heidelberg, pp 835–888
Draghi F, Robotti G, Jacob D, Bianchi S (2010) Interventional musculoskeletal ultrasonography: precautions and contraindications. J Ultrasound 13:126–133
Bianchi S, Zamorani MP (2007) US guided interventional procedures. In: Bianchi S, Martinoli C (eds) Ultrasound of the musculoskeletal system. Springer, Heidelberg, pp 891–917
Wempe MK, Sellon JL, Sayeed YA, Smith J (2012) Feasibility of first metatarsophalangeal joint injections for sesamoid disorders: a cadaveric investigation. PM R 4:556–560. doi:10.1016/j.pmrj.2012.01.011
Guerini H, Ayral X, Vuillemin V, Morvan G, Thévenin F, Campagna R et al (2012) Ultrasound-guided injection in osteoarticular pathologies: general principles and precautions. Diagn Interv Imaging 93(9):674–679. doi:10.1016/j.diii.2012.06.010
Thomson CE, Beggs I, Martin DJ, McMillan D, Edwards RT, Russell D et al (2013) Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. J Bone Joint Surg Am 95:790–798. doi:10.2106/JBJS.I.01780
Hughes RJ, Ali K, Jones H, Kendall S, Connell DA (2007) Treatment of Morton’s neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. AJR Am J Roentgenol 188:1535–1539
Fanucci E, Masala S, Fabiano S, Perugia D, Squillaci E, Varrucciu V et al (2004) Treatment of intermetatarsal Morton’s neuroma with alcohol injection under US guide: 10-month follow-up. Eur Radiol 14:514–518
Sofka CM, Adler RS (2002) Ultrasound-guided interventions in the foot and ankle. Semin Musculoskelet Radiol 6:163–168
Morvan G, Brasseur J, Sans N (2005) Superficial US of superficial bones. J Radiol 86:1892–1903
Torriani M, Kattapuram SV (2003) Technical innovation: dynamic sonography of the forefoot: the sonographic Mulder sign. AJR Am J Roentgenol 180:1121–1123
Gregg J, Silberstein M, Schneider T, Marks P (2006) Sonographic and MRI evaluation of the plantar plate: a prospective study. Eur Radiol 16:2661–2669
Gregg JM, Schneider T, Marks P (2008) MR imaging and ultrasound of metatarsalgia-the lesser metatarsals. Radiol Clin N Am 46:1061–1078. doi:10.1016/j.rcl.2008.09.004
Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Østergaard M (2004) Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum 50:2103–2112
Klocke R, Glew D, Cox N, Blake DR (2001) Sonographic erosions of the rheumatoid little toe. Ann Rheum Dis 60:896–904
Doty JF, Coughlin MJ (2013) Mtatarsophalangeal joint instability of the lesser toes. J Foot Ankle Surg 19:S1067–S2516. doi:10.1053/j.jfas.2013.03.005
Carlson RM, Dux K, Stuck RM (2013) Ultrasound imaging for diagnosis of plantar plate ruptures of the lesser metatarsophalangeal joints: a retrospective case series. J Foot Ankle Surg 52:786–788. doi:10.1053/j.jfas.2013.05.009
Abreu E, Aubert S, Wavreille G, Gheno R, Canella C, Cotten A (2013) Peripheral tumor and tumor-like neurogenic lesions. Eur J Radiol 82:38–50. doi:10.1016/j.ejrad.2011.04.036
Redd RA, Peters VJ, Emery SF, Branch HM, Rifkin MD (1989) Morton neuroma: sonographic evaluation. Radiology 171:415–417
Quinn TJ, Jacobson JA, Craig JG, van Holsbeeck MT (2000) Sonography of Morton’s neuromas. Am J Roentgenol 174:1723–1728
Sofka CM, Adler RS, Ciavarra GA, Pavlov H (2007) Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection—preliminary results. HSS J 3:44–49
Yap LP, McNally E (2012) Patient’s assessment of discomfort during ultrasound-guided injection of Morton’s neuroma: selecting the optimal approach. J Clin Ultrasound 40:330–334. doi:10.1002/jcu.21926
Koski JM (1998) Ultrasound detection of plantar bursitis of the forefoot in patients with early rheumatoid arthritis. J Rheumatol 25:229–230
Bowen CJ, Culliford D, Dewbury K, Sampson M, Burridge J, Hooper L et al (2010) The clinical importance of ultrasound detectable forefoot bursae in rheumatoid arthritis. Rheumatology (Oxford) 49:191–192. doi:10.1093/rheumatology/kep307
Bancroft LW, Peterson JJ, Kransdorf MJ (2008) Imaging of soft tissue lesions of the foot and ankle. Radiol Clin N Am 46:1093–0103, vii. doi:10.1016/j.rcl.2008.08.007
Masih S, Antebi A (2003) Imaging of pigmented villonodular synovitis. Semin Musculoskelet Radiol 7:205–216
Wan JM, Magarelli N, Peh WC, Guglielmi G, Shek TW (2010) Imaging of giant cell tumour of the tendon sheath. Radiol Med 115:141–151. doi:10.1007/s11547-010-0515-2
Potter GK, Feldman JS (1990) Neoplasms of the peripheral nervous system. Clin Podiatr Med Surg 7:141–149
Bianchi S (2008) Ultrasound of the peripheral nerves. Joint Bone Spine 75:643–649. doi:10.1016/j.jbspin.2008.07.002
Bos GD, Esther RJ, Woll TS (2002) Foot tumors: diagnosis and treatment. J Am Acad Orthop Surg 10:259–270
Boyse TD, Fessell DP, Jacobson JA, Lin J, van Holsbeeck MT, Hayes CW (2001) US of soft-tissue foreign bodies and associated complications with surgical correlation. Radiographics 21:1251–1256
Nwawka OK, Kabutey NK, Locke CM, Castro-Aragon I, Kim D (2014) Ultrasound-guided needle localization to aid foreign body removal in pediatric patients. J Foot Ankle Surg 53:67–70. doi:10.1053/j.jfas.2013.09.006
Soubrier M, Dubost JJ, Boisgard S, Sauvezie B, Gaillard P, Michel JL et al (2003) Insufficiency fracture. A survey of 60 cases and review of the literature. Joint Bone Spine 70:209–218
Bodner G, Stöckl B, Fierlinger A, Schocke M, Bernathova M (2005) Sonographic findings in stress fractures of the lower limb: preliminary findings. Eur Radiol 15:356–359
Banal F, Etchepare F, Rouhier B, Rosenberg C, Foltz V, Rozenberg S et al (2006) Ultrasound ability in early diagnosis of stress fracture of metatarsal bone. Ann Rheum Dis 65:977–978
Conflict of interest
Stefano Bianchi declare that he has no conflict of interest.
Human and animal studies
The study described in this article did not include any procedures involving humans or animals.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bianchi, S. Practical US of the forefoot. J Ultrasound 17, 151–164 (2014). https://doi.org/10.1007/s40477-014-0078-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40477-014-0078-5