Morton’s Neuroma or Intermetatarsal Bursitis—A Prospective Diagnostic Study of Intermetatarsal Pain

<b>Background:</b> Intermetatarsal bursitis (IMB) is emerging as a diagnostic consideration for patients with forefoot pain. However, few investigations have been conducted into the incidence of IMB among patients with forefoot pain. The symptoms of IMB are described as mimicking those o...

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Main Authors: Sif Binder Larsen, Cecilie Mørck Offersen, Eva Dyrberg, Jens Kurt Johansen, Naja Bjørslev Lange, Birthe Højlund Bech, Michael Bachmann Nielsen, Søren Tobias Torp-Pedersen
Format: Article
Language:English
Published: MDPI AG 2025-05-01
Series:Diagnostics
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Online Access:https://www.mdpi.com/2075-4418/15/11/1339
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author Sif Binder Larsen
Cecilie Mørck Offersen
Eva Dyrberg
Jens Kurt Johansen
Naja Bjørslev Lange
Birthe Højlund Bech
Michael Bachmann Nielsen
Søren Tobias Torp-Pedersen
author_facet Sif Binder Larsen
Cecilie Mørck Offersen
Eva Dyrberg
Jens Kurt Johansen
Naja Bjørslev Lange
Birthe Højlund Bech
Michael Bachmann Nielsen
Søren Tobias Torp-Pedersen
author_sort Sif Binder Larsen
collection DOAJ
description <b>Background:</b> Intermetatarsal bursitis (IMB) is emerging as a diagnostic consideration for patients with forefoot pain. However, few investigations have been conducted into the incidence of IMB among patients with forefoot pain. The symptoms of IMB are described as mimicking those of Morton’s neuroma (MN). Currently, the best method to differentiate between MN and IMB is radiological evaluation. Based on this, the aim of this study was to investigate the incidence of IMB and MN in a prospective cohort of patients with intermetatarsal pain diagnosed with radiological evaluation and compared to a control group. <b>Methods:</b> This study included 26 patients and 13 controls. All participants underwent magnetic resonance imaging (MRI) and ultrasound (US) of one forefoot. <b>Results:</b> Among the 26 patients, 5 (19.2%) had MN and 14 (53.8%) had IMB on MRI compared to US, with which 25 (96.2%) cases of IMB and 0 with MN were identified. In the control group, both modalities found asymptomatic web space pathology in four cases (30.8%), and US identified normal intermetatarsal bursas in five cases. Additionally, our results indicate that MN patients have more severe pain and a longer history of pain compared to IMB patients. <b>Conclusions:</b> Based on our MRI results, we conclude that IMB is frequent in patients with intermetatarsal pain. Differentiation between MN and IMB with US is complex and should be performed with caution and an understanding of both conditions. Normal intermetatarsal bursas are also visible on US as hypoechoic but non-expansive masses.
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spelling doaj-art-4027aec60b814cc2b9931006d1cb03c82025-08-20T02:32:57ZengMDPI AGDiagnostics2075-44182025-05-011511133910.3390/diagnostics15111339Morton’s Neuroma or Intermetatarsal Bursitis—A Prospective Diagnostic Study of Intermetatarsal PainSif Binder Larsen0Cecilie Mørck Offersen1Eva Dyrberg2Jens Kurt Johansen3Naja Bjørslev Lange4Birthe Højlund Bech5Michael Bachmann Nielsen6Søren Tobias Torp-Pedersen7Department of Diagnostic Radiology, Rigshospitalet, 2100 Copenhagen, DenmarkDepartment of Diagnostic Radiology, Rigshospitalet, 2100 Copenhagen, DenmarkDepartment of Diagnostic Radiology, Rigshospitalet, 2100 Copenhagen, DenmarkDepartment of Orthopedic Surgery, Hvidovre Hospital, 2650 Hvidovre, DenmarkDepartment of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, DenmarkDepartment of Diagnostic Radiology, Rigshospitalet, 2100 Copenhagen, DenmarkDepartment of Diagnostic Radiology, Rigshospitalet, 2100 Copenhagen, DenmarkDepartment of Diagnostic Radiology, Rigshospitalet, 2100 Copenhagen, Denmark<b>Background:</b> Intermetatarsal bursitis (IMB) is emerging as a diagnostic consideration for patients with forefoot pain. However, few investigations have been conducted into the incidence of IMB among patients with forefoot pain. The symptoms of IMB are described as mimicking those of Morton’s neuroma (MN). Currently, the best method to differentiate between MN and IMB is radiological evaluation. Based on this, the aim of this study was to investigate the incidence of IMB and MN in a prospective cohort of patients with intermetatarsal pain diagnosed with radiological evaluation and compared to a control group. <b>Methods:</b> This study included 26 patients and 13 controls. All participants underwent magnetic resonance imaging (MRI) and ultrasound (US) of one forefoot. <b>Results:</b> Among the 26 patients, 5 (19.2%) had MN and 14 (53.8%) had IMB on MRI compared to US, with which 25 (96.2%) cases of IMB and 0 with MN were identified. In the control group, both modalities found asymptomatic web space pathology in four cases (30.8%), and US identified normal intermetatarsal bursas in five cases. Additionally, our results indicate that MN patients have more severe pain and a longer history of pain compared to IMB patients. <b>Conclusions:</b> Based on our MRI results, we conclude that IMB is frequent in patients with intermetatarsal pain. Differentiation between MN and IMB with US is complex and should be performed with caution and an understanding of both conditions. Normal intermetatarsal bursas are also visible on US as hypoechoic but non-expansive masses.https://www.mdpi.com/2075-4418/15/11/1339Morton’s neuromaintermetatarsal bursitis/bursaweb spaceultrasoundmagnetic resonance imagingdiagnostic criteria
spellingShingle Sif Binder Larsen
Cecilie Mørck Offersen
Eva Dyrberg
Jens Kurt Johansen
Naja Bjørslev Lange
Birthe Højlund Bech
Michael Bachmann Nielsen
Søren Tobias Torp-Pedersen
Morton’s Neuroma or Intermetatarsal Bursitis—A Prospective Diagnostic Study of Intermetatarsal Pain
Diagnostics
Morton’s neuroma
intermetatarsal bursitis/bursa
web space
ultrasound
magnetic resonance imaging
diagnostic criteria
title Morton’s Neuroma or Intermetatarsal Bursitis—A Prospective Diagnostic Study of Intermetatarsal Pain
title_full Morton’s Neuroma or Intermetatarsal Bursitis—A Prospective Diagnostic Study of Intermetatarsal Pain
title_fullStr Morton’s Neuroma or Intermetatarsal Bursitis—A Prospective Diagnostic Study of Intermetatarsal Pain
title_full_unstemmed Morton’s Neuroma or Intermetatarsal Bursitis—A Prospective Diagnostic Study of Intermetatarsal Pain
title_short Morton’s Neuroma or Intermetatarsal Bursitis—A Prospective Diagnostic Study of Intermetatarsal Pain
title_sort morton s neuroma or intermetatarsal bursitis a prospective diagnostic study of intermetatarsal pain
topic Morton’s neuroma
intermetatarsal bursitis/bursa
web space
ultrasound
magnetic resonance imaging
diagnostic criteria
url https://www.mdpi.com/2075-4418/15/11/1339
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