Intermetatarsal Bursitis, Intermetatarsal Neuroma, Morton Neuroma
Conditions
Keywords
Forefoot pain, Metatarsalgia
Brief summary
The aim of this study is to investigate the incidence of intermetatarsal bursitis and Morton's neuroma in patients with metatarsalgia (i.e. pain in the forefoot) and control subjects by diagnostic imaging with ultrasound and MRI.
Detailed description
In a group of patients with intermetatarsal pain found by an orthopedic surgeon, the investigators want to assess the incidences of intermetatarsal bursitis and Morton's neuroma, using diagnostic imaging; ultrasound and MRI. The hypothesis is, that intermetatarsal bursitis is an overlooked diagnosis in patients with metatarsalgia. As a result of sparse literature and lack of knowledge about this condition with symptoms mimicking Morton's neuroma, a part of patients diagnosed with Morton's neuroma, suffers from intermetatarsal bursitis instead. Additionally, the investigators want to evaluate the clinical sign opening toes. Based on clinical photos of the feet, the investigators want to document the presence of opening toes and investigate if there is a correlation with either intermetatarsal bursitis and/or Morton's neuroma.
Interventions
DIAGNOSTIC_TESTMRI with contrast
MRI of the forefoot with contrast (Gadovist)
DIAGNOSTIC_TESTUltrasound
Ultrasound imaging of the forefoot
Sponsors
The Danish Rheumatism Association
Hvidovre University Hospital
Bispebjerg Hospital
Gentofte Hospital
Rigshospitalet, Denmark
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Intervention model description
This is a diagnostic study with a patient and a control group.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Age \> 18 years * Pain in an intermetatarsal space (patient group)
Exclusion criteria
* Age \<18 years * Open wounds or ongoing infection in the forefoot at the time of examination * Persons with contraindications to participate in MRI scan * Persons with a history of significant trauma in the forefoot, e.g. any fracture or previous surgeries in the forefoot * Persons who have previously received treatment for Morton's neuroma in the same foot, e.g. injection (within 6 months) or operation (anytime) * Persons with severely impaired renal function (GFR \<30 ml/min) * Persons with a systemic inflammatory condition like rheumatoid arthritis, due to clinically silent intermetatarsal bursitis in this group (control group)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of normal findings on US | 8 weeks | When no findings is observed. |
| Incidence of intermetatarsal bursitis on MRI | 8 weeks | High intensity on T2 weighted images, low signal on T1. Thin peripheral enhancement on T1 contrast enhanced pictures. |
| Incidence of intermetatarsal bursitis on US | 8 weeks | Hypoechoic mass between metatarsal heads closest to dorsal surface of foot. Compressible. Activity on power/color doppler. |
| Incidence of Morton's neuroma on MRI | 8 weeks | Low to Intermediate signal in T1 and T2. Contrast enhancement of the nodular focus. |
| Incidence of Morton's neuroma on US | 8 weeks | Hypoechoic mass between metatarsal heads closest to plantar surface of foot. Non-compressible. The interdigital nerve can be seen entering the mass. Close relation to the interdigital artery. |
| Incidence of other pathology on MRI | 8 weeks | Other pathology than intermetatarsal bursitis or Morton's neuroma. |
| Incidence of other pathology on US | 8 weeks | Other pathology than intermetatarsal bursitis or Morton's neuroma. |
| Incidence of normal findings on MRI | 8 weeks | When no findings is observed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Opening toes | 8 weeks | Presence of opening toes/V-sign/spreading toes. |
Countries
Denmark
Outcome results
None listed