Intermetatarsal bursitis is a common cause of metatarsalgia and is frequently associated with Morton neuromas and plantar plate tears.
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Clinical presentation
Symptoms include forefoot pain, feeling of walking a lump, swelling and/or tingling 2.
Pathology
Etiology
- trauma
- infection
- rheumatoid arthritis
- gout
Radiographic features
Fluid collections between the metatarsal heads; fluid collections <3 mm may be physiological 1,2.
Ultrasound
- hypoechoic, compressible soft tissue structure in the webspace
- hyperemia may be present on color Doppler
MRI
MRI signal characteristics
- T1: low signal
- T2: high signal
- T1 C+ (Gd): thin peripheral enhancement
Differential diagnosis
- physiological fluid in the intermetatarsal bursa should be considered if <3 mm
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Morton neuroma
- non-compressible solid mass on ultrasound
- enhancing mass on MRI
- often occurs in association with intermetatarsal bursitis