MRI utility in patients with non-traumatic metatarsalgia: A tertiary musculoskeletal center observational study

AimTo assess the utility of MRI of the forefoot in the workup of patients with non-traumatic metatarsalgia and inconclusive initial radiographs.Patients and methodsThe study included 125 patients (46 males and 79 female) with a mean age 38.8 years (age range 7–74 years) presented with forefoot pain. Patients with history of a clear recent forefoot trauma, gross osteo-articular deformities and previous forefoot surgery were excluded. Radiographic evaluations of the fore-foot followed by MRI imaging were performed using 1.5-T scanner. We stratified our patients into 4 groups: (a) stress-related, (b) arthritic-related, (c) infection-related, and (d) neoplastic disorders.ResultsThe most common causes of fore-foot pain, in our series, were Morton neuroma in 20 cases (16%), metatarsophalangeal (MTP) instability syndromes in 15 cases (12%) and sesamoid pathologies in 9 cases (7.2%) of the stress-related group. In arthritic group, rheumatoid arthritis and osteo-arthritis were equally the commonest entities (9.6%). Foreign body invasion in 10 patients (8%) was the common cause of infection-related forefoot pain. In the neoplastic category plantar fibromas were the commonest lesion (5.6%) in our series.ConclusionMR imaging depicted numerous forefoot soft-tissue and early osteo-articular processes in absence of gross fractures or other remarkable findings on radiographic screening.