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Morton Neuroma: MR Imaging in Prone, Supine, and Upright Weight-bearing Body Positions¹

¹ From the Institute of Diagnostic Radiology, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland (D.W., K.T., J.K.W., B.M.); Orthopedic Practice, Zurich, Switzerland (H.P.K., H.Z.); and Departments of Orthopedic Surgery (P.V.) and Radiology (J.H., M.Z.), Orthopedic University Hospital Balgrist, Zurich, Switzerland. Received November 26, 2001; revision requested February 8, 2002; final revision received May 29; accepted July 15. Address correspondence to D.W. (e-mail: dominik.weishaupt@dmr.usz.ch).

View larger version (124K): [in a new window]   Figure 1a. Different forefoot positions in MR imaging of Morton neuroma. (a) Patient is placed in prone position, with the foot placed in plantar flexion in a circular polarized send-receive extremity coil. (b) Patient is placed in supine position, with dorsiflexion of the foot. The foot is placed in a flexible transmit-receive wraparound surface coil. (c) Positioning device designed for MR imaging of the forefoot in a weight-bearing position. The device consists of a wooden footplate that permits integration of the flexible transmit-receive wraparound surface coil. The device can be placed in the center of the magnet bore of an open-configuration MR system. The cushions used for stabilizing the forefoot within the coil are not shown.

View larger version (115K): [in a new window]   Figure 1b. Different forefoot positions in MR imaging of Morton neuroma. (a) Patient is placed in prone position, with the foot placed in plantar flexion in a circular polarized send-receive extremity coil. (b) Patient is placed in supine position, with dorsiflexion of the foot. The foot is placed in a flexible transmit-receive wraparound surface coil. (c) Positioning device designed for MR imaging of the forefoot in a weight-bearing position. The device consists of a wooden footplate that permits integration of the flexible transmit-receive wraparound surface coil. The device can be placed in the center of the magnet bore of an open-configuration MR system. The cushions used for stabilizing the forefoot within the coil are not shown.

View larger version (110K): [in a new window]   Figure 1c. Different forefoot positions in MR imaging of Morton neuroma. (a) Patient is placed in prone position, with the foot placed in plantar flexion in a circular polarized send-receive extremity coil. (b) Patient is placed in supine position, with dorsiflexion of the foot. The foot is placed in a flexible transmit-receive wraparound surface coil. (c) Positioning device designed for MR imaging of the forefoot in a weight-bearing position. The device consists of a wooden footplate that permits integration of the flexible transmit-receive wraparound surface coil. The device can be placed in the center of the magnet bore of an open-configuration MR system. The cushions used for stabilizing the forefoot within the coil are not shown.

View larger version (84K): [in a new window]   Figure 2a. Positional dependence of a surgically confirmed Morton neuroma in the third intermetatarsal space in a 60-year-old woman. MP2, MP3, and MP4 are metatarsophalangeal joint spaces of the second, third, and fourth rays, respectively; M2, M3, and M4 are metatarsal heads of the second, third, and fourth rays, respectively; and PP4 is the proximal phalanges of the fourth ray. (a) T1-weighted SE MR image (600/15) obtained perpendicular to the metatarsal bone with the patient in prone (plantar flexion of the foot) position demonstrates a typical Morton neuroma (arrows). The visibility of Morton neuroma was rated as good (score 3). (b) On a T1-weighted SE MR image (500/19) obtained perpendicular to the metatarsal bone with the patient in supine (dorsiflexion of the foot) position, the visibility of Morton neuroma (arrows) was rated as moderate (score 2). (c) On T1-weighted MR image (500/19) obtained with the patient in weight-bearing position, the visibility of Morton neuroma (arrows) was rated as moderate (score 2). Compared with the location of Morton neuroma in prone position, Morton neuroma at both supine and weight-bearing positions shows slight distal migration along the axis of the metatarsal ray.

View larger version (80K): [in a new window]   Figure 2b. Positional dependence of a surgically confirmed Morton neuroma in the third intermetatarsal space in a 60-year-old woman. MP2, MP3, and MP4 are metatarsophalangeal joint spaces of the second, third, and fourth rays, respectively; M2, M3, and M4 are metatarsal heads of the second, third, and fourth rays, respectively; and PP4 is the proximal phalanges of the fourth ray. (a) T1-weighted SE MR image (600/15) obtained perpendicular to the metatarsal bone with the patient in prone (plantar flexion of the foot) position demonstrates a typical Morton neuroma (arrows). The visibility of Morton neuroma was rated as good (score 3). (b) On a T1-weighted SE MR image (500/19) obtained perpendicular to the metatarsal bone with the patient in supine (dorsiflexion of the foot) position, the visibility of Morton neuroma (arrows) was rated as moderate (score 2). (c) On T1-weighted MR image (500/19) obtained with the patient in weight-bearing position, the visibility of Morton neuroma (arrows) was rated as moderate (score 2). Compared with the location of Morton neuroma in prone position, Morton neuroma at both supine and weight-bearing positions shows slight distal migration along the axis of the metatarsal ray.

View larger version (76K): [in a new window]   Figure 2c. Positional dependence of a surgically confirmed Morton neuroma in the third intermetatarsal space in a 60-year-old woman. MP2, MP3, and MP4 are metatarsophalangeal joint spaces of the second, third, and fourth rays, respectively; M2, M3, and M4 are metatarsal heads of the second, third, and fourth rays, respectively; and PP4 is the proximal phalanges of the fourth ray. (a) T1-weighted SE MR image (600/15) obtained perpendicular to the metatarsal bone with the patient in prone (plantar flexion of the foot) position demonstrates a typical Morton neuroma (arrows). The visibility of Morton neuroma was rated as good (score 3). (b) On a T1-weighted SE MR image (500/19) obtained perpendicular to the metatarsal bone with the patient in supine (dorsiflexion of the foot) position, the visibility of Morton neuroma (arrows) was rated as moderate (score 2). (c) On T1-weighted MR image (500/19) obtained with the patient in weight-bearing position, the visibility of Morton neuroma (arrows) was rated as moderate (score 2). Compared with the location of Morton neuroma in prone position, Morton neuroma at both supine and weight-bearing positions shows slight distal migration along the axis of the metatarsal ray.

View larger version (172K): [in a new window]   Figure 3a. Positional dependence of the shape and location of a Morton neuroma in the third intermetatarsal space in a 48-year-old woman. Morton neuroma was proven with surgical exploration. M2, M3, and M4 are metatarsal heads of the second, third, and fourth rays, respectively, and MP3 and MP4 are metatarsophalangeal joint spaces of the third and fourth rays, respectively. (a) On a T1-weighted SE MR image (600/15) obtained perpendicular to the metatarsal bone with the patient in prone position, Morton neuroma (arrows) is pear shaped and located below the plantar cortical line (P). (b) On a T1-weighted SE MR image (500/19) obtained perpendicular to the metatarsal bone with the patient in supine position, Morton neuroma (arrows) is dumbbell shaped and located above the virtual plantar cortical line (P). (c) On a T1-weighted SE MR image (500/19) obtained perpendicular to the metatarsal bone with the patient in the weight-bearing position, Morton neuroma (arrows) is inverted pear shaped and located above the plantar cortical line (P).

View larger version (171K): [in a new window]   Figure 3b. Positional dependence of the shape and location of a Morton neuroma in the third intermetatarsal space in a 48-year-old woman. Morton neuroma was proven with surgical exploration. M2, M3, and M4 are metatarsal heads of the second, third, and fourth rays, respectively, and MP3 and MP4 are metatarsophalangeal joint spaces of the third and fourth rays, respectively. (a) On a T1-weighted SE MR image (600/15) obtained perpendicular to the metatarsal bone with the patient in prone position, Morton neuroma (arrows) is pear shaped and located below the plantar cortical line (P). (b) On a T1-weighted SE MR image (500/19) obtained perpendicular to the metatarsal bone with the patient in supine position, Morton neuroma (arrows) is dumbbell shaped and located above the virtual plantar cortical line (P). (c) On a T1-weighted SE MR image (500/19) obtained perpendicular to the metatarsal bone with the patient in the weight-bearing position, Morton neuroma (arrows) is inverted pear shaped and located above the plantar cortical line (P).

View larger version (129K): [in a new window]   Figure 3c. Positional dependence of the shape and location of a Morton neuroma in the third intermetatarsal space in a 48-year-old woman. Morton neuroma was proven with surgical exploration. M2, M3, and M4 are metatarsal heads of the second, third, and fourth rays, respectively, and MP3 and MP4 are metatarsophalangeal joint spaces of the third and fourth rays, respectively. (a) On a T1-weighted SE MR image (600/15) obtained perpendicular to the metatarsal bone with the patient in prone position, Morton neuroma (arrows) is pear shaped and located below the plantar cortical line (P). (b) On a T1-weighted SE MR image (500/19) obtained perpendicular to the metatarsal bone with the patient in supine position, Morton neuroma (arrows) is dumbbell shaped and located above the virtual plantar cortical line (P). (c) On a T1-weighted SE MR image (500/19) obtained perpendicular to the metatarsal bone with the patient in the weight-bearing position, Morton neuroma (arrows) is inverted pear shaped and located above the plantar cortical line (P).

View larger version (90K): [in a new window]   Figure 4a. Positional dependence of a surgically confirmed Morton neuroma located in the third intermetatarsal space in a 31-year-old man. M2, M3, and M4 are the metatarsal heads of the second, third, and fourth rays, respectively, and MP3 and MP4 are metatarsophalangeal joint spaces of the third and fourth rays, respectively. On T1-weighted SE MR images (600/15) obtained perpendicular to the metatarsal bone with the patient in (a) prone and (b) supine positions, the Morton neuroma (arrows) is located below the plantar cortical line (P) between two adjacent metatarsal heads. (c) On T1-weighted SE MR image (500/19) obtained with the patient in a weight-bearing position, the Morton neuroma (arrows) is located above the plantar cortical line (P).

View larger version (87K): [in a new window]   Figure 4b. Positional dependence of a surgically confirmed Morton neuroma located in the third intermetatarsal space in a 31-year-old man. M2, M3, and M4 are the metatarsal heads of the second, third, and fourth rays, respectively, and MP3 and MP4 are metatarsophalangeal joint spaces of the third and fourth rays, respectively. On T1-weighted SE MR images (600/15) obtained perpendicular to the metatarsal bone with the patient in (a) prone and (b) supine positions, the Morton neuroma (arrows) is located below the plantar cortical line (P) between two adjacent metatarsal heads. (c) On T1-weighted SE MR image (500/19) obtained with the patient in a weight-bearing position, the Morton neuroma (arrows) is located above the plantar cortical line (P).

View larger version (70K): [in a new window]   Figure 4c. Positional dependence of a surgically confirmed Morton neuroma located in the third intermetatarsal space in a 31-year-old man. M2, M3, and M4 are the metatarsal heads of the second, third, and fourth rays, respectively, and MP3 and MP4 are metatarsophalangeal joint spaces of the third and fourth rays, respectively. On T1-weighted SE MR images (600/15) obtained perpendicular to the metatarsal bone with the patient in (a) prone and (b) supine positions, the Morton neuroma (arrows) is located below the plantar cortical line (P) between two adjacent metatarsal heads. (c) On T1-weighted SE MR image (500/19) obtained with the patient in a weight-bearing position, the Morton neuroma (arrows) is located above the plantar cortical line (P).

View larger version (135K): [in a new window]   Figure 5a. Positional dependence of the size of Morton neuroma in the third intermetatarsal space in a 50-year-old woman. The neuroma was proven with surgical exploration. MP2, MP3, and MP4 are metatarsophalangeal joint spaces of the second, third, and fourth rays, respectively, and M2, M3, and M4 are the metatarsal heads of the second, third, and fourth rays, respectively. T1-weighted SE MR images (500/19) obtained with the patient in (a) prone, (b) supine, and (c) weight-bearing positions. The transverse diameter (d) of Morton neuroma is 10 mm in prone position, 7 mm in supine position, and 7 mm in weight-bearing position. Between supine and weight-bearing positions, the Morton neuroma slightly migrated proximally along the axis of the metatarsal bone.

View larger version (130K): [in a new window]   Figure 5b. Positional dependence of the size of Morton neuroma in the third intermetatarsal space in a 50-year-old woman. The neuroma was proven with surgical exploration. MP2, MP3, and MP4 are metatarsophalangeal joint spaces of the second, third, and fourth rays, respectively, and M2, M3, and M4 are the metatarsal heads of the second, third, and fourth rays, respectively. T1-weighted SE MR images (500/19) obtained with the patient in (a) prone, (b) supine, and (c) weight-bearing positions. The transverse diameter (d) of Morton neuroma is 10 mm in prone position, 7 mm in supine position, and 7 mm in weight-bearing position. Between supine and weight-bearing positions, the Morton neuroma slightly migrated proximally along the axis of the metatarsal bone.

View larger version (110K): [in a new window]   Figure 5c. Positional dependence of the size of Morton neuroma in the third intermetatarsal space in a 50-year-old woman. The neuroma was proven with surgical exploration. MP2, MP3, and MP4 are metatarsophalangeal joint spaces of the second, third, and fourth rays, respectively, and M2, M3, and M4 are the metatarsal heads of the second, third, and fourth rays, respectively. T1-weighted SE MR images (500/19) obtained with the patient in (a) prone, (b) supine, and (c) weight-bearing positions. The transverse diameter (d) of Morton neuroma is 10 mm in prone position, 7 mm in supine position, and 7 mm in weight-bearing position. Between supine and weight-bearing positions, the Morton neuroma slightly migrated proximally along the axis of the metatarsal bone.