Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Injection vs ultrasound for neuroma diagnosis

Discussion in 'General Issues and Discussion Forum' started by NewsBot, Aug 15, 2006.

  1. NewsBot

    NewsBot The Admin that posts the news.


    Members do not see these Ads. Sign Up.
    Hydrocortisone/local anaesthetic injection versus ultrasound in the diagnosis of interdigital neuroma
    Nikiforos Pandelis Saragas
    Foot and Ankle Surgery Volume 12, Issue 3 , 2006, Pages 149-151
  2. conp

    conp Active Member

    I know radiologists use a "push" technique (very technical term I made up-not sure if it does have a name) whereby they push on the area that is hypoechoic whilst performing diagnostic ultrasound to differentiate neuroma from bursa. This puts beyond doubt (if there was any) that it is indeed a neuroma or bursa. I wonder how the injection would differentiate this when considering that it should alleviate pain in both conditions.
    I have only read the abstract so I am not priviledge to further info.

    By the way, what do people find the most effective treatment for morton's neuroma and in what order from conservative to less conservative would you go. I have had a recent large amount of cases of neuroma's. Could be cold weather and closed shoes. Not sure why.
    Any experience would be helpful

    Last edited: Aug 16, 2006
  3. Admin2

    Admin2 Administrator Staff Member

  4. Mart

    Mart Well-Known Member

    I am curious about how this works. Could you please elaborate on the manouver and interpretation if you are familiar with it.

    I have been looking at inter-metatarsal spaces for several months with Diagnostic ultrasound.

    I have yet to make unequivocal judgement on my interpretation.

    The difficulty I am having is noticing any clear demarcation of tissue echogenicity whilst noticing definite nebulous interspace motion which is coincident either with sudden palpable clicking or sudden tissue displacement.

    My assumption is that if a bursa is present, it will be clearly anechoic and compressibe (provided it is not within a high pressure space) wheas a neuroma will be less differentiated and non compressible.

    My suspicion is that the neuroma is poorly or subtly differentiated from surrounding fatty tissue, and may be impossible to differentiate from mucoid degeneration.

    I am also curious to to know if anyone has tried to visualise a neuroma by surrounding it with volume of local anaestheic forming a vissible anechoic margin. I alos cannot see how a nerve block would be capable to differentiate between bursa or neuroma.

    Any ultrasound examiners out there going/gone through same process?


  5. milo2145

    milo2145 Member

    this "push" test is called a positive mulders click.
    you hold the foot at both sides by the metatarsals firmly so that your squeezing the metatarsals together, then you push up where the patient is experiencing pain, usually between the third and fourth metatarsals.
    if you feel - and rarely if you have good hearing! - hear a click, then it is a postitive mulders click, and you can almost be sure the patient has a neuroma.
    apparently it is the neuroma slipping between the mets that produces the click
  6. Mart

    Mart Well-Known Member

    thanks for your comment milo but I doubt that the "mulders sign" is what is being refered to here in this ultrsound exam technique


  7. NewsBot

    NewsBot The Admin that posts the news.

    The operational characteristics of ultrasonography for the diagnosis of plantar intermetatarsal neuroma.
    Kankanala G, Jain AS.
    J Foot Ankle Surg. 2007 Jul-Aug;46(4):213-7.
  8. Mart

    Mart Well-Known Member

    I agree that injection would be unhelpful to differentiate conditions.

    I saw a patient today with the most unequivocal US exam I have done for inter-metatarsal neurofibroma. As I mentioned previously, this exam for me has been difficult to me to gain confidence with. The attatched frozen images are pretty easy to interpret but the video are really nice. If you read this Craig and are amenable they would be useful additions as attachments but several MBs. Not sure if this is possible but please drop me a line if so and I’ll prepare something.

    53 year old female;

    Chronic unrelenting weight-bearing right foot metatarsalgia of increasing pain over past two years. She has obvious clinical signs of a space filing lesion in distal right foot3/4 inter-metatarsal space which with slight dorsiflexion of 4th metatarsal head will migrate plantarly or dorsally according to angle of applied force. Patient reports clicking sensation when walking but interestingly no pain in digits, I wonder if this might be because it doesn’t appear to surround the nerve but seems clearly plantar to it and perhaps experiencing less compressive stress than if being surrounded on all sides.. Diagnostic ultrasound exam is fairly unequivocal for neuroma rather than bursa (lesion incompressible and complex rather than uniform hypo-echoicity).

    A clearly differentiated incompressible inhomogeneous hypoechoic mass was seen lying plantar to proper digital nerve, the mass could be clearly seen to displace dorsally and compress against nerve with lateral compression of forefoot. Measurement of mass was 7.4mm deep, 6.1mm wide, 16.8mm long.



    The St. James Foot Clinic
    1749 Portage Ave.
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918

    Attached Files:

    Last edited: May 7, 2008

Share This Page