Forefoot Pain in the Lesser Toes: Anatomical Considerations and Magnetic Resonance Imaging Findings

Abstract

Various conditions may result in forefoot pain. Magnetic resonance (MR) imaging allows accurate assessment of many of these conditions. We provide an overview of forefoot disorders divided into bones, capsule and plantar plate, musculotendinous structures, neurovascular structures, and subcutaneous tissue. We review normal anatomical features as well as MR imaging findings of common disorders.

The Impact of Kinesiology Taping on a Greek Foot with a Hammertoe—A Case Report

“…Weber [ 18 ] confirm the association of a longer metatarsal II with increased pressure under its surface. Hulstaert [ 19 ] point to the relationship between a deformity in the smaller toes and damage to the plantar plate, usually accompanied by damage to the collateral ligaments. Initially, this produces metatarsalgia and oedema, which develops into incorrect toe positioning—a hammer, mallet, claw and crossover toe, and a disruption to the biomechanics of the toe.…”

A Rare Case of Lateral Forefoot Pain: Plantar Adventitious Bursitis

“…In comparison to the synovial bursa located among muscles, tendons, ligaments, or bones, the inner surface of the adventitious bursa is not lined by synovium [5]. Plantar adventitious bursitis usually occurs at the first and fifth metatarsal heads [4] and should be distinguished from other disorders, including stress fractures, plantar plate ruptures, arthritis, intermetatarsal bursitis, Morton neuromas, and tenosynovitis. All lesions mentioned above are still difficult to diagnose through physical examinations because the related structures are approximated and overlapped together at the plantar area.…”

“…US is a useful tool for determining the location and extent of the foot lesions [8][9]. US is widely used in musculoskeletal medicine because it can provide real-time imaging and dynamic assessments [4,9]. Scanning the whole metatarsal bones and adjacent joints can help identify stress fractures, plantar plate ruptures [10], and joint arthritis/synovitis.…”

“…Some clinical pearls are worth sharing regarding investigation for patients with lateral forefoot pain. First, the investigators should be aware of the fact that the lesions over the forefoot may be difficult to visualize because of the thick keratin layer, which attenuates the US signals [4]. Second, plantar adventitious bursitis occurs at the subcutaneous layer, whereas the underlying toe flexor tendons and intermetatarsal bursa should not be affected.…”

“…Foot disorders hinder ambulation and worsen patients' quality of life [2]. Tendon sprain, stress fracture, arthritis, interdigital neuroma [3], and intrinsic muscle disorders [4] can elicit foot pain. However, little is known about the pain caused by plantar adventitious bursitis [5].…”