0:00

So we talked about evaluation

0:04

of Morton's neuroma,

0:07

and, um, in my institution, we, um,

0:11

have more gotten used to, um,

0:13

ultrasound actually for Morton Aroma.

0:15

Um, I used to feel only comfortable with MRI

0:19

for Morton's Roma, but then when you do ultrasound,

0:22

it's a little bit, I feel like it's a little bit easier,

0:24

you feel a little bit more confident,

0:26

but it is a hard diagnosis, um, either way.

0:29

So in this case, um,

0:30

what we're doing is we're gonna be scrolling through the,

0:33

um, the forefoot at the M TP level.

0:35

I'm looking at the inter metatarsal areas,

0:38

and what you can see here in the third

0:43

web space, there is this hypo intense, uh, structure

0:48

between the toes that is not really centered

0:52

around the capsular area.

0:54

So that's, um, a good sign that you're not dealing

0:57

with just a kind of a pseudo neuroma

1:00

or the peri capsular scarring.

1:02

And this would be concerning for a more neuroma.

1:04

Now, of course, you would wanna correlate

1:07

with the patient's symptoms, so sometimes of course,

1:09

we might see things that look like more aromas,

1:13

but the patient's asymptomatic.

1:14

Um, and, and this is, you know, a hard area.

1:20

We might just be seeing the peri cap, the peri, uh,

1:22

neural scar tissue.

1:23

And so you wanna definitely correlate with the, the history.

1:27

One thing that I, I didn't mention, uh, previously,

1:29

and this, this case is, uh, um,

1:32

has something else very abnormal on the medial side,

1:34

but you often see, um, a little bit

1:37

of callous formation at the, uh, basis

1:39

of the plantar aspects of the fifth and first MTP joints.

1:43

So, um, don't be alarmed if you see, uh, some kind

1:47

of scar tissue or even, um, edema signal along the base

1:51

of the, uh, the fifth MTP in the first.

1:53

Now this case, um, has a finding that is, uh,

1:58

not typical of callus.

1:59

So, um, what we're seeing here is way too much, uh,

2:05

rounded mass, like, um, signal, um, than,

2:08

than one might expect for, for callus.

2:10

Um, as we're looking here,

2:13

we can see there's multiple nodular mass lake, uh,

2:15

structures along the medial plantar aspect.

2:20

And this, this one picture, I think tells it all.

2:23

So one

2:24

of the Mass lake structures is actually along this linear,

2:27

um, structure that,

2:29

that we discussed is part of the plantar fascia.

2:32

And if you look carefully, um, at these masses,

2:35

they are hypo intense on T one,

2:37

but they actually have some black streaks in them,

2:40

and that's a sign you're dealing with a fibrous lesion.

2:43

Uh, and so if you have a fibrous lesion, um,

2:47

in the plantar fascia, um, you do want to think about

2:52

plantar fibromatosis.

2:54

Uh, so plantar fibromatosis, there's multiple fibromas along

2:58

The plantar fascia.

3:00

Not uncommon. Um, often we see like one

3:03

or two, this is kind of a larger one.

3:04

So you do wanna, um, kind of correlate with the history,

3:07

make sure there's not like a rapidly growing sarcoma, uh,

3:11

that, that you could, you know, uh,

3:13

be mistaken to call it a fibroma.

3:15

But usually if you have like one or two small ones

3:18

and it's, um, kind of has that kind of,

3:19

those black streaks within it, then it's a, a good sign

3:22

that it's a, uh, a, a planter, uh, fibroma case.

3:26

So it's just a nice case of that.