Medical Analysis Report

I. Imaging Findings

According to the imaging (including ultrasound and MRI) provided by the patient and clinical symptoms (a 55-year-old male with pain in the plantar forefoot), the primary observations are as follows:

• Ultrasound: A localized hypoechoic or slightly mixed echo area with relatively defined borders is seen in the intermetatarsal space of the forefoot (most commonly in the third intermetatarsal space). On color Doppler, a small amount of blood flow signal may be visible in this region.
• MRI:
  • On coronal and sagittal T1-weighted images, the lesion appears roughly isointense with the surrounding muscle and has relatively distinct margins.
  • On T2-weighted or FS T2-weighted images, the lesion demonstrates a markedly lower signal compared to fat tissue (slightly hypointense to intermediate signal relative to muscle).
  • On contrast-enhanced scans (especially fat-suppressed enhanced sequences), the lesion shows significant enhancement, which aids in localization and delineation.
  • The lesion is located beneath the intermetatarsal ligament and closely adjacent to the region of the intermetatarsal nerve bundle.

No evident bone destruction, fracture signs, or significant soft tissue swelling is observed on imaging. The primary findings focus on intermetatarsal nerve tissue thickening, exudation, or indirect signs of nerve involvement.

II. Potential Diagnoses

Based on the imaging findings and clinical history, the following diagnoses or differentials should be considered:

1. Morton’s Neuroma (Intermetatarsal Neuroma): Caused by thickening or degeneration of the nerve in the intermetatarsal space of the forefoot. Clinically, it often presents as burning or stabbing pain in the plantar forefoot. On MRI and ultrasound, a localized abnormal signal or hypoechoic area is commonly detected, most frequently in the third intermetatarsal space.
2. Intermetatarsal Bursitis / Bursal Effusion: May appear as a round or oval fluid-filled lesion, typically displaying high signal intensity on T2-weighted images or anechoic regions on ultrasound, with a location slightly different than that of neuromas.
3. Metatarsal Stress Fracture (Fatigue Fracture): Should be considered in middle-aged to older individuals or in those who engage in long periods of walking or running. MRI findings often include bone marrow edema and disruption of trabecular structures, while ultrasound is less sensitive.
4. Tenosynovial Cyst or Soft Tissue Mass: May also present as a small nodular lesion but is typically found near tendons or joints. On MRI, these lesions often demonstrate various degrees of fluid signal or cystic characteristics.

III. Final Diagnosis

Taking into account the patient’s age, the location and nature of the pain, as well as imaging findings (thickening of the nerve bundle on ultrasound and MRI, T1 isointense, T2 hypointense, and evident contrast enhancement), the most likely diagnosis is:

Morton’s Neuroma (Intermetatarsal Neuroma).

If clinical doubts persist or further confirmation is required, ultrasound- or image-guided injections (e.g., alcohol ablation or corticosteroid injection) can be conducted, or if necessary, a biopsy or surgical exploration may be performed.

IV. Treatment Plan and Rehabilitation

For Morton’s Neuroma, the following treatment and rehabilitation strategies can be considered:

1. Conservative Treatment:
   • Wear comfortable shoes or use forefoot cushions and orthotic insoles to reduce friction and pressure on the intermetatarsal nerve.
   • Adjust daily activities: avoid prolonged standing, walking, or running, especially when it causes excessive toe compression.
2. Pharmacotherapy and Local Injections:
   • Ultrasound- or image-guided corticosteroid or alcohol injections can be used to reduce pain and inflammation.
   • Short-term use of oral anti-inflammatory and analgesic drugs (e.g., NSAIDs) may help alleviate symptoms.
3. Surgical Treatment:
   • For patients who do not respond to conservative treatments and whose symptoms significantly impair their quality of life, surgical excision or nerve decompression may be considered.

Rehabilitation / Exercise Prescription Suggestions (FITT-VP Principle)

• Frequency: Begin 2–3 times per week initially. As pain subsides, gradually increase to 3–4 times per week.
• Intensity: Exercise at a comfortable level with mild or no pain. Start with low-intensity walking or cycling, avoiding excessive pressure on the forefoot.
• Time: Each session should last around 20–30 minutes following a gradual progression. Increase by 5 minutes as tolerance improves.
• Type: Choose aerobic exercises that place minimal pressure on the forefoot, such as swimming, elliptical training, or seated cycling. If walking or jogging, opt for flat surfaces with appropriate shoes and arch support.
• Progression: When the patient can tolerate the initial exercise load without significant discomfort, increase the exercise volume or duration by about 5–10% for the next phase.

Throughout the rehabilitation process, closely monitor for increased foot pain, numbness, or discomfort. If severe pain, swelling, or other abnormal symptoms occur, seek medical consultation promptly and adjust the plan accordingly.

Disclaimer

This report is for reference only and does not replace professional medical advice or an in-person consultation. Specific treatment plans should be formulated by specialists based on the patient’s clinical condition and individual differences.