Those who did indicated that they routinely look at the plantar fat pads of the forefoot and report atrophy if they find it.
This is subjective…since we don’t have standard measurements, it is not necessary or appropriate to measure.
Bruno Vande Berg asked what the other foot looks like…..which is a very good question.
If it looks the same but the symptoms are only on one side that would undermine the relevance of this finding!
Unfortunately, without a clinical indication, I will not image the other foot.
I know that we don’t routinely look at the plantar fat pad thickness in our forefoot US….
In those cases where we don’t find plantar plate pathology, neuroma or bursitis, it might be worthwhile….especially since we have the opportunity for side to side comparison—-if only one foot is symptomatic, that might be helpful. But I don’t know.
But it would be important to use light probe pressure as you could easily compress and alter the fat pad measurement.
James Linklater pointed out the serendipitous demonstration of the M2-M3 deep transverse intermetatarsal ligament….which we don’t often see so well
On Thu, Apr 18, 2024 at 9:01 AM hilary umans <hilary.umans> wrote:
There is mild 2nd intermetatarsal bursal edema
No submetatarsal bursitis
No webspace mass or plantar plate tear or findings to suggest plantar plate degeneration
More proximal images do not show neuropathic muscle atrophy or edema
All I do see is thinning of the submetatarsal fat pad, deep to 2nd-4th MT heads, maybe slightly worse at the 2nd?
Remote bunionectomy and 1st MT osteotomy, 1st MT is relatively short
No stress fracture or stress reaction
I suppose fat pad atrophy is a diagnosis of exclusion….though I’m not really sure it explains her pain
I am not aware of any normative data for fat pad thickness, though I’m sure it varies by age, gender and patient size
Do you ever report this….on MRI? on US?
