This was a consult today from my colleague Jeremy Grubin, who did not agree with the referrer’s clinical diagnosis 
If you look proximally in this case the dark T1 soft tissue thickening in the 2nd webspace is indeterminate…you must look at both the long and short axis images to see if you can tell if it is truly centered in the plantar webspace or if it is eccentric—as in this case, diagnostic of pseudoneuroma
I find that the short axis fluid sensitive series is more useful for bright signal tears (which we can actually see in a minority of cases of PP tear) and intermetatarsal or submetatarsal bursitis. In this case we see dark thickening of the lateral 2nd MTP joint plantar plate
There is developmental elongation of the 2nd MT (with respect to a baseline drawn between the 1st and 3rd MT head) and there is subtle, but real / acquired tibial deviation of the 2nd toe, which suggests plantar plate degeneration / tear….it’s a tough call, but in the top left and bottom right image I think you will agree that the dark webspace "mass" is eccentric along the lateral 2nd MTP joint capsule….this is clearly a pseudoneuroma
There’s minimal increased intrasubstance PDFS signal without a focal defect in the lateral 2nd MTP joint PP insertion
We cannot know if this is PP degeneration with pseudoneuroma or if there had been previous tear with exuberant scar remodeling at the lateral insertion and adjacent pseudoneuroma.
In either case, it is not a "true" webspace neuroma…they are treated differently.
At the risk of embarrassing my fabulous co-author Rodrigo Aguilar and appearing like a shameless self-promoter, I am sharing what I think is an excellent new reference on this topic
My interest in sharing is that none of you will call something like this a webspace neuroma….that results in mistreatment and often times miserably unhappy patients
The download link is active through May 10, 2024
https://authors.elsevier.com/a/1ioDN3sQgGdER3
