Diagnostic and Therapeutic Challenge of Metatarsalgia in a Patient With Rheumatoid Arthritis

A 63-year-old female patient, with a past history of rheumatoid arthritis, presented with insidious pain on the left foot second and third metatarsophalangeal joints, associated with swelling and morning stiffness (mean time: four hours). Physical examination evidenced a tender and soft nodularity i...

Full description

Saved in:
Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2022-01, Vol.14 (1), p.e21751
Main Authors: Malta, João N, Martins, Joana, Azenha, António, Lemos Pereira, Pedro
Format: Article
Language:English
Subjects:
Biopsy
Case reports
Edema
Foot diseases
Magnetic resonance imaging
Medical diagnosis
Monoclonal antibodies
Orthopedics
Pain
Patients
Physical Medicine & Rehabilitation
Range of motion
Rehabilitation
Rheumatoid arthritis
Rheumatology
Ultrasonic imaging
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A 63-year-old female patient, with a past history of rheumatoid arthritis, presented with insidious pain on the left foot second and third metatarsophalangeal joints, associated with swelling and morning stiffness (mean time: four hours). Physical examination evidenced a tender and soft nodularity in the third intermetatarsal space, along with sharp pain, consistent with Morton's neuroma. Foot ultrasound suggested Morton's neuroma, but not excluding the possibility of rheumatoid arthritis involvement. Foot magnetic resonance imaging suggested the possibility of extensive synovitis of the third metatarsophalangeal joint, but not excluding the coexistence of Morton's neuroma because of the mass effect. Finally, the patient underwent an ultrasound-guided needle biopsy of the nodule, which confirmed metatarsophalangeal joint synovitis. The foot is a common location of rheumatoid arthritis manifestation, and metatarsophalangeal joint synovitis can mimic Morton's neuroma. After a definite diagnosis, the patient recovered lower limb functional impairment after introducing adalimumab and a rehabilitation program. This case highlights the importance of an accurate differential diagnosis, pharmacological rheumatoid arthritis control, and physical medicine and rehabilitation programs to optimal clinical and functional improvement.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.21751