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Review
. 2020 Jul-Aug;40(4):1107-1124.
doi: 10.1148/rg.2020190145. Epub 2020 May 15.

High-Resolution MRI of the First Metatarsophalangeal Joint: Gross Anatomy and Injury Characterization

James T P D Hallinan  1 , Sheronda M Statum  1 , Brady K Huang  1 , Higor Grando Bezerra  1 , Diego A L Garcia  1 , Graeme M Bydder  1 , Christine B Chung  1
Affiliations
Review

High-Resolution MRI of the First Metatarsophalangeal Joint: Gross Anatomy and Injury Characterization

James T P D Hallinan et al. Radiographics. 2020 Jul-Aug.

Abstract

The first metatarsophalangeal joint (MTPJ) is vital to the biomechanics of the foot and supports a weight up to eight times heavier than the body during athletic activities. The first MTPJ comprises osseous and cartilaginous surfaces along with a complex of supporting structures, including the dorsal extensor tendons, collateral ligaments, and a plantar plate complex. In contradistinction to the lesser MTPJ plantar plates, a single dominant fibrocartilaginous capsular thickening does not exist at the first MTPJ. Instead, the plantar plate complex comprises a fibrocartilaginous pad that invests the hallux sesamoids and is inseparable from the plantar capsule, the intersesamoid ligament, paired metatarsosesamoid and sesamoid phalangeal ligaments (SPLs), and the musculotendinous structures. Acute injury at the first MTPJ is typically secondary to forced hyperextension-turf toe-and can involve multiple structures. During hyperextension, the resulting forces primarily load the distal SPLs, making these structures more susceptible to injury. SPL injuries are best seen in the sagittal plane at MRI. Radiography can also aid in diagnosis of full-thickness SPL tears, demonstrating reduced sesamoid excursion at lateral dorsiflexed (stress) views. Hallux valgus is another common condition, resulting in progressive disabling deformity at the first MTPJ. Without appropriate treatment, first MTPJ injuries may progress to degenerative hallux rigidus. The authors detail the anatomy of the first MTPJ in cadaveric forefeet by using high-resolution 3-T and 11.7-T MRI and anatomic-pathologic correlation. Injuries to the plantar plate complex, collateral ligaments, and extensor mechanism are discussed using clinical case examples. Online supplemental material is available for this article. ©RSNA, 2020.

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Figures

First MTPJ anatomy. Sagittal (a) and coronal cross-sectional (b) drawings (plane in b represented by the dotted line in a) show how the medial SPL (★), lateral SPL (not shown), and lateral (#) and medial (*) MTSLs secure the lateral (L) and medial (M) sesamoids. These ligaments form a plantar plate complex with the joint capsule, ISL, and musculotendinous structures. At the dorsal first MTPJ, the EHB (dotted arrow) attaches to the proximal phalanx (PP) and lies deep and slightly lateral to the EHL (solid arrow). The first metatarsal crest (arrowhead in b) is shown between the grooved sesamoid facets. FHL = flexor hallucis longus, IS = intersesamoid ligament, MT = metatarsal.
Figure 1a.
First MTPJ anatomy. Sagittal (a) and coronal cross-sectional (b) drawings (plane in b represented by the dotted line in a) show how the medial SPL (★), lateral SPL (not shown), and lateral (#) and medial (*) MTSLs secure the lateral (L) and medial (M) sesamoids. These ligaments form a plantar plate complex with the joint capsule, ISL, and musculotendinous structures. At the dorsal first MTPJ, the EHB (dotted arrow) attaches to the proximal phalanx (PP) and lies deep and slightly lateral to the EHL (solid arrow). The first metatarsal crest (arrowhead in b) is shown between the grooved sesamoid facets. FHL = flexor hallucis longus, IS = intersesamoid ligament, MT = metatarsal.
First MTPJ anatomy. Sagittal (a) and coronal cross-sectional (b) drawings (plane in b represented by the dotted line in a) show how the medial SPL (★), lateral SPL (not shown), and lateral (#) and medial (*) MTSLs secure the lateral (L) and medial (M) sesamoids. These ligaments form a plantar plate complex with the joint capsule, ISL, and musculotendinous structures. At the dorsal first MTPJ, the EHB (dotted arrow) attaches to the proximal phalanx (PP) and lies deep and slightly lateral to the EHL (solid arrow). The first metatarsal crest (arrowhead in b) is shown between the grooved sesamoid facets. FHL = flexor hallucis longus, IS = intersesamoid ligament, MT = metatarsal.
Figure 1b.
First MTPJ anatomy. Sagittal (a) and coronal cross-sectional (b) drawings (plane in b represented by the dotted line in a) show how the medial SPL (★), lateral SPL (not shown), and lateral (#) and medial (*) MTSLs secure the lateral (L) and medial (M) sesamoids. These ligaments form a plantar plate complex with the joint capsule, ISL, and musculotendinous structures. At the dorsal first MTPJ, the EHB (dotted arrow) attaches to the proximal phalanx (PP) and lies deep and slightly lateral to the EHL (solid arrow). The first metatarsal crest (arrowhead in b) is shown between the grooved sesamoid facets. FHL = flexor hallucis longus, IS = intersesamoid ligament, MT = metatarsal.
First MTPJ anatomy. (a) Drawing depicts a view from below the first MTPJ musculotendinous structures. Laterally, the oblique (ADo) and transverse (ADt) heads of the adductor hallucis provide resistance to medial displacement. Medially, the abductor hallucis tendon (AB) inserts at the medial sesamoid (M) and medial capsuloligamentous structures, preventing hallux valgus. The lateral (FHBl) and medial (FHBm) heads of the FHB insert at the respective sesamoids, preventing distal sesamoid migration. Inset in a shows the MTPJ with the FHL and tendons removed. IS = intersesamoid ligament. (b, c) Gross anatomy of a cadaveric first MTPJ specimen (b) is also shown with the medial structures dissected and then with plantar disarticulation, with the plantar plate complex (c) viewed from the dorsal aspect. Paired SPLs (☆) and the medial SPL (arrow in b) are continuous with the capsule and fibrocartilaginous pad (*), preventing proximal sesamoid migration. The ISL (dotted line in c) prevents sesamoid splaying. Chondral defects are noted at the metatarsal head (arrowheads in c). L = lateral sesamoid, MT = metatarsal, PP = proximal phalanx.
Figure 2a.
First MTPJ anatomy. (a) Drawing depicts a view from below the first MTPJ musculotendinous structures. Laterally, the oblique (ADo) and transverse (ADt) heads of the adductor hallucis provide resistance to medial displacement. Medially, the abductor hallucis tendon (AB) inserts at the medial sesamoid (M) and medial capsuloligamentous structures, preventing hallux valgus. The lateral (FHBl) and medial (FHBm) heads of the FHB insert at the respective sesamoids, preventing distal sesamoid migration. Inset in a shows the MTPJ with the FHL and tendons removed. IS = intersesamoid ligament. (b, c) Gross anatomy of a cadaveric first MTPJ specimen (b) is also shown with the medial structures dissected and then with plantar disarticulation, with the plantar plate complex (c) viewed from the dorsal aspect. Paired SPLs (☆) and the medial SPL (arrow in b) are continuous with the capsule and fibrocartilaginous pad (*), preventing proximal sesamoid migration. The ISL (dotted line in c) prevents sesamoid splaying. Chondral defects are noted at the metatarsal head (arrowheads in c). L = lateral sesamoid, MT = metatarsal, PP = proximal phalanx.
First MTPJ anatomy. (a) Drawing depicts a view from below the first MTPJ musculotendinous structures. Laterally, the oblique (ADo) and transverse (ADt) heads of the adductor hallucis provide resistance to medial displacement. Medially, the abductor hallucis tendon (AB) inserts at the medial sesamoid (M) and medial capsuloligamentous structures, preventing hallux valgus. The lateral (FHBl) and medial (FHBm) heads of the FHB insert at the respective sesamoids, preventing distal sesamoid migration. Inset in a shows the MTPJ with the FHL and tendons removed. IS = intersesamoid ligament. (b, c) Gross anatomy of a cadaveric first MTPJ specimen (b) is also shown with the medial structures dissected and then with plantar disarticulation, with the plantar plate complex (c) viewed from the dorsal aspect. Paired SPLs (☆) and the medial SPL (arrow in b) are continuous with the capsule and fibrocartilaginous pad (*), preventing proximal sesamoid migration. The ISL (dotted line in c) prevents sesamoid splaying. Chondral defects are noted at the metatarsal head (arrowheads in c). L = lateral sesamoid, MT = metatarsal, PP = proximal phalanx.
Figure 2b.
First MTPJ anatomy. (a) Drawing depicts a view from below the first MTPJ musculotendinous structures. Laterally, the oblique (ADo) and transverse (ADt) heads of the adductor hallucis provide resistance to medial displacement. Medially, the abductor hallucis tendon (AB) inserts at the medial sesamoid (M) and medial capsuloligamentous structures, preventing hallux valgus. The lateral (FHBl) and medial (FHBm) heads of the FHB insert at the respective sesamoids, preventing distal sesamoid migration. Inset in a shows the MTPJ with the FHL and tendons removed. IS = intersesamoid ligament. (b, c) Gross anatomy of a cadaveric first MTPJ specimen (b) is also shown with the medial structures dissected and then with plantar disarticulation, with the plantar plate complex (c) viewed from the dorsal aspect. Paired SPLs (☆) and the medial SPL (arrow in b) are continuous with the capsule and fibrocartilaginous pad (*), preventing proximal sesamoid migration. The ISL (dotted line in c) prevents sesamoid splaying. Chondral defects are noted at the metatarsal head (arrowheads in c). L = lateral sesamoid, MT = metatarsal, PP = proximal phalanx.
First MTPJ anatomy. (a) Drawing depicts a view from below the first MTPJ musculotendinous structures. Laterally, the oblique (ADo) and transverse (ADt) heads of the adductor hallucis provide resistance to medial displacement. Medially, the abductor hallucis tendon (AB) inserts at the medial sesamoid (M) and medial capsuloligamentous structures, preventing hallux valgus. The lateral (FHBl) and medial (FHBm) heads of the FHB insert at the respective sesamoids, preventing distal sesamoid migration. Inset in a shows the MTPJ with the FHL and tendons removed. IS = intersesamoid ligament. (b, c) Gross anatomy of a cadaveric first MTPJ specimen (b) is also shown with the medial structures dissected and then with plantar disarticulation, with the plantar plate complex (c) viewed from the dorsal aspect. Paired SPLs (☆) and the medial SPL (arrow in b) are continuous with the capsule and fibrocartilaginous pad (*), preventing proximal sesamoid migration. The ISL (dotted line in c) prevents sesamoid splaying. Chondral defects are noted at the metatarsal head (arrowheads in c). L = lateral sesamoid, MT = metatarsal, PP = proximal phalanx.
Figure 2c.
First MTPJ anatomy. (a) Drawing depicts a view from below the first MTPJ musculotendinous structures. Laterally, the oblique (ADo) and transverse (ADt) heads of the adductor hallucis provide resistance to medial displacement. Medially, the abductor hallucis tendon (AB) inserts at the medial sesamoid (M) and medial capsuloligamentous structures, preventing hallux valgus. The lateral (FHBl) and medial (FHBm) heads of the FHB insert at the respective sesamoids, preventing distal sesamoid migration. Inset in a shows the MTPJ with the FHL and tendons removed. IS = intersesamoid ligament. (b, c) Gross anatomy of a cadaveric first MTPJ specimen (b) is also shown with the medial structures dissected and then with plantar disarticulation, with the plantar plate complex (c) viewed from the dorsal aspect. Paired SPLs (☆) and the medial SPL (arrow in b) are continuous with the capsule and fibrocartilaginous pad (*), preventing proximal sesamoid migration. The ISL (dotted line in c) prevents sesamoid splaying. Chondral defects are noted at the metatarsal head (arrowheads in c). L = lateral sesamoid, MT = metatarsal, PP = proximal phalanx.
First MTPJ anatomy in a cadaveric specimen. Axial (a), central sagittal (b), and medial sagittal (c) gradient-echo images (5000/10) show how the lateral (L) and medial (M) sesamoids are connected by the ISL (☆). A fibrocartilaginous pad (arrowheads) is seen distal to the ISL, which merges with the medial SPL (black arrow) and lateral SPL (not shown). Dorsally, the EHB tendon (dotted arrow) attaches to the proximal phalanx and lies deep to the EHL tendon (white arrow).
Figure 3a.
First MTPJ anatomy in a cadaveric specimen. Axial (a), central sagittal (b), and medial sagittal (c) gradient-echo images (5000/10) show how the lateral (L) and medial (M) sesamoids are connected by the ISL (☆). A fibrocartilaginous pad (arrowheads) is seen distal to the ISL, which merges with the medial SPL (black arrow) and lateral SPL (not shown). Dorsally, the EHB tendon (dotted arrow) attaches to the proximal phalanx and lies deep to the EHL tendon (white arrow).
First MTPJ anatomy in a cadaveric specimen. Axial (a), central sagittal (b), and medial sagittal (c) gradient-echo images (5000/10) show how the lateral (L) and medial (M) sesamoids are connected by the ISL (☆). A fibrocartilaginous pad (arrowheads) is seen distal to the ISL, which merges with the medial SPL (black arrow) and lateral SPL (not shown). Dorsally, the EHB tendon (dotted arrow) attaches to the proximal phalanx and lies deep to the EHL tendon (white arrow).
Figure 3b.
First MTPJ anatomy in a cadaveric specimen. Axial (a), central sagittal (b), and medial sagittal (c) gradient-echo images (5000/10) show how the lateral (L) and medial (M) sesamoids are connected by the ISL (☆). A fibrocartilaginous pad (arrowheads) is seen distal to the ISL, which merges with the medial SPL (black arrow) and lateral SPL (not shown). Dorsally, the EHB tendon (dotted arrow) attaches to the proximal phalanx and lies deep to the EHL tendon (white arrow).
First MTPJ anatomy in a cadaveric specimen. Axial (a), central sagittal (b), and medial sagittal (c) gradient-echo images (5000/10) show how the lateral (L) and medial (M) sesamoids are connected by the ISL (☆). A fibrocartilaginous pad (arrowheads) is seen distal to the ISL, which merges with the medial SPL (black arrow) and lateral SPL (not shown). Dorsally, the EHB tendon (dotted arrow) attaches to the proximal phalanx and lies deep to the EHL tendon (white arrow).
Figure 3c.
First MTPJ anatomy in a cadaveric specimen. Axial (a), central sagittal (b), and medial sagittal (c) gradient-echo images (5000/10) show how the lateral (L) and medial (M) sesamoids are connected by the ISL (☆). A fibrocartilaginous pad (arrowheads) is seen distal to the ISL, which merges with the medial SPL (black arrow) and lateral SPL (not shown). Dorsally, the EHB tendon (dotted arrow) attaches to the proximal phalanx and lies deep to the EHL tendon (white arrow).
First metatarsosesamoid joint anatomy in a cadaveric specimen. Coronal gradient-echo image (5000/10) shows how the paired lateral (#) and medial (*) MTSLs secure the lateral (L) and medial (M) sesamoids. These ligaments form a plantar plate complex along with the joint capsule, intersesamoid ligament (IS), and musculotendinous structures, including the abductor hallucis muscle and tendon (black arrow). The fibers of the ISL are intimately associated with the FHL tendon sheath and a deep synovial fold (arrowhead). At the dorsal first MTPJ, the EHB (dotted arrow) lies deep and slightly lateral to the EHL (white arrow).
Figure 4.
First metatarsosesamoid joint anatomy in a cadaveric specimen. Coronal gradient-echo image (5000/10) shows how the paired lateral (#) and medial (*) MTSLs secure the lateral (L) and medial (M) sesamoids. These ligaments form a plantar plate complex along with the joint capsule, intersesamoid ligament (IS), and musculotendinous structures, including the abductor hallucis muscle and tendon (black arrow). The fibers of the ISL are intimately associated with the FHL tendon sheath and a deep synovial fold (arrowhead). At the dorsal first MTPJ, the EHB (dotted arrow) lies deep and slightly lateral to the EHL (white arrow).
Normal anatomy of the first MTSLs. Coronal (a) and lateral sagittal (b) PDW images (2000/35) depict how the lateral (#) and medial (*) MTSLs secure the lateral (L) and medial (M) sesamoids. The MTSLs are components of the plantar plate complex and attach to the sesamoids in close relation to the FHB tendons. The insertion of the lateral head of the FHB tendon can be seen (arrowhead). The lateral MTSL inserts adjacent to the conjoint adductor hallucis tendon (dotted arrow), which resists varus stress. The medial MTSL inserts adjacent to the abductor hallucis tendon (solid arrow), which resists valgus stress. The rhomboid lateral MTSL (white dotted line in b) blends with the capsule and lateral SPL (☆). Ext = extensor tendons.
Figure 5a.
Normal anatomy of the first MTSLs. Coronal (a) and lateral sagittal (b) PDW images (2000/35) depict how the lateral (#) and medial (*) MTSLs secure the lateral (L) and medial (M) sesamoids. The MTSLs are components of the plantar plate complex and attach to the sesamoids in close relation to the FHB tendons. The insertion of the lateral head of the FHB tendon can be seen (arrowhead). The lateral MTSL inserts adjacent to the conjoint adductor hallucis tendon (dotted arrow), which resists varus stress. The medial MTSL inserts adjacent to the abductor hallucis tendon (solid arrow), which resists valgus stress. The rhomboid lateral MTSL (white dotted line in b) blends with the capsule and lateral SPL (☆). Ext = extensor tendons.
Normal anatomy of the first MTSLs. Coronal (a) and lateral sagittal (b) PDW images (2000/35) depict how the lateral (#) and medial (*) MTSLs secure the lateral (L) and medial (M) sesamoids. The MTSLs are components of the plantar plate complex and attach to the sesamoids in close relation to the FHB tendons. The insertion of the lateral head of the FHB tendon can be seen (arrowhead). The lateral MTSL inserts adjacent to the conjoint adductor hallucis tendon (dotted arrow), which resists varus stress. The medial MTSL inserts adjacent to the abductor hallucis tendon (solid arrow), which resists valgus stress. The rhomboid lateral MTSL (white dotted line in b) blends with the capsule and lateral SPL (☆). Ext = extensor tendons.
Figure 5b.
Normal anatomy of the first MTSLs. Coronal (a) and lateral sagittal (b) PDW images (2000/35) depict how the lateral (#) and medial (*) MTSLs secure the lateral (L) and medial (M) sesamoids. The MTSLs are components of the plantar plate complex and attach to the sesamoids in close relation to the FHB tendons. The insertion of the lateral head of the FHB tendon can be seen (arrowhead). The lateral MTSL inserts adjacent to the conjoint adductor hallucis tendon (dotted arrow), which resists varus stress. The medial MTSL inserts adjacent to the abductor hallucis tendon (solid arrow), which resists valgus stress. The rhomboid lateral MTSL (white dotted line in b) blends with the capsule and lateral SPL (☆). Ext = extensor tendons.
Musculotendinous structures of the first MTPJ. Coronal PDW images (2000/35) of the metatarsosesamoid joint (a) and the distal first metatarsal (MT) (b) depict the attachment of the adductor (dotted arrow) and abductor (solid arrow) hallucis tendons to the lateral (L) and medial (M) sesamoids. These tendons insert in close relation to the lateral (#) and medial (*) MTSLs and the lateral (+ = tendon, lat = muscle belly) and medial (☆) heads of the FHB. The adductor hallucis conjoint tendon is formed from the transverse (t = muscle, solid oval = tendon) and oblique (o = muscle, dashed oval = tendon) heads. Dorsally, the extensor tendons (e) can be seen secured by the lateral and medial sagittal bands (arrowheads).
Figure 6a.
Musculotendinous structures of the first MTPJ. Coronal PDW images (2000/35) of the metatarsosesamoid joint (a) and the distal first metatarsal (MT) (b) depict the attachment of the adductor (dotted arrow) and abductor (solid arrow) hallucis tendons to the lateral (L) and medial (M) sesamoids. These tendons insert in close relation to the lateral (#) and medial (*) MTSLs and the lateral (+ = tendon, lat = muscle belly) and medial (☆) heads of the FHB. The adductor hallucis conjoint tendon is formed from the transverse (t = muscle, solid oval = tendon) and oblique (o = muscle, dashed oval = tendon) heads. Dorsally, the extensor tendons (e) can be seen secured by the lateral and medial sagittal bands (arrowheads).
Musculotendinous structures of the first MTPJ. Coronal PDW images (2000/35) of the metatarsosesamoid joint (a) and the distal first metatarsal (MT) (b) depict the attachment of the adductor (dotted arrow) and abductor (solid arrow) hallucis tendons to the lateral (L) and medial (M) sesamoids. These tendons insert in close relation to the lateral (#) and medial (*) MTSLs and the lateral (+ = tendon, lat = muscle belly) and medial (☆) heads of the FHB. The adductor hallucis conjoint tendon is formed from the transverse (t = muscle, solid oval = tendon) and oblique (o = muscle, dashed oval = tendon) heads. Dorsally, the extensor tendons (e) can be seen secured by the lateral and medial sagittal bands (arrowheads).
Figure 6b.
Musculotendinous structures of the first MTPJ. Coronal PDW images (2000/35) of the metatarsosesamoid joint (a) and the distal first metatarsal (MT) (b) depict the attachment of the adductor (dotted arrow) and abductor (solid arrow) hallucis tendons to the lateral (L) and medial (M) sesamoids. These tendons insert in close relation to the lateral (#) and medial (*) MTSLs and the lateral (+ = tendon, lat = muscle belly) and medial (☆) heads of the FHB. The adductor hallucis conjoint tendon is formed from the transverse (t = muscle, solid oval = tendon) and oblique (o = muscle, dashed oval = tendon) heads. Dorsally, the extensor tendons (e) can be seen secured by the lateral and medial sagittal bands (arrowheads).
Axial (long-axis) PDW image (2000/35) shows the first MTPJ collateral ligaments. Lateral (arrows) and medial (arrowheads) collateral ligaments resist varus and valgus first MTPJ forces, respectively.
Figure 7.
Axial (long-axis) PDW image (2000/35) shows the first MTPJ collateral ligaments. Lateral (arrows) and medial (arrowheads) collateral ligaments resist varus and valgus first MTPJ forces, respectively.
Turf toe in a 28-year-old professional American football player. Arrowheads = FHL, MT = first metatarsal. (a) Sagittal PDW FS image of the right first MTPJ shows complete tearing of the medial SPL (arrow). Additional high-grade tearing of the lateral SPL was apparent (not shown). PP = first proximal phalanx. (b, c) Coronal PDW FS images of the lateral (L) and medial (M) sesamoids (b) and just distal to the sesamoids (c) show the medial SPL tear extending into the ISL (★) and central plantar plate (*). Partial tearing of the medial MTSL (dotted arrow) is also seen. (d) Lateral dynamic dorsiflexed radiograph of both feet shows increased proximal migration of the right medial sesamoid compared to the left medial sesamoid. The medial sesamoids and proximal phalanges are outlined (dashed lines).
Figure 8a.
Turf toe in a 28-year-old professional American football player. Arrowheads = FHL, MT = first metatarsal. (a) Sagittal PDW FS image of the right first MTPJ shows complete tearing of the medial SPL (arrow). Additional high-grade tearing of the lateral SPL was apparent (not shown). PP = first proximal phalanx. (b, c) Coronal PDW FS images of the lateral (L) and medial (M) sesamoids (b) and just distal to the sesamoids (c) show the medial SPL tear extending into the ISL (★) and central plantar plate (*). Partial tearing of the medial MTSL (dotted arrow) is also seen. (d) Lateral dynamic dorsiflexed radiograph of both feet shows increased proximal migration of the right medial sesamoid compared to the left medial sesamoid. The medial sesamoids and proximal phalanges are outlined (dashed lines).
Turf toe in a 28-year-old professional American football player. Arrowheads = FHL, MT = first metatarsal. (a) Sagittal PDW FS image of the right first MTPJ shows complete tearing of the medial SPL (arrow). Additional high-grade tearing of the lateral SPL was apparent (not shown). PP = first proximal phalanx. (b, c) Coronal PDW FS images of the lateral (L) and medial (M) sesamoids (b) and just distal to the sesamoids (c) show the medial SPL tear extending into the ISL (★) and central plantar plate (*). Partial tearing of the medial MTSL (dotted arrow) is also seen. (d) Lateral dynamic dorsiflexed radiograph of both feet shows increased proximal migration of the right medial sesamoid compared to the left medial sesamoid. The medial sesamoids and proximal phalanges are outlined (dashed lines).
Figure 8b.
Turf toe in a 28-year-old professional American football player. Arrowheads = FHL, MT = first metatarsal. (a) Sagittal PDW FS image of the right first MTPJ shows complete tearing of the medial SPL (arrow). Additional high-grade tearing of the lateral SPL was apparent (not shown). PP = first proximal phalanx. (b, c) Coronal PDW FS images of the lateral (L) and medial (M) sesamoids (b) and just distal to the sesamoids (c) show the medial SPL tear extending into the ISL (★) and central plantar plate (*). Partial tearing of the medial MTSL (dotted arrow) is also seen. (d) Lateral dynamic dorsiflexed radiograph of both feet shows increased proximal migration of the right medial sesamoid compared to the left medial sesamoid. The medial sesamoids and proximal phalanges are outlined (dashed lines).
Turf toe in a 28-year-old professional American football player. Arrowheads = FHL, MT = first metatarsal. (a) Sagittal PDW FS image of the right first MTPJ shows complete tearing of the medial SPL (arrow). Additional high-grade tearing of the lateral SPL was apparent (not shown). PP = first proximal phalanx. (b, c) Coronal PDW FS images of the lateral (L) and medial (M) sesamoids (b) and just distal to the sesamoids (c) show the medial SPL tear extending into the ISL (★) and central plantar plate (*). Partial tearing of the medial MTSL (dotted arrow) is also seen. (d) Lateral dynamic dorsiflexed radiograph of both feet shows increased proximal migration of the right medial sesamoid compared to the left medial sesamoid. The medial sesamoids and proximal phalanges are outlined (dashed lines).
Figure 8c.
Turf toe in a 28-year-old professional American football player. Arrowheads = FHL, MT = first metatarsal. (a) Sagittal PDW FS image of the right first MTPJ shows complete tearing of the medial SPL (arrow). Additional high-grade tearing of the lateral SPL was apparent (not shown). PP = first proximal phalanx. (b, c) Coronal PDW FS images of the lateral (L) and medial (M) sesamoids (b) and just distal to the sesamoids (c) show the medial SPL tear extending into the ISL (★) and central plantar plate (*). Partial tearing of the medial MTSL (dotted arrow) is also seen. (d) Lateral dynamic dorsiflexed radiograph of both feet shows increased proximal migration of the right medial sesamoid compared to the left medial sesamoid. The medial sesamoids and proximal phalanges are outlined (dashed lines).
Turf toe in a 28-year-old professional American football player. Arrowheads = FHL, MT = first metatarsal. (a) Sagittal PDW FS image of the right first MTPJ shows complete tearing of the medial SPL (arrow). Additional high-grade tearing of the lateral SPL was apparent (not shown). PP = first proximal phalanx. (b, c) Coronal PDW FS images of the lateral (L) and medial (M) sesamoids (b) and just distal to the sesamoids (c) show the medial SPL tear extending into the ISL (★) and central plantar plate (*). Partial tearing of the medial MTSL (dotted arrow) is also seen. (d) Lateral dynamic dorsiflexed radiograph of both feet shows increased proximal migration of the right medial sesamoid compared to the left medial sesamoid. The medial sesamoids and proximal phalanges are outlined (dashed lines).
Figure 8d.
Turf toe in a 28-year-old professional American football player. Arrowheads = FHL, MT = first metatarsal. (a) Sagittal PDW FS image of the right first MTPJ shows complete tearing of the medial SPL (arrow). Additional high-grade tearing of the lateral SPL was apparent (not shown). PP = first proximal phalanx. (b, c) Coronal PDW FS images of the lateral (L) and medial (M) sesamoids (b) and just distal to the sesamoids (c) show the medial SPL tear extending into the ISL (★) and central plantar plate (*). Partial tearing of the medial MTSL (dotted arrow) is also seen. (d) Lateral dynamic dorsiflexed radiograph of both feet shows increased proximal migration of the right medial sesamoid compared to the left medial sesamoid. The medial sesamoids and proximal phalanges are outlined (dashed lines).
Turf toe in a 24-year-old professional football player. (a, b) Sagittal PDW (a) and sagittal PDW FS (b) images show complete tearing of the lateral SPL (arrow). Complete tearing of the medial SPL was also present (not shown). Slight proximal migration of the lateral (L) and medial (M) sesamoids is noted on the static MR images (a–c). MT = first metatarsal, PP = first proximal phalanx. (c) Axial (long-axis) PDW FS image shows marked edema at the plantar plate complex and lateral (dotted arrow) and medial (solid arrow) SPLs. (d) Lateral dynamic dorsiflexed radiograph of both feet shows proximal medial and lateral sesamoid migration in the right foot because of SPL tearing.
Figure 9a.
Turf toe in a 24-year-old professional football player. (a, b) Sagittal PDW (a) and sagittal PDW FS (b) images show complete tearing of the lateral SPL (arrow). Complete tearing of the medial SPL was also present (not shown). Slight proximal migration of the lateral (L) and medial (M) sesamoids is noted on the static MR images (a–c). MT = first metatarsal, PP = first proximal phalanx. (c) Axial (long-axis) PDW FS image shows marked edema at the plantar plate complex and lateral (dotted arrow) and medial (solid arrow) SPLs. (d) Lateral dynamic dorsiflexed radiograph of both feet shows proximal medial and lateral sesamoid migration in the right foot because of SPL tearing.
Turf toe in a 24-year-old professional football player. (a, b) Sagittal PDW (a) and sagittal PDW FS (b) images show complete tearing of the lateral SPL (arrow). Complete tearing of the medial SPL was also present (not shown). Slight proximal migration of the lateral (L) and medial (M) sesamoids is noted on the static MR images (a–c). MT = first metatarsal, PP = first proximal phalanx. (c) Axial (long-axis) PDW FS image shows marked edema at the plantar plate complex and lateral (dotted arrow) and medial (solid arrow) SPLs. (d) Lateral dynamic dorsiflexed radiograph of both feet shows proximal medial and lateral sesamoid migration in the right foot because of SPL tearing.
Figure 9b.
Turf toe in a 24-year-old professional football player. (a, b) Sagittal PDW (a) and sagittal PDW FS (b) images show complete tearing of the lateral SPL (arrow). Complete tearing of the medial SPL was also present (not shown). Slight proximal migration of the lateral (L) and medial (M) sesamoids is noted on the static MR images (a–c). MT = first metatarsal, PP = first proximal phalanx. (c) Axial (long-axis) PDW FS image shows marked edema at the plantar plate complex and lateral (dotted arrow) and medial (solid arrow) SPLs. (d) Lateral dynamic dorsiflexed radiograph of both feet shows proximal medial and lateral sesamoid migration in the right foot because of SPL tearing.
Turf toe in a 24-year-old professional football player. (a, b) Sagittal PDW (a) and sagittal PDW FS (b) images show complete tearing of the lateral SPL (arrow). Complete tearing of the medial SPL was also present (not shown). Slight proximal migration of the lateral (L) and medial (M) sesamoids is noted on the static MR images (a–c). MT = first metatarsal, PP = first proximal phalanx. (c) Axial (long-axis) PDW FS image shows marked edema at the plantar plate complex and lateral (dotted arrow) and medial (solid arrow) SPLs. (d) Lateral dynamic dorsiflexed radiograph of both feet shows proximal medial and lateral sesamoid migration in the right foot because of SPL tearing.
Figure 9c.
Turf toe in a 24-year-old professional football player. (a, b) Sagittal PDW (a) and sagittal PDW FS (b) images show complete tearing of the lateral SPL (arrow). Complete tearing of the medial SPL was also present (not shown). Slight proximal migration of the lateral (L) and medial (M) sesamoids is noted on the static MR images (a–c). MT = first metatarsal, PP = first proximal phalanx. (c) Axial (long-axis) PDW FS image shows marked edema at the plantar plate complex and lateral (dotted arrow) and medial (solid arrow) SPLs. (d) Lateral dynamic dorsiflexed radiograph of both feet shows proximal medial and lateral sesamoid migration in the right foot because of SPL tearing.
Turf toe in a 24-year-old professional football player. (a, b) Sagittal PDW (a) and sagittal PDW FS (b) images show complete tearing of the lateral SPL (arrow). Complete tearing of the medial SPL was also present (not shown). Slight proximal migration of the lateral (L) and medial (M) sesamoids is noted on the static MR images (a–c). MT = first metatarsal, PP = first proximal phalanx. (c) Axial (long-axis) PDW FS image shows marked edema at the plantar plate complex and lateral (dotted arrow) and medial (solid arrow) SPLs. (d) Lateral dynamic dorsiflexed radiograph of both feet shows proximal medial and lateral sesamoid migration in the right foot because of SPL tearing.
Figure 9d.
Turf toe in a 24-year-old professional football player. (a, b) Sagittal PDW (a) and sagittal PDW FS (b) images show complete tearing of the lateral SPL (arrow). Complete tearing of the medial SPL was also present (not shown). Slight proximal migration of the lateral (L) and medial (M) sesamoids is noted on the static MR images (a–c). MT = first metatarsal, PP = first proximal phalanx. (c) Axial (long-axis) PDW FS image shows marked edema at the plantar plate complex and lateral (dotted arrow) and medial (solid arrow) SPLs. (d) Lateral dynamic dorsiflexed radiograph of both feet shows proximal medial and lateral sesamoid migration in the right foot because of SPL tearing.
Skimboarder toe. Coronal T1-weighted (a) and T2-weighted FS (b) images show high-grade tearing of the medial sagittal band (arrowhead) and lateral subluxation of the extensor tendons (black arrow) due to forced hyperextension. Tearing of the medial capsular structures and collateral ligament is noted (white arrow) with additional medial sesamoiditis or degeneration. Skimboarders use their great toe for traction when mounting their waxed boards. The board can slip posteriorly, leading to forced first MTPJ hyperextension. L = lateral, M = medial.
Figure 10a.
Skimboarder toe. Coronal T1-weighted (a) and T2-weighted FS (b) images show high-grade tearing of the medial sagittal band (arrowhead) and lateral subluxation of the extensor tendons (black arrow) due to forced hyperextension. Tearing of the medial capsular structures and collateral ligament is noted (white arrow) with additional medial sesamoiditis or degeneration. Skimboarders use their great toe for traction when mounting their waxed boards. The board can slip posteriorly, leading to forced first MTPJ hyperextension. L = lateral, M = medial.
Skimboarder toe. Coronal T1-weighted (a) and T2-weighted FS (b) images show high-grade tearing of the medial sagittal band (arrowhead) and lateral subluxation of the extensor tendons (black arrow) due to forced hyperextension. Tearing of the medial capsular structures and collateral ligament is noted (white arrow) with additional medial sesamoiditis or degeneration. Skimboarders use their great toe for traction when mounting their waxed boards. The board can slip posteriorly, leading to forced first MTPJ hyperextension. L = lateral, M = medial.
Figure 10b.
Skimboarder toe. Coronal T1-weighted (a) and T2-weighted FS (b) images show high-grade tearing of the medial sagittal band (arrowhead) and lateral subluxation of the extensor tendons (black arrow) due to forced hyperextension. Tearing of the medial capsular structures and collateral ligament is noted (white arrow) with additional medial sesamoiditis or degeneration. Skimboarders use their great toe for traction when mounting their waxed boards. The board can slip posteriorly, leading to forced first MTPJ hyperextension. L = lateral, M = medial.
Medial MTSL tear in a 21-year-old man. Coronal (a) and axial (b) T2-weighted FS images show mild chondral loss (*) at the medial sesamoid and metatarsal head articulation. Partial tearing of the medial MTSL and capsular structures is seen with a fluid cleft at the sesamoid insertion (arrow). Thickening and altered signal intensity of the medial head of the FHB and abductor hallucis tendons (arrowhead) is compatible with tendinosis. These medial plantar structures interlink to prevent hallux valgus. L = lateral sesamoid, MT = first metatarsal.
Figure 11a.
Medial MTSL tear in a 21-year-old man. Coronal (a) and axial (b) T2-weighted FS images show mild chondral loss (*) at the medial sesamoid and metatarsal head articulation. Partial tearing of the medial MTSL and capsular structures is seen with a fluid cleft at the sesamoid insertion (arrow). Thickening and altered signal intensity of the medial head of the FHB and abductor hallucis tendons (arrowhead) is compatible with tendinosis. These medial plantar structures interlink to prevent hallux valgus. L = lateral sesamoid, MT = first metatarsal.
Medial MTSL tear in a 21-year-old man. Coronal (a) and axial (b) T2-weighted FS images show mild chondral loss (*) at the medial sesamoid and metatarsal head articulation. Partial tearing of the medial MTSL and capsular structures is seen with a fluid cleft at the sesamoid insertion (arrow). Thickening and altered signal intensity of the medial head of the FHB and abductor hallucis tendons (arrowhead) is compatible with tendinosis. These medial plantar structures interlink to prevent hallux valgus. L = lateral sesamoid, MT = first metatarsal.
Figure 11b.
Medial MTSL tear in a 21-year-old man. Coronal (a) and axial (b) T2-weighted FS images show mild chondral loss (*) at the medial sesamoid and metatarsal head articulation. Partial tearing of the medial MTSL and capsular structures is seen with a fluid cleft at the sesamoid insertion (arrow). Thickening and altered signal intensity of the medial head of the FHB and abductor hallucis tendons (arrowhead) is compatible with tendinosis. These medial plantar structures interlink to prevent hallux valgus. L = lateral sesamoid, MT = first metatarsal.
Lateral MTSL tear in a 54-year-old woman with right hallux valgus and first web space pain. Coronal T2-weighted FS (a) and PDW (b) images show chondral loss at the lateral sesamoid (*) and first metatarsal articulation (dashed oval). There is partial tearing of the lateral MTSL (☆) with adjacent first web space edema and adductor hallucis tendinosis (solid white arrow). Medial sagittal band tearing (dotted arrow) and mild lateral subluxation of the extensor tendons (black arrow) are due to underlying hallux valgus. There is atrophy of the abductor hallucis and the FHB muscles (arrowheads) due to long-standing hallux valgus deformity. f = flexor hallucis longus tendon, MT = first metatarsal.
Figure 12a.
Lateral MTSL tear in a 54-year-old woman with right hallux valgus and first web space pain. Coronal T2-weighted FS (a) and PDW (b) images show chondral loss at the lateral sesamoid (*) and first metatarsal articulation (dashed oval). There is partial tearing of the lateral MTSL (☆) with adjacent first web space edema and adductor hallucis tendinosis (solid white arrow). Medial sagittal band tearing (dotted arrow) and mild lateral subluxation of the extensor tendons (black arrow) are due to underlying hallux valgus. There is atrophy of the abductor hallucis and the FHB muscles (arrowheads) due to long-standing hallux valgus deformity. f = flexor hallucis longus tendon, MT = first metatarsal.
Lateral MTSL tear in a 54-year-old woman with right hallux valgus and first web space pain. Coronal T2-weighted FS (a) and PDW (b) images show chondral loss at the lateral sesamoid (*) and first metatarsal articulation (dashed oval). There is partial tearing of the lateral MTSL (☆) with adjacent first web space edema and adductor hallucis tendinosis (solid white arrow). Medial sagittal band tearing (dotted arrow) and mild lateral subluxation of the extensor tendons (black arrow) are due to underlying hallux valgus. There is atrophy of the abductor hallucis and the FHB muscles (arrowheads) due to long-standing hallux valgus deformity. f = flexor hallucis longus tendon, MT = first metatarsal.
Figure 12b.
Lateral MTSL tear in a 54-year-old woman with right hallux valgus and first web space pain. Coronal T2-weighted FS (a) and PDW (b) images show chondral loss at the lateral sesamoid (*) and first metatarsal articulation (dashed oval). There is partial tearing of the lateral MTSL (☆) with adjacent first web space edema and adductor hallucis tendinosis (solid white arrow). Medial sagittal band tearing (dotted arrow) and mild lateral subluxation of the extensor tendons (black arrow) are due to underlying hallux valgus. There is atrophy of the abductor hallucis and the FHB muscles (arrowheads) due to long-standing hallux valgus deformity. f = flexor hallucis longus tendon, MT = first metatarsal.
Lateral MTSL tear and adductor hallucis tendinosis and atrophy in a 69-year-old woman with hallux valgus and persistent foot pain. Coronal PDW (a, c) and T2-weighted FS (b) images show first MTPJ degenerative changes with chondral loss and subchondral edema most apparent at the lateral sesamoid (L) and metatarsal articulation. There is partial tearing of the lateral MTSL (dashed circle) and lateral collateral ligament (black arrow). More proximally in b, there is predislocation syndrome with edema surrounding the distal second (m) and third metatarsal shafts and MTPJs due to capsulitis. Tendinosis of the transverse (solid white arrow) and oblique (dotted arrow) heads of the adductor hallucis is apparent with fatty muscle atrophy (arrowheads) seen proximally in c. f = flexor hallucis longus tendon, M = medial sesamoid, MT = metatarsal.
Figure 13a.
Lateral MTSL tear and adductor hallucis tendinosis and atrophy in a 69-year-old woman with hallux valgus and persistent foot pain. Coronal PDW (a, c) and T2-weighted FS (b) images show first MTPJ degenerative changes with chondral loss and subchondral edema most apparent at the lateral sesamoid (L) and metatarsal articulation. There is partial tearing of the lateral MTSL (dashed circle) and lateral collateral ligament (black arrow). More proximally in b, there is predislocation syndrome with edema surrounding the distal second (m) and third metatarsal shafts and MTPJs due to capsulitis. Tendinosis of the transverse (solid white arrow) and oblique (dotted arrow) heads of the adductor hallucis is apparent with fatty muscle atrophy (arrowheads) seen proximally in c. f = flexor hallucis longus tendon, M = medial sesamoid, MT = metatarsal.
Lateral MTSL tear and adductor hallucis tendinosis and atrophy in a 69-year-old woman with hallux valgus and persistent foot pain. Coronal PDW (a, c) and T2-weighted FS (b) images show first MTPJ degenerative changes with chondral loss and subchondral edema most apparent at the lateral sesamoid (L) and metatarsal articulation. There is partial tearing of the lateral MTSL (dashed circle) and lateral collateral ligament (black arrow). More proximally in b, there is predislocation syndrome with edema surrounding the distal second (m) and third metatarsal shafts and MTPJs due to capsulitis. Tendinosis of the transverse (solid white arrow) and oblique (dotted arrow) heads of the adductor hallucis is apparent with fatty muscle atrophy (arrowheads) seen proximally in c. f = flexor hallucis longus tendon, M = medial sesamoid, MT = metatarsal.
Figure 13b.
Lateral MTSL tear and adductor hallucis tendinosis and atrophy in a 69-year-old woman with hallux valgus and persistent foot pain. Coronal PDW (a, c) and T2-weighted FS (b) images show first MTPJ degenerative changes with chondral loss and subchondral edema most apparent at the lateral sesamoid (L) and metatarsal articulation. There is partial tearing of the lateral MTSL (dashed circle) and lateral collateral ligament (black arrow). More proximally in b, there is predislocation syndrome with edema surrounding the distal second (m) and third metatarsal shafts and MTPJs due to capsulitis. Tendinosis of the transverse (solid white arrow) and oblique (dotted arrow) heads of the adductor hallucis is apparent with fatty muscle atrophy (arrowheads) seen proximally in c. f = flexor hallucis longus tendon, M = medial sesamoid, MT = metatarsal.
Lateral MTSL tear and adductor hallucis tendinosis and atrophy in a 69-year-old woman with hallux valgus and persistent foot pain. Coronal PDW (a, c) and T2-weighted FS (b) images show first MTPJ degenerative changes with chondral loss and subchondral edema most apparent at the lateral sesamoid (L) and metatarsal articulation. There is partial tearing of the lateral MTSL (dashed circle) and lateral collateral ligament (black arrow). More proximally in b, there is predislocation syndrome with edema surrounding the distal second (m) and third metatarsal shafts and MTPJs due to capsulitis. Tendinosis of the transverse (solid white arrow) and oblique (dotted arrow) heads of the adductor hallucis is apparent with fatty muscle atrophy (arrowheads) seen proximally in c. f = flexor hallucis longus tendon, M = medial sesamoid, MT = metatarsal.
Figure 13c.
Lateral MTSL tear and adductor hallucis tendinosis and atrophy in a 69-year-old woman with hallux valgus and persistent foot pain. Coronal PDW (a, c) and T2-weighted FS (b) images show first MTPJ degenerative changes with chondral loss and subchondral edema most apparent at the lateral sesamoid (L) and metatarsal articulation. There is partial tearing of the lateral MTSL (dashed circle) and lateral collateral ligament (black arrow). More proximally in b, there is predislocation syndrome with edema surrounding the distal second (m) and third metatarsal shafts and MTPJs due to capsulitis. Tendinosis of the transverse (solid white arrow) and oblique (dotted arrow) heads of the adductor hallucis is apparent with fatty muscle atrophy (arrowheads) seen proximally in c. f = flexor hallucis longus tendon, M = medial sesamoid, MT = metatarsal.
Bipartite sesamoiditis. (a–c) Axial (a) and sagittal T2-weighted FS (b) and sagittal (c) PDW images show medial sesamoiditis in a 24-year-old woman with pain at the plantar aspect of the right first MTPJ. There is a bifid appearance of the medial sesamoid with marrow edema (solid arrow in a and b) at both components. Smooth corticated margins and the presence of a waist at the superior margin of the sesamoid (arrow in c) are more suggestive of bipartite sesamoiditis rather than a fracture. Partial tearing of the medial SPL is also seen (dotted arrow). Radiographs were not available in this patient but are useful for assessment and follow-up. L = lateral sesamoid. (d, e) Dorsoplantar (d) and lateral (e) radiographs in a 15-year-old patient with plantar trauma show separation of two components at the medial sesamoid (dashed circles). This was a challenging case, with the proximal rounded margins of the distal component (arrowhead) suggestive of diastasis of a bipartite sesamoid rather than a fracture. Despite the challenges in differentiating the two conditions, fracture and diastasis are treated similarly with initial conservative management.
Figure 14a.
Bipartite sesamoiditis. (a–c) Axial (a) and sagittal T2-weighted FS (b) and sagittal (c) PDW images show medial sesamoiditis in a 24-year-old woman with pain at the plantar aspect of the right first MTPJ. There is a bifid appearance of the medial sesamoid with marrow edema (solid arrow in a and b) at both components. Smooth corticated margins and the presence of a waist at the superior margin of the sesamoid (arrow in c) are more suggestive of bipartite sesamoiditis rather than a fracture. Partial tearing of the medial SPL is also seen (dotted arrow). Radiographs were not available in this patient but are useful for assessment and follow-up. L = lateral sesamoid. (d, e) Dorsoplantar (d) and lateral (e) radiographs in a 15-year-old patient with plantar trauma show separation of two components at the medial sesamoid (dashed circles). This was a challenging case, with the proximal rounded margins of the distal component (arrowhead) suggestive of diastasis of a bipartite sesamoid rather than a fracture. Despite the challenges in differentiating the two conditions, fracture and diastasis are treated similarly with initial conservative management.
Bipartite sesamoiditis. (a–c) Axial (a) and sagittal T2-weighted FS (b) and sagittal (c) PDW images show medial sesamoiditis in a 24-year-old woman with pain at the plantar aspect of the right first MTPJ. There is a bifid appearance of the medial sesamoid with marrow edema (solid arrow in a and b) at both components. Smooth corticated margins and the presence of a waist at the superior margin of the sesamoid (arrow in c) are more suggestive of bipartite sesamoiditis rather than a fracture. Partial tearing of the medial SPL is also seen (dotted arrow). Radiographs were not available in this patient but are useful for assessment and follow-up. L = lateral sesamoid. (d, e) Dorsoplantar (d) and lateral (e) radiographs in a 15-year-old patient with plantar trauma show separation of two components at the medial sesamoid (dashed circles). This was a challenging case, with the proximal rounded margins of the distal component (arrowhead) suggestive of diastasis of a bipartite sesamoid rather than a fracture. Despite the challenges in differentiating the two conditions, fracture and diastasis are treated similarly with initial conservative management.
Figure 14b.
Bipartite sesamoiditis. (a–c) Axial (a) and sagittal T2-weighted FS (b) and sagittal (c) PDW images show medial sesamoiditis in a 24-year-old woman with pain at the plantar aspect of the right first MTPJ. There is a bifid appearance of the medial sesamoid with marrow edema (solid arrow in a and b) at both components. Smooth corticated margins and the presence of a waist at the superior margin of the sesamoid (arrow in c) are more suggestive of bipartite sesamoiditis rather than a fracture. Partial tearing of the medial SPL is also seen (dotted arrow). Radiographs were not available in this patient but are useful for assessment and follow-up. L = lateral sesamoid. (d, e) Dorsoplantar (d) and lateral (e) radiographs in a 15-year-old patient with plantar trauma show separation of two components at the medial sesamoid (dashed circles). This was a challenging case, with the proximal rounded margins of the distal component (arrowhead) suggestive of diastasis of a bipartite sesamoid rather than a fracture. Despite the challenges in differentiating the two conditions, fracture and diastasis are treated similarly with initial conservative management.
Bipartite sesamoiditis. (a–c) Axial (a) and sagittal T2-weighted FS (b) and sagittal (c) PDW images show medial sesamoiditis in a 24-year-old woman with pain at the plantar aspect of the right first MTPJ. There is a bifid appearance of the medial sesamoid with marrow edema (solid arrow in a and b) at both components. Smooth corticated margins and the presence of a waist at the superior margin of the sesamoid (arrow in c) are more suggestive of bipartite sesamoiditis rather than a fracture. Partial tearing of the medial SPL is also seen (dotted arrow). Radiographs were not available in this patient but are useful for assessment and follow-up. L = lateral sesamoid. (d, e) Dorsoplantar (d) and lateral (e) radiographs in a 15-year-old patient with plantar trauma show separation of two components at the medial sesamoid (dashed circles). This was a challenging case, with the proximal rounded margins of the distal component (arrowhead) suggestive of diastasis of a bipartite sesamoid rather than a fracture. Despite the challenges in differentiating the two conditions, fracture and diastasis are treated similarly with initial conservative management.
Figure 14c.
Bipartite sesamoiditis. (a–c) Axial (a) and sagittal T2-weighted FS (b) and sagittal (c) PDW images show medial sesamoiditis in a 24-year-old woman with pain at the plantar aspect of the right first MTPJ. There is a bifid appearance of the medial sesamoid with marrow edema (solid arrow in a and b) at both components. Smooth corticated margins and the presence of a waist at the superior margin of the sesamoid (arrow in c) are more suggestive of bipartite sesamoiditis rather than a fracture. Partial tearing of the medial SPL is also seen (dotted arrow). Radiographs were not available in this patient but are useful for assessment and follow-up. L = lateral sesamoid. (d, e) Dorsoplantar (d) and lateral (e) radiographs in a 15-year-old patient with plantar trauma show separation of two components at the medial sesamoid (dashed circles). This was a challenging case, with the proximal rounded margins of the distal component (arrowhead) suggestive of diastasis of a bipartite sesamoid rather than a fracture. Despite the challenges in differentiating the two conditions, fracture and diastasis are treated similarly with initial conservative management.
Bipartite sesamoiditis. (a–c) Axial (a) and sagittal T2-weighted FS (b) and sagittal (c) PDW images show medial sesamoiditis in a 24-year-old woman with pain at the plantar aspect of the right first MTPJ. There is a bifid appearance of the medial sesamoid with marrow edema (solid arrow in a and b) at both components. Smooth corticated margins and the presence of a waist at the superior margin of the sesamoid (arrow in c) are more suggestive of bipartite sesamoiditis rather than a fracture. Partial tearing of the medial SPL is also seen (dotted arrow). Radiographs were not available in this patient but are useful for assessment and follow-up. L = lateral sesamoid. (d, e) Dorsoplantar (d) and lateral (e) radiographs in a 15-year-old patient with plantar trauma show separation of two components at the medial sesamoid (dashed circles). This was a challenging case, with the proximal rounded margins of the distal component (arrowhead) suggestive of diastasis of a bipartite sesamoid rather than a fracture. Despite the challenges in differentiating the two conditions, fracture and diastasis are treated similarly with initial conservative management.
Figure 14d.
Bipartite sesamoiditis. (a–c) Axial (a) and sagittal T2-weighted FS (b) and sagittal (c) PDW images show medial sesamoiditis in a 24-year-old woman with pain at the plantar aspect of the right first MTPJ. There is a bifid appearance of the medial sesamoid with marrow edema (solid arrow in a and b) at both components. Smooth corticated margins and the presence of a waist at the superior margin of the sesamoid (arrow in c) are more suggestive of bipartite sesamoiditis rather than a fracture. Partial tearing of the medial SPL is also seen (dotted arrow). Radiographs were not available in this patient but are useful for assessment and follow-up. L = lateral sesamoid. (d, e) Dorsoplantar (d) and lateral (e) radiographs in a 15-year-old patient with plantar trauma show separation of two components at the medial sesamoid (dashed circles). This was a challenging case, with the proximal rounded margins of the distal component (arrowhead) suggestive of diastasis of a bipartite sesamoid rather than a fracture. Despite the challenges in differentiating the two conditions, fracture and diastasis are treated similarly with initial conservative management.
Bipartite sesamoiditis. (a–c) Axial (a) and sagittal T2-weighted FS (b) and sagittal (c) PDW images show medial sesamoiditis in a 24-year-old woman with pain at the plantar aspect of the right first MTPJ. There is a bifid appearance of the medial sesamoid with marrow edema (solid arrow in a and b) at both components. Smooth corticated margins and the presence of a waist at the superior margin of the sesamoid (arrow in c) are more suggestive of bipartite sesamoiditis rather than a fracture. Partial tearing of the medial SPL is also seen (dotted arrow). Radiographs were not available in this patient but are useful for assessment and follow-up. L = lateral sesamoid. (d, e) Dorsoplantar (d) and lateral (e) radiographs in a 15-year-old patient with plantar trauma show separation of two components at the medial sesamoid (dashed circles). This was a challenging case, with the proximal rounded margins of the distal component (arrowhead) suggestive of diastasis of a bipartite sesamoid rather than a fracture. Despite the challenges in differentiating the two conditions, fracture and diastasis are treated similarly with initial conservative management.
Figure 14e.
Bipartite sesamoiditis. (a–c) Axial (a) and sagittal T2-weighted FS (b) and sagittal (c) PDW images show medial sesamoiditis in a 24-year-old woman with pain at the plantar aspect of the right first MTPJ. There is a bifid appearance of the medial sesamoid with marrow edema (solid arrow in a and b) at both components. Smooth corticated margins and the presence of a waist at the superior margin of the sesamoid (arrow in c) are more suggestive of bipartite sesamoiditis rather than a fracture. Partial tearing of the medial SPL is also seen (dotted arrow). Radiographs were not available in this patient but are useful for assessment and follow-up. L = lateral sesamoid. (d, e) Dorsoplantar (d) and lateral (e) radiographs in a 15-year-old patient with plantar trauma show separation of two components at the medial sesamoid (dashed circles). This was a challenging case, with the proximal rounded margins of the distal component (arrowhead) suggestive of diastasis of a bipartite sesamoid rather than a fracture. Despite the challenges in differentiating the two conditions, fracture and diastasis are treated similarly with initial conservative management.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Figure 15a.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Figure 15b.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Figure 15c.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Figure 15d.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Figure 15e.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Figure 15f.
Sesamoid fracture. (a, b) Medial sesamoid fracture in a 32-year-old man after a fall. Axial T2-weighted FS (a) and sagittal PDW (b) images show an irregular cleft through the medial sesamoid with edema at the bony fragments and mild displacement likely caused by a fracture (solid white arrow). An intact medial SPL is apparent (dotted arrow). Differentiating a bipartite sesamoid from a fracture can be challenging. Irregular margins, displacement of the bony components, and a clear history of trauma are more suggestive of a fracture. Radiographs can be useful in assessment and follow-up, but radiographs were not available in this patient. L = lateral sesamoid. (c) Dorsoplantar radiograph in a 49-year-old woman with trauma to the medial sesamoid shows a cleft at the medial sesamoid with slightly irregular margins and no rounded waist (dashed circle). These imaging features are more suggestive of a fracture. (d, e) Dorsoplantar radiograph (d) obtained at 1-year follow-up and axial CT image (e) show interval osseous bridging due to healing. (f) Medial oblique radiograph in a 24-year-old woman shows an irregular fracture of the proximal lateral sesamoid (arrowhead) associated with a dislocation at the first MTPJ due to a motor vehicle accident.
Extensor tendon injury in a 70-year-old woman after resection of dorsal first MTPJ osteophytes (cheilectomy). Coronal PDW (a) and sagittal T2-weighted FS (b) images show partial tearing of the extensor tendons at the level of the metatarsal (MT) head, most marked at the EHB (solid white arrow) near the proximal phalanx insertion, with less marked changes at the EHL with an intact distal phalanx (DP) insertion (arrowheads). The dorsal medial sagittal band (black arrow) is partly torn with first MTPJ degeneration and subchondral cysts, along with tearing of the plantar plate complex distally (dotted arrow).
Figure 16a.
Extensor tendon injury in a 70-year-old woman after resection of dorsal first MTPJ osteophytes (cheilectomy). Coronal PDW (a) and sagittal T2-weighted FS (b) images show partial tearing of the extensor tendons at the level of the metatarsal (MT) head, most marked at the EHB (solid white arrow) near the proximal phalanx insertion, with less marked changes at the EHL with an intact distal phalanx (DP) insertion (arrowheads). The dorsal medial sagittal band (black arrow) is partly torn with first MTPJ degeneration and subchondral cysts, along with tearing of the plantar plate complex distally (dotted arrow).
Extensor tendon injury in a 70-year-old woman after resection of dorsal first MTPJ osteophytes (cheilectomy). Coronal PDW (a) and sagittal T2-weighted FS (b) images show partial tearing of the extensor tendons at the level of the metatarsal (MT) head, most marked at the EHB (solid white arrow) near the proximal phalanx insertion, with less marked changes at the EHL with an intact distal phalanx (DP) insertion (arrowheads). The dorsal medial sagittal band (black arrow) is partly torn with first MTPJ degeneration and subchondral cysts, along with tearing of the plantar plate complex distally (dotted arrow).
Figure 16b.
Extensor tendon injury in a 70-year-old woman after resection of dorsal first MTPJ osteophytes (cheilectomy). Coronal PDW (a) and sagittal T2-weighted FS (b) images show partial tearing of the extensor tendons at the level of the metatarsal (MT) head, most marked at the EHB (solid white arrow) near the proximal phalanx insertion, with less marked changes at the EHL with an intact distal phalanx (DP) insertion (arrowheads). The dorsal medial sagittal band (black arrow) is partly torn with first MTPJ degeneration and subchondral cysts, along with tearing of the plantar plate complex distally (dotted arrow).
Collateral ligament tears and predislocation syndrome. Axial PDW (a) and coronal T2-weighted FS (b) images show hallux valgus with partial tears of the medial (solid arrow) and lateral (dotted arrow) collateral ligaments with first MTPJ degenerative changes. Capsular thickening and surrounding edema (arrowheads) are seen at the second MTPJ. These imaging features are consistent with adhesive capsulitis, which in association with hallux valgus is termed predislocation syndrome. As the name implies, if the underlying biomechanical abnormality is not corrected, the second MTPJ plantar plate will tear, resulting in instability and eventual dislocation. MT = first metatarsal.
Figure 17a.
Collateral ligament tears and predislocation syndrome. Axial PDW (a) and coronal T2-weighted FS (b) images show hallux valgus with partial tears of the medial (solid arrow) and lateral (dotted arrow) collateral ligaments with first MTPJ degenerative changes. Capsular thickening and surrounding edema (arrowheads) are seen at the second MTPJ. These imaging features are consistent with adhesive capsulitis, which in association with hallux valgus is termed predislocation syndrome. As the name implies, if the underlying biomechanical abnormality is not corrected, the second MTPJ plantar plate will tear, resulting in instability and eventual dislocation. MT = first metatarsal.
Collateral ligament tears and predislocation syndrome. Axial PDW (a) and coronal T2-weighted FS (b) images show hallux valgus with partial tears of the medial (solid arrow) and lateral (dotted arrow) collateral ligaments with first MTPJ degenerative changes. Capsular thickening and surrounding edema (arrowheads) are seen at the second MTPJ. These imaging features are consistent with adhesive capsulitis, which in association with hallux valgus is termed predislocation syndrome. As the name implies, if the underlying biomechanical abnormality is not corrected, the second MTPJ plantar plate will tear, resulting in instability and eventual dislocation. MT = first metatarsal.
Figure 17b.
Collateral ligament tears and predislocation syndrome. Axial PDW (a) and coronal T2-weighted FS (b) images show hallux valgus with partial tears of the medial (solid arrow) and lateral (dotted arrow) collateral ligaments with first MTPJ degenerative changes. Capsular thickening and surrounding edema (arrowheads) are seen at the second MTPJ. These imaging features are consistent with adhesive capsulitis, which in association with hallux valgus is termed predislocation syndrome. As the name implies, if the underlying biomechanical abnormality is not corrected, the second MTPJ plantar plate will tear, resulting in instability and eventual dislocation. MT = first metatarsal.
Treatment for hallux valgus. Axial PDW (a), coronal T2-weighted FS (b), and sagittal PDW (c) images in a 37-year-old man with reduced extension at the right first MTPJ who had hallux valgus corrective surgery 17 years earlier and hardware removed 1 year before. Postoperative changes and metallic artifacts are seen at the first metatarsal (MT) and proximal phalanx (PP) because of osteotomies. There is thickening of the medial collateral ligament (white arrow) and MTSL (☆) with postsurgical fibrosis appearing as low signal intensity along an attenuated medial sagittal band (arrowheads). Lateralization and tendinosis of the extensor tendons (black arrow) with underlying synovitis, fibrosis, and capsulitis (*) lead to reduced extension. The medial SPL (dotted arrow) shows only mild degeneration. L = lateral sesamoid, M = medial sesamoid.
Figure 18a.
Treatment for hallux valgus. Axial PDW (a), coronal T2-weighted FS (b), and sagittal PDW (c) images in a 37-year-old man with reduced extension at the right first MTPJ who had hallux valgus corrective surgery 17 years earlier and hardware removed 1 year before. Postoperative changes and metallic artifacts are seen at the first metatarsal (MT) and proximal phalanx (PP) because of osteotomies. There is thickening of the medial collateral ligament (white arrow) and MTSL (☆) with postsurgical fibrosis appearing as low signal intensity along an attenuated medial sagittal band (arrowheads). Lateralization and tendinosis of the extensor tendons (black arrow) with underlying synovitis, fibrosis, and capsulitis (*) lead to reduced extension. The medial SPL (dotted arrow) shows only mild degeneration. L = lateral sesamoid, M = medial sesamoid.
Treatment for hallux valgus. Axial PDW (a), coronal T2-weighted FS (b), and sagittal PDW (c) images in a 37-year-old man with reduced extension at the right first MTPJ who had hallux valgus corrective surgery 17 years earlier and hardware removed 1 year before. Postoperative changes and metallic artifacts are seen at the first metatarsal (MT) and proximal phalanx (PP) because of osteotomies. There is thickening of the medial collateral ligament (white arrow) and MTSL (☆) with postsurgical fibrosis appearing as low signal intensity along an attenuated medial sagittal band (arrowheads). Lateralization and tendinosis of the extensor tendons (black arrow) with underlying synovitis, fibrosis, and capsulitis (*) lead to reduced extension. The medial SPL (dotted arrow) shows only mild degeneration. L = lateral sesamoid, M = medial sesamoid.
Figure 18b.
Treatment for hallux valgus. Axial PDW (a), coronal T2-weighted FS (b), and sagittal PDW (c) images in a 37-year-old man with reduced extension at the right first MTPJ who had hallux valgus corrective surgery 17 years earlier and hardware removed 1 year before. Postoperative changes and metallic artifacts are seen at the first metatarsal (MT) and proximal phalanx (PP) because of osteotomies. There is thickening of the medial collateral ligament (white arrow) and MTSL (☆) with postsurgical fibrosis appearing as low signal intensity along an attenuated medial sagittal band (arrowheads). Lateralization and tendinosis of the extensor tendons (black arrow) with underlying synovitis, fibrosis, and capsulitis (*) lead to reduced extension. The medial SPL (dotted arrow) shows only mild degeneration. L = lateral sesamoid, M = medial sesamoid.
Treatment for hallux valgus. Axial PDW (a), coronal T2-weighted FS (b), and sagittal PDW (c) images in a 37-year-old man with reduced extension at the right first MTPJ who had hallux valgus corrective surgery 17 years earlier and hardware removed 1 year before. Postoperative changes and metallic artifacts are seen at the first metatarsal (MT) and proximal phalanx (PP) because of osteotomies. There is thickening of the medial collateral ligament (white arrow) and MTSL (☆) with postsurgical fibrosis appearing as low signal intensity along an attenuated medial sagittal band (arrowheads). Lateralization and tendinosis of the extensor tendons (black arrow) with underlying synovitis, fibrosis, and capsulitis (*) lead to reduced extension. The medial SPL (dotted arrow) shows only mild degeneration. L = lateral sesamoid, M = medial sesamoid.
Figure 18c.
Treatment for hallux valgus. Axial PDW (a), coronal T2-weighted FS (b), and sagittal PDW (c) images in a 37-year-old man with reduced extension at the right first MTPJ who had hallux valgus corrective surgery 17 years earlier and hardware removed 1 year before. Postoperative changes and metallic artifacts are seen at the first metatarsal (MT) and proximal phalanx (PP) because of osteotomies. There is thickening of the medial collateral ligament (white arrow) and MTSL (☆) with postsurgical fibrosis appearing as low signal intensity along an attenuated medial sagittal band (arrowheads). Lateralization and tendinosis of the extensor tendons (black arrow) with underlying synovitis, fibrosis, and capsulitis (*) lead to reduced extension. The medial SPL (dotted arrow) shows only mild degeneration. L = lateral sesamoid, M = medial sesamoid.
Gouty arthropathy at the first MTPJ in a 73-year-old man with left hallux valgus and first MTPJ pain and swelling. Coronal T2-weighted FS (a) and axial PDW (b) images show first MTPJ degenerative changes with a heterogeneous-signal-intensity soft-tissue mass medially (arrowheads) and bony erosion at the first metatarsal head (*). The underlying medial collateral ligament is poorly visualized, and there is a large proximal phalangeal cyst (dotted arrow) extending from the joint. These findings are compatible with a gouty tophus and intra-articular involvement.
Figure 19a.
Gouty arthropathy at the first MTPJ in a 73-year-old man with left hallux valgus and first MTPJ pain and swelling. Coronal T2-weighted FS (a) and axial PDW (b) images show first MTPJ degenerative changes with a heterogeneous-signal-intensity soft-tissue mass medially (arrowheads) and bony erosion at the first metatarsal head (*). The underlying medial collateral ligament is poorly visualized, and there is a large proximal phalangeal cyst (dotted arrow) extending from the joint. These findings are compatible with a gouty tophus and intra-articular involvement.
Gouty arthropathy at the first MTPJ in a 73-year-old man with left hallux valgus and first MTPJ pain and swelling. Coronal T2-weighted FS (a) and axial PDW (b) images show first MTPJ degenerative changes with a heterogeneous-signal-intensity soft-tissue mass medially (arrowheads) and bony erosion at the first metatarsal head (*). The underlying medial collateral ligament is poorly visualized, and there is a large proximal phalangeal cyst (dotted arrow) extending from the joint. These findings are compatible with a gouty tophus and intra-articular involvement.
Figure 19b.
Gouty arthropathy at the first MTPJ in a 73-year-old man with left hallux valgus and first MTPJ pain and swelling. Coronal T2-weighted FS (a) and axial PDW (b) images show first MTPJ degenerative changes with a heterogeneous-signal-intensity soft-tissue mass medially (arrowheads) and bony erosion at the first metatarsal head (*). The underlying medial collateral ligament is poorly visualized, and there is a large proximal phalangeal cyst (dotted arrow) extending from the joint. These findings are compatible with a gouty tophus and intra-articular involvement.
Rheumatoid arthritis at the first MTPJ in a 32-year-old woman with known rheumatoid arthritis and first toe pain and stiffness. Coronal T2-weighted FS (a) and axial T1-weighted (b) images show prominent bone marrow edema at the first MTPJ, mainly involving the metatarsal head (*) as well as the medial (M) and lateral (L) sesamoids. These imaging findings are associated with joint effusion and synovial hypertrophy (solid arrows). An erosion is seen along the lateral aspect of the metatarsal head (dotted arrow). The constellation of findings suggests an inflammatory arthropathy.
Figure 20a.
Rheumatoid arthritis at the first MTPJ in a 32-year-old woman with known rheumatoid arthritis and first toe pain and stiffness. Coronal T2-weighted FS (a) and axial T1-weighted (b) images show prominent bone marrow edema at the first MTPJ, mainly involving the metatarsal head (*) as well as the medial (M) and lateral (L) sesamoids. These imaging findings are associated with joint effusion and synovial hypertrophy (solid arrows). An erosion is seen along the lateral aspect of the metatarsal head (dotted arrow). The constellation of findings suggests an inflammatory arthropathy.
Rheumatoid arthritis at the first MTPJ in a 32-year-old woman with known rheumatoid arthritis and first toe pain and stiffness. Coronal T2-weighted FS (a) and axial T1-weighted (b) images show prominent bone marrow edema at the first MTPJ, mainly involving the metatarsal head (*) as well as the medial (M) and lateral (L) sesamoids. These imaging findings are associated with joint effusion and synovial hypertrophy (solid arrows). An erosion is seen along the lateral aspect of the metatarsal head (dotted arrow). The constellation of findings suggests an inflammatory arthropathy.
Figure 20b.
Rheumatoid arthritis at the first MTPJ in a 32-year-old woman with known rheumatoid arthritis and first toe pain and stiffness. Coronal T2-weighted FS (a) and axial T1-weighted (b) images show prominent bone marrow edema at the first MTPJ, mainly involving the metatarsal head (*) as well as the medial (M) and lateral (L) sesamoids. These imaging findings are associated with joint effusion and synovial hypertrophy (solid arrows). An erosion is seen along the lateral aspect of the metatarsal head (dotted arrow). The constellation of findings suggests an inflammatory arthropathy.
Methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis at the first MTPJ in a 70-year-old woman with a diabetic wound at the medial first toe. Coronal T1-weighted (a) and T2-weighted (b) FS images show a large soft-tissue ulcer along the medial aspect of the first MTPJ (arrowhead). There is irregularity and loss of the normal T1-weighted marrow signal at the medial sesamoid (arrow) with edema at the sesamoid and medial metatarsal head (*). These changes are suspicious for osteomyelitis. Soft-tissue swelling and edema around the first digit with a small first MTPJ effusion are also noted.
Figure 21a.
Methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis at the first MTPJ in a 70-year-old woman with a diabetic wound at the medial first toe. Coronal T1-weighted (a) and T2-weighted (b) FS images show a large soft-tissue ulcer along the medial aspect of the first MTPJ (arrowhead). There is irregularity and loss of the normal T1-weighted marrow signal at the medial sesamoid (arrow) with edema at the sesamoid and medial metatarsal head (*). These changes are suspicious for osteomyelitis. Soft-tissue swelling and edema around the first digit with a small first MTPJ effusion are also noted.
Methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis at the first MTPJ in a 70-year-old woman with a diabetic wound at the medial first toe. Coronal T1-weighted (a) and T2-weighted (b) FS images show a large soft-tissue ulcer along the medial aspect of the first MTPJ (arrowhead). There is irregularity and loss of the normal T1-weighted marrow signal at the medial sesamoid (arrow) with edema at the sesamoid and medial metatarsal head (*). These changes are suspicious for osteomyelitis. Soft-tissue swelling and edema around the first digit with a small first MTPJ effusion are also noted.
Figure 21b.
Methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis at the first MTPJ in a 70-year-old woman with a diabetic wound at the medial first toe. Coronal T1-weighted (a) and T2-weighted (b) FS images show a large soft-tissue ulcer along the medial aspect of the first MTPJ (arrowhead). There is irregularity and loss of the normal T1-weighted marrow signal at the medial sesamoid (arrow) with edema at the sesamoid and medial metatarsal head (*). These changes are suspicious for osteomyelitis. Soft-tissue swelling and edema around the first digit with a small first MTPJ effusion are also noted.
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