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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
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Learn directly from the MSK Master himself.
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Musculoskeletal Imaging
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For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Practice Cases
Worklist 1
10 topics, 11 min.
Practice Cases
Worklist 2
10 topics, 18 min.
Practice Cases
Worklist 3
10 topics, 37 min.
Practice Cases
Worklist 4
10 topics, 7 min.
Practice Cases
Worklist 5
10 topics, 46 min.
0:00
This is a 45-year-old woman who sustained an
0:04
injury to her left foot about six months ago.
0:08
Typically, people who present with this type
0:11
of injury that we're describing here have
0:14
a history of a jogging or dancing injury,
0:18
so that's something to look in the history.
0:21
And the other important finding would be
0:24
biomechanical alteration, either due to a short
0:28
first metatarsal or long second metatarsal.
0:31
So those are things that can help us
0:34
clinically to think about this diagnosis.
0:37
On T1-weighted images, what we're seeing
0:39
is focal replacement of the marrow signal
0:44
in the subchondral area, just beneath the
0:47
subchondral plate in the second metatarsal.
0:51
This is outlined by marrow edema or fluid
0:55
sensitive sequences in the coronal plane
0:58
or long-axis plane; we can see that the
1:01
subchondral plate is slightly flattened.
1:04
On sagittal images, that is more evident; there
1:07
is flattening, focal flattening of the plate.
1:10
And this is in the setting of slight subchondral
1:13
plate collapse with associated bone marrow
1:16
signal abnormalities only affecting the second
1:20
metatarsal head, typical of Freiberg's infraction.
Wk 1, Case 3 - Review
HIDEInteractive Transcript
0:00
This is a 45-year-old woman who sustained an
0:04
injury to her left foot about six months ago.
0:08
Typically, people who present with this type
0:11
of injury that we're describing here have
0:14
a history of a jogging or dancing injury,
0:18
so that's something to look in the history.
0:21
And the other important finding would be
0:24
biomechanical alteration, either due to a short
0:28
first metatarsal or long second metatarsal.
0:31
So those are things that can help us
0:34
clinically to think about this diagnosis.
0:37
On T1-weighted images, what we're seeing
0:39
is focal replacement of the marrow signal
0:44
in the subchondral area, just beneath the
0:47
subchondral plate in the second metatarsal.
0:51
This is outlined by marrow edema or fluid
0:55
sensitive sequences in the coronal plane
0:58
or long-axis plane; we can see that the
1:01
subchondral plate is slightly flattened.
1:04
On sagittal images, that is more evident; there
1:07
is flattening, focal flattening of the plate.
1:10
And this is in the setting of slight subchondral
1:13
plate collapse with associated bone marrow
1:16
signal abnormalities only affecting the second
1:20
metatarsal head, typical of Freiberg's infraction.
Report
Patient History
45-year-old woman who injured her left 2nd toe 6 months prior, now complaining of pain in the same toe.
Findings
Skeletal/osseous:
High-grade subchondral osteoedema involving the head of the 2nd metatarsal, with associated very mild flattening and cortical irregularity of the metatarsal head. Moderate associated capsulitis.
Periarticular osteoedema involving the 1st tarsometatarsal articulation.
No other reactive pattern of marrow edema. No micro- or macro-trabecular fracture.
Claw toe deformities of the 2nd to 5th toes. Mild hallux valgus deformity.
Incidental bipartite tibial sesamoid, versus a remote corticated tibial sesamoid fracture. No sesamoiditis.
Articulations:
Mild to moderate capsulitis involving the 1st to 5th metatarsophalangeal joints. Capsulitis most pronounced surrounding the 2nd metatarsophalangeal joint.
Mild lateral subluxation at the 2nd metatarsophalangeal joint articulation.
Moderate to marked 1st tarsometatarsal arthrosis with focal moderate-sized penetrating osteochondral erosions and surrounding periarticular osteoedema.
Moderate to marked naviculocuneiform arthrosis with dorsal osteophytic spurring and subcortical pseudocyst formation of the navicular.
Mild talonavicular arthrosis with dorsal osteophytic spurring and moderate capsulitis with a small effusion.
Mild capsulitis/arthrosis at the tibial and fibular sesamoid phalangeal joints.
Lisfranc joint:
Intact.
Tendon:
Intact:
Ligaments:
Intact.
Plantar plates:
Intact.
Soft tissues:
Second intermetatarsal bursal thickening without effusion. No evidence for a bulky Morton’s neuroma. Soft tissue thickening/callus formation adjacent to the 2nd and 3rd metatarsal heads, consistent with altered biomechanics of weight-bearing. Otherwise unremarkable.
Other:
None.
Impressions
1. Early Freiberg’s infraction 2nd metatarsal head. Associated moderate capsulitis.
2. Moderate to marked 1st tarsometatarsal arthrosis with penetrating osteochondral erosions and periarticular osteoedema. Moderate to marked naviculocuneiform arthrosis.
Case Discussion
Faculty
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Jenny T Bencardino, MD
Vice-Chair, Academic Affairs Department of Radiology
Montefiore Radiology
Edward Smitaman, MD
Clinical Associate Professor
University of California San Diego
Tags
Musculoskeletal (MSK)
MRI
Foot & Ankle
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