Case Challenge

Foot & Ankle

Stephen J Pomeranz

Gain confidence interpreting Foot & Ankle MRI Cases with MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME. Try it free!

Case Review

Musculoskeletal (MSK)

Post-Course Activities

This Power Pack is comprised of 25 unique Foot / Ankle MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Foot & Ankle MRI Cases

Case 10 - 18-year-old female presents with painful mass on left foot

<div>HISTORY:&#160;This 18-year-old female presents with palpable soft tissue mass subjacent to the first MP joint, noticed for the past 1 to 2 months. Painful with shoes and ambulation. Evaluate for soft tissue tumor.(QUIZ ANSWER) PRIMARY FINDING:&#160;Pressure lesion due to ambulation.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Within the subcutaneous soft tissues along the plantar aspect of the first MP joint and sesamoid bones, there is a large, ovoid mass-like structure measuring 4.5cm in greatest dimension x 3.5 x 1.5cm. This is well-circumscribed and demonstrates a mildly lobulated configuration. There is peripheral signal hypointensity indicating a rim or rind of fibrosis. There is intermediate T2 and hyperintense fat-sat signal centrally, suggesting a component of complex fluid. The location and appearance are characteristic for a so-called pressure lesion due to ambulation, with associated adventitious bursa/pseudobursa formation, chronic in nature. Lobulation of the lesion medially is reminiscent of plantar fibromatosis, but the constellation of findings remains most compatible with a giant pressure lesion. The findings are not suspicious for a neoplastic lesion.&#160;Underlying sesamoid bones are unremarkable, with no sesamoiditis. First MP joint unremarkable.&#160;There is a focal area of subcutaneous soft tissue thickening and fibrosis subjacent to the fifth MP joint, similar in configuration but much smaller than the finding subjacent to the first MP joint, also compatible with chronic pressure-related soft tissue changes due to ambulation. No associated adventitious bursa/pseudobursa in this location.&#160;Visualized musculature and tendons about the forefoot are unremarkable. No substantive arthropathy about the MP joints.&#160;No direct or indirect evidence of plantar plate tear along the MP joints. No MP joint capsulitis. No Morton's neuroma.&#160;CONCLUSION:&#160;1. Findings within the subcutaneous soft tissues along the plantar aspect of the first MP joint as detailed above, characteristic for a so-called pressure lesion due to ambulation, with associated adventitious bursa/pseudobursa formation. See above for details. Smaller area of chronic pressure-related soft tissue thickening and fibrosis is present subjacent to the fifth MP joint.&#160;2. Pertinent negatives as above.</div>

Case

Plantar plate tear along the metatarsophalangeal joints

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