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14b - Answer: 59-year-old female presents with right foot pain

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 59-year-old female presents with right foot pain and tenderness on palpitation increasing peroneal resistance, not responsive to conservative therapy and immobilization. X-ray reportedly shows increased space. Plantar fasciitis surgery 4 years ago. Evaluate for partial tear of peroneal tendon. 

(QUIZ ANSWER) WHICH METATARSAL?: 

5th.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

No acute macrofracture. 

No substantive arthrosis demonstrated. 

Tiny, essentially nondisplaced fragment at the base of the 5th metatarsal. No acute macrofracture demonstrated. Mild capsulitis in the 5th tarsometatarsal joint with small effusion and fraying of the peroneus brevis insertion but no macrotear. 

Distal peroneus longus, medial, and anterior tendons are intact. Hindfoot is largely excluded from field of view on the foot MRI. 

No substantive arthrosis demonstrated in the midfoot or visualized hindfoot. 

Moderate MTP arthrosis with mild capsulitis. Bipartite medial sesamoid. 

No tarsal coalition or accessory ossicles. 

No evidence of plantar fasciitis. 

CONCLUSION

1. Tiny, essentially nondisplaced fragment at the base of the 5th metatarsal. No acute macrofracture demonstrated. Mild capsulitis in the 5th tarsometatarsal joint with small effusion and fraying of the peroneus brevis insertion but no macrotear. 

2. Moderate 1st MTP arthrosis with mild capsulitis. Bipartite medial sesamoid. 

3. No evidence of recurrent plantar fasciitis.

LESSON 2, TOPIC 42

Case Challenge: Foot & Ankle MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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