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18b - Answer: 20-year-old male presents with left foot pain at the anterior midfoot

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

HISTORY: 

This 20-year-old male presents with left foot pain at the anterior midfoot and 1st metatarsal, ongoing for one month. No reported trauma. No history of surgery or cancer.

(QUIZ ANSWER) PRIMARY FINDING: 

Partial tear involving lateral collateral ligament.

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 or chronic fracture or bony injury. No stress injury or stress fracture of the 1st metatarsal. Mild hallux valgus deformity. Lisfranc joint is intact, without injury or fracture.

Tear of the proper collateral ligament proximal segment at the 1st MTP joint, with mild MTP joint capsulitis. Insertional irregularity of the accessory collateral ligament at the lateral sesamoid versus normal structures medially. Remaining ligament structures are intact.

No muscle atrophy or muscle injury. The posterior tibialis, peroneus longus and brevis tendon insertions are intact, without tear injury or tendinopathy. The flexor and extensor tendons are unremarkable.

The distal plantar fascia is intact, without thickening, active inflammation, or tear.

Swelling 1st intermetatarsal space. More dorsally positioned 4th ray relative to the 1st 2nd and 3rd toes.

The neurovascular complex is intact, without impingement neuropathy or vascular anomaly.

No joint effusion or intra-articular bodies.

CONCLUSION:

1. No fracture or stress fracture. No sesamoiditis. Turf toe mimic with partial tear involving the main or proper lateral collateral ligament at the 1st MTP Plantar plate intact otherwise. Small focus of 1st intermetatarsal space swelling and tiny 2nd intermetatarsal bursal cyst.

2. Insertional irregularity of the FHB lateral head attachment to the lateral sesamoid.

3. Mild hallux valgus deformity.

LESSON 2, TOPIC 54

Case Challenge: Foot & Ankle MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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