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25b - Answer: 17-year-old male presents with pain on top of right foot

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

HISTORY: 

This 17-year-old male presents with right foot pain after injury playing football one day prior.

(QUIZ ANSWER) PRIMARY FINDING: 

Lisfranc ligament tear.

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

FINDINGS:

The Lisfranc ligament is torn with minimal/mild widening of the Lisfranc interval over 4mm. Classification, isolated form. Widened C1-C2 interval and tear of C1 C2 ligament. Dorsal Lisfranc and plantar C1-C2 and C1-C3 ligament tears. 

Multifocal bone contusions are present within the right foot involving the second metatarsal base and shaft, the adjacent distal aspect of the intermediate cuneiform, the distal and medial aspect of the navicular adjacent to the articulation with the medial cuneiform and the medial talar body. No evidence of linear macrofracture.

Incidental note is made of an os trigonum with no bone marrow edema surrounding its synchondrosis to suggest an os trigonum syndrome. No talar dome osteochondral lesion. No evidence of tarsal coalition. 

Tendinosis of the distal-most aspect of the posterior tibial tendon at and just proximal to its insertion on the plantar and proximal aspect of the medial cuneiform is present without evidence of discrete tendon tear. Otherwise, the tendons throughout the right foot appear intact with no evidence of tendinosis, tenosynovitis, or tendon tear. 

Muscular edema is present within the dorsal interosseous muscle between the first and second metatarsals and the adductor hallucis muscle compatible with low-grade muscular strains or contusions. Otherwise, the muscles in the right foot are unremarkable.  

Severe subcutaneous edema/soft tissue swelling is present throughout the dorsum of the foot. 

The plantar fascia is intact with no evidence of plantar fasciitis or plantar fascial tear. The sinus tarsi is unremarkable. A small of capsular fluid is present within the posterior ankle joint without drainable ankle effusion. 

No evidence of Morton's neuroma. No evidence of plantar plate tear. 

CONCLUSION

1. The Lisfranc ligament is torn with minimal/mild widening of the Lisfranc interval over 4mm. Classification, isolated form. Widened C1-C2 interval and tear of C1 C2 ligament. Dorsal Lisfranc and plantar C1-C2 and C1-C3 ligament tears. 

2. Multifocal bone contusions involving the second metatarsal base and shaft, the adjacent distal aspect of the intermediate cuneiform, the distal and medial aspect of the navicular adjacent to its articulation with the medial cuneiform and the medial talar body (with no evidence of linear macrofracture). 

3. Tendinosis of the distal-most aspect of the posterior tibial tendon at and just proximal to its insertion on the proximal and inferior-most aspect of the medial cuneiform with no evidence of discrete tendon tear. 

4. Low-grade muscular strains (or contusions) of the dorsal interosseous muscle between the first and second metatarsals and the adductor hallucis muscle which demonstrate muscular edema with no evidence of discrete muscular tear. 

5. Severe subcutaneous edema/soft tissue swelling throughout the dorsum of the foot.

LESSON 2, TOPIC 75

Case Challenge: Foot & Ankle MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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