Skip to main content
Top
Published in: European Radiology 4/2015

01-04-2015 | Musculoskeletal

First metatarsophalangeal joint- MRI findings in asymptomatic volunteers

Authors: Tobias Johannes Dietrich, Flora Luciana Figueira da Silva, Marcelo Rodrigues de Abreu, Georg Klammer, Christian W. A. Pfirrmann

Published in: European Radiology | Issue 4/2015

Login to get access

Abstract

Objectives

To evaluate the spectrum and frequency of MR findings of the first metatarsophalangeal joint (MTPJ) in asymptomatic volunteers.

Methods

MR imaging of 30 asymptomatic forefeet was performed with a dedicated extremity 1.5-Tesla system. Participants were between 20 and 49 years of age (mean ± SD: 35.5 ± 8.4 years). Two radiologists assessed cartilage, bone, capsuloligamentous structures, and tendons of first MTPJs on MR images.

Results

Cartilage defects were observed in 27 % (n = 8) of first MTPJs, most frequently located at the base of the proximal phalanx (23 %, n = 7), whereas cartilage defects of the metatarsal head (13 %, n = 4) and the metatarsosesamoid compartment were rare (0 %–3 %, n = 0-1). Bone marrow oedema-like signal changes were present in 37 % (n = 11) and subchondral cysts in 20 % (n = 6) of first MTPJs. Hyperintense areas on intermediate-weighted sequences (range: 30–43 %, n = 9–13) and on fluid-sensitive sequences with fat suppression (range: 33–60 %, n = 10–18) within the medial and lateral collateral ligament complex were common. Plantar recesses (77 %, n = 23) and distal dorsal recesses (87 %, n = 26) were frequently observed.

Conclusions

Cartilage defects, bone marrow oedema-like signal changes, subchondral cysts, plantar recesses, and distal dorsal recesses were common findings on MRI of first MTPJs in asymptomatic volunteers. The collateral ligaments were often heterogeneous in structure and showed increased signal intensity.

Key Points

Cartilage defects of asymptomatic first metatarsophalangeal joints were common on MRI.
The collateral ligaments were often heterogeneous in structure and showed increased signal intensity.
Areas of increased signal intensity within the flexor and extensor tendons were rare.
These observations need to be considered in MR examinations of symptomatic cases.
Literature
1.
go back to reference Ashman CJ, Klecker RJ, Yu JS (2001) Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging. Radiographics 21:1425–1440CrossRefPubMed Ashman CJ, Klecker RJ, Yu JS (2001) Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging. Radiographics 21:1425–1440CrossRefPubMed
2.
go back to reference Sanders TG, Rathur SK (2008) Imaging of painful conditions of the hallucal sesamoid complex and plantar capsular structures of the first metatarsophalangeal joint. Radiol Clin North Am 46:1079–1092CrossRefPubMed Sanders TG, Rathur SK (2008) Imaging of painful conditions of the hallucal sesamoid complex and plantar capsular structures of the first metatarsophalangeal joint. Radiol Clin North Am 46:1079–1092CrossRefPubMed
3.
go back to reference Karasick D, Schweitzer ME (1998) Disorders of the hallux sesamoid complex: MR features. Skeletal Radiol 27:411–418CrossRefPubMed Karasick D, Schweitzer ME (1998) Disorders of the hallux sesamoid complex: MR features. Skeletal Radiol 27:411–418CrossRefPubMed
4.
go back to reference Schweitzer ME, Maheshwari S, Shabshin N (1999) Hallux valgus and hallux rigidus: MRI findings. Clin Imaging 23:397–402CrossRefPubMed Schweitzer ME, Maheshwari S, Shabshin N (1999) Hallux valgus and hallux rigidus: MRI findings. Clin Imaging 23:397–402CrossRefPubMed
5.
go back to reference Nwawka OK, Hayashi D, Diaz LE et al (2013) Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights Imaging 4:581–593CrossRefPubMedCentralPubMed Nwawka OK, Hayashi D, Diaz LE et al (2013) Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights Imaging 4:581–593CrossRefPubMedCentralPubMed
6.
go back to reference Prescott JW, Yu JS (2012) The aging athlete: part 1, “boomeritis” of the lower extremity. AJR 199:W294–W306CrossRefPubMed Prescott JW, Yu JS (2012) The aging athlete: part 1, “boomeritis” of the lower extremity. AJR 199:W294–W306CrossRefPubMed
7.
go back to reference Michelson J, Dunn L (2005) Tenosynovitis of the flexor hallucis longus: a clinical study of the spectrum of presentation and treatment. Foot Ankle Int 26:291–303PubMed Michelson J, Dunn L (2005) Tenosynovitis of the flexor hallucis longus: a clinical study of the spectrum of presentation and treatment. Foot Ankle Int 26:291–303PubMed
8.
go back to reference Theumann NH, Pfirrmann CW, Mohana Borges AV, Trudell DJ, Resnick D (2002) Metatarsophalangeal joint of the great toe: normal MR, MR arthrographic, and MR bursographic findings in cadavers. J Comput Assist Tomogr 26:829–838CrossRefPubMed Theumann NH, Pfirrmann CW, Mohana Borges AV, Trudell DJ, Resnick D (2002) Metatarsophalangeal joint of the great toe: normal MR, MR arthrographic, and MR bursographic findings in cadavers. J Comput Assist Tomogr 26:829–838CrossRefPubMed
9.
go back to reference Erickson SJ, Rosengarten JL (1993) MR imaging of the forefoot: normal anatomic findings. AJR 160:565–571CrossRefPubMed Erickson SJ, Rosengarten JL (1993) MR imaging of the forefoot: normal anatomic findings. AJR 160:565–571CrossRefPubMed
10.
go back to reference Lepage-Saucier M, Linda DD, Chang EY et al (2013) MRI of the metatarsophalangeal joints: improved assessment with toe traction and MR arthrography. AJR 200:868–871CrossRefPubMed Lepage-Saucier M, Linda DD, Chang EY et al (2013) MRI of the metatarsophalangeal joints: improved assessment with toe traction and MR arthrography. AJR 200:868–871CrossRefPubMed
11.
go back to reference Shortt CP (2010) Magnetic resonance imaging of the midfoot and forefoot: normal variants and pitfalls. Magn Reson Imaging Clin N Am 18:707–715CrossRefPubMed Shortt CP (2010) Magnetic resonance imaging of the midfoot and forefoot: normal variants and pitfalls. Magn Reson Imaging Clin N Am 18:707–715CrossRefPubMed
12.
go back to reference Karasick D, Wapner KL (1990) Hallux valgus deformity: preoperative radiologic assessment. AJR 155:119–123CrossRefPubMed Karasick D, Wapner KL (1990) Hallux valgus deformity: preoperative radiologic assessment. AJR 155:119–123CrossRefPubMed
13.
go back to reference Weir JP (2005) Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 19:231–240PubMed Weir JP (2005) Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 19:231–240PubMed
14.
go back to reference Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374CrossRefPubMed Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374CrossRefPubMed
15.
go back to reference Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363PubMed Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363PubMed
16.
go back to reference Kadakia AR, Molloy A (2011) Current concepts review: traumatic disorders of the first metatarsophalangeal joint and sesamoid complex. Foot Ankle Int 32:834–839CrossRefPubMed Kadakia AR, Molloy A (2011) Current concepts review: traumatic disorders of the first metatarsophalangeal joint and sesamoid complex. Foot Ankle Int 32:834–839CrossRefPubMed
17.
go back to reference Waldrop NE, Zirker CA, Wijdicks CA, Laprade RF, Clanton TO (2013) Radiographic evaluation of plantar plate injury: an in vitro biomechanical study. Foot Ankle Int 34:403–408CrossRefPubMed Waldrop NE, Zirker CA, Wijdicks CA, Laprade RF, Clanton TO (2013) Radiographic evaluation of plantar plate injury: an in vitro biomechanical study. Foot Ankle Int 34:403–408CrossRefPubMed
18.
go back to reference Lucas DE, Philbin T, Hatic S (2014) The plantar plate of the first metatarsophalangeal joint: an anatomical study. Foot Ankle Spec 108–112 Lucas DE, Philbin T, Hatic S (2014) The plantar plate of the first metatarsophalangeal joint: an anatomical study. Foot Ankle Spec 108–112
19.
go back to reference George E, Harris AH, Dragoo JL, Hunt KJ (2014) Incidence and risk factors for turf toe injuries in intercollegiate football: data from the national collegiate athletic association injury surveillance system. Foot Ankle Int 35:108–115CrossRefPubMed George E, Harris AH, Dragoo JL, Hunt KJ (2014) Incidence and risk factors for turf toe injuries in intercollegiate football: data from the national collegiate athletic association injury surveillance system. Foot Ankle Int 35:108–115CrossRefPubMed
20.
go back to reference Yu JS, Tanner JR (2002) Considerations in metatarsalgia and midfoot pain: an MR imaging perspective. Semin Musculoskelet Radiol 6:91–104CrossRefPubMed Yu JS, Tanner JR (2002) Considerations in metatarsalgia and midfoot pain: an MR imaging perspective. Semin Musculoskelet Radiol 6:91–104CrossRefPubMed
21.
go back to reference Unger K, Rahimi F, Bareither D, Muehleman C (2000) The relationship between articular cartilage degeneration and bone changes of the first metatarsophalangeal joint. J Foot Ankle Surg 39:24–33CrossRefPubMed Unger K, Rahimi F, Bareither D, Muehleman C (2000) The relationship between articular cartilage degeneration and bone changes of the first metatarsophalangeal joint. J Foot Ankle Surg 39:24–33CrossRefPubMed
22.
go back to reference Smith SE, Landorf KB, Gilheany MF, Menz HB (2011) Development and reliability of an intraoperative first metatarsophalangeal joint cartilage evaluation tool for use in hallux valgus surgery. J Foot Ankle Surg 50:31–36CrossRefPubMed Smith SE, Landorf KB, Gilheany MF, Menz HB (2011) Development and reliability of an intraoperative first metatarsophalangeal joint cartilage evaluation tool for use in hallux valgus surgery. J Foot Ankle Surg 50:31–36CrossRefPubMed
23.
go back to reference Bock P, Kristen KH, Kröner A, Engel A (2004) Hallux valgus and cartilage degeneration in the first metatarsophalangeal joint. J Bone Joint Surg (Br) 86:669–673CrossRef Bock P, Kristen KH, Kröner A, Engel A (2004) Hallux valgus and cartilage degeneration in the first metatarsophalangeal joint. J Bone Joint Surg (Br) 86:669–673CrossRef
24.
go back to reference Buck FM, Grehn H, Hilbe M, Pfirrmann CW, Manzanell S, Hodler J (2009) Degeneration of the long biceps tendon: comparison of MRI with gross anatomy and histology. AJR 193:1367–1375CrossRefPubMed Buck FM, Grehn H, Hilbe M, Pfirrmann CW, Manzanell S, Hodler J (2009) Degeneration of the long biceps tendon: comparison of MRI with gross anatomy and histology. AJR 193:1367–1375CrossRefPubMed
25.
go back to reference Bydder M, Rahal A, Fullerton GD, Bydder GM (2007) The magic angle effect: a source of artifact, determinant of image contrast, and technique for imaging. J Magn Reson Imaging 25:290–300CrossRefPubMed Bydder M, Rahal A, Fullerton GD, Bydder GM (2007) The magic angle effect: a source of artifact, determinant of image contrast, and technique for imaging. J Magn Reson Imaging 25:290–300CrossRefPubMed
26.
go back to reference Frankel JP, Harrington J (1990) Symptomatic bipartite sesamoids. J Foot Surg 29:318–323PubMed Frankel JP, Harrington J (1990) Symptomatic bipartite sesamoids. J Foot Surg 29:318–323PubMed
27.
go back to reference Zanetti M, Bruder E, Romero J, Hodler J (2000) Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology 215:835–840CrossRefPubMed Zanetti M, Bruder E, Romero J, Hodler J (2000) Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology 215:835–840CrossRefPubMed
28.
go back to reference Tewes DP, Fischer DA, Fritts HM, Guanche CA (1994) MRI findings of acute turf toe. A case report and review of anatomy. Clin Orthop Relat Res 304:200–203PubMed Tewes DP, Fischer DA, Fritts HM, Guanche CA (1994) MRI findings of acute turf toe. A case report and review of anatomy. Clin Orthop Relat Res 304:200–203PubMed
29.
go back to reference Yao L, Cracchiolo A, Farahani K, Seeger LL (1996) Magnetic resonance imaging of plantar plate rupture. Foot Ankle Int 17:33–36CrossRefPubMed Yao L, Cracchiolo A, Farahani K, Seeger LL (1996) Magnetic resonance imaging of plantar plate rupture. Foot Ankle Int 17:33–36CrossRefPubMed
30.
go back to reference Rodeo SA, O’Brien S, Warren RF, Barnes R, Wickiewicz TL, Dillingham MF (1990) Turf-toe: an analysis of metatarsophalangeal joint sprains in professional football players. Am J Sports Med 18:280–285CrossRefPubMed Rodeo SA, O’Brien S, Warren RF, Barnes R, Wickiewicz TL, Dillingham MF (1990) Turf-toe: an analysis of metatarsophalangeal joint sprains in professional football players. Am J Sports Med 18:280–285CrossRefPubMed
31.
go back to reference Deland JT, Lee KT, Sobel M, DiCarlo EF (1995) Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int 16:480–486CrossRefPubMed Deland JT, Lee KT, Sobel M, DiCarlo EF (1995) Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int 16:480–486CrossRefPubMed
32.
go back to reference Mohana-Borges AV, Theumann NH, Pfirrmann CW, Chung CB, Resnick DL, Trudell DJ (2003) Lesser metatarsophalangeal joints: standard MR imaging, MR arthrography, and MR bursography—initial results in 48 cadaveric joints. Radiology 227:175–182CrossRefPubMed Mohana-Borges AV, Theumann NH, Pfirrmann CW, Chung CB, Resnick DL, Trudell DJ (2003) Lesser metatarsophalangeal joints: standard MR imaging, MR arthrography, and MR bursography—initial results in 48 cadaveric joints. Radiology 227:175–182CrossRefPubMed
33.
go back to reference Bade H, Koebke J, Nieden A (1997) Radiologic anatomy of the metacarpophalangeal joints II to V. Surg Radiol Anat 19:323–327CrossRefPubMed Bade H, Koebke J, Nieden A (1997) Radiologic anatomy of the metacarpophalangeal joints II to V. Surg Radiol Anat 19:323–327CrossRefPubMed
Metadata
Title
First metatarsophalangeal joint- MRI findings in asymptomatic volunteers
Authors
Tobias Johannes Dietrich
Flora Luciana Figueira da Silva
Marcelo Rodrigues de Abreu
Georg Klammer
Christian W. A. Pfirrmann
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3489-y

Other articles of this Issue 4/2015

European Radiology 4/2015 Go to the issue