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Skimboarder's Toe: Findings on High-Field MRI

Lane F. Donnelly1, Jeffrey B. Betts and Bradley L. Fricke

1 All authors: Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039.



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  		Fig. 1. —Photograph shows skimboarder traveling from very shallow to slightly deeper water and oriented sideways in relationship to skimboard.

 


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  		Fig. 2A. —39-year-old male skimboarder who sustained hyperdorsiflexion injury of left first metatarsophalangeal joint. Sagittal T2-weighted image of first metatarsophalangeal joint shows soft-tissue swelling (arrowheads) predominantly dorsal to first metatarsophalangeal joint. Dorsal aspect of extensor expansion is disrupted (large arrow). Plantar plate is intact (small arrows).

 


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  		Fig. 2B. —39-year-old male skimboarder who sustained hyperdorsiflexion injury of left first metatarsophalangeal joint. Axial (footprint) T2-weighted fast spin-echo image shows increased-signal-intensity edema surrounding first and second metatarsophalangeal joints. Extensor expansion shows laxity and disruption medially (arrows). Some edema is seen within first metatarsophalangeal head (arrowhead).

 


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  		Fig. 2C. —39-year-old male skimboarder who sustained hyperdorsiflexion injury of left first metatarsophalangeal joint. Coronal (short-axis) fast spin-echo intermediate-weight image shows a rind of high-signal-intensity edema (arrows) surrounding distal metatarsal bone. Edema is more prominent dorsally. Extensor expansion is not well visualized, secondary to injury. Extensor hallucis longus tendon is intact (arrowhead).

 


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  		Fig. 3A. —Hyperdorsiflexion injury of second metatarsophalangeal joint of 37-year-old skimboarder. Axial (footprint) T2-weighted fast spin-echo image shows increased signal intensity within soft tissues surrounding second metatarsophalangeal joint, consistent with edema. High signal intensity is seen within marrow of second proximal phalanx (arrows), consistent with edema. Wavy and discontinuous medial aspect of extensor expansion (arrowheads) is consistent with disruption.

 


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  		Fig. 3B. —Hyperdorsiflexion injury of second metatarsophalangeal joint of 37-year-old skimboarder. Axial (footprint) T1-weighted spin-echo image shows low-signal-intensity, nondisplaced facture (arrow) through medial aspect of proximal portion of first phalanx.

 


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  		Fig. 3C. —Hyperdorsiflexion injury of second metatarsophalangeal joint of 37-year-old skimboarder. Sagittal T2-weighted fast spin-echo image shows predominance of high-signal-intensity edema (large arrows) in dorsal soft tissue surrounding second metatarsophalangeal joint. Edema is scarce in plantar region. Dorsal aspect of extensor expansion is disrupted and poorly defined (small arrows). Signal intensity is increased in second proximal phalanx, consistent with edema. Plantar plate (arrowheads) has normal low signal intensity.

 


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  		Fig. 4A. —Diagrams of structures in dorsal aspect of metatarsophalangeal joint and mechanism of hyperdorsiflexion injury. With foot in neutral position, extensor hallucis longus tendon (blue) traverses under extensor expansion (white fibrous band) at level of metatarsophalangeal joint (arrow).

 


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  		Fig. 4B. —Diagrams of structures in dorsal aspect of metatarsophalangeal joint and mechanism of hyperdorsiflexion injury. With foot in hyperdorsiflexion, extensor hallucis longus tendon exerts force in dorsal direction at level of metatarsophalangeal joint, leading to disruption of dorsal portion of extensor expansion (arrow).

 

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