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MRI of Metatarsal Head Subchondral Fractures in Patients with Forefoot Pain

Martin Torriani1, Bijoy J. Thomas, Miriam A. Bredella and Hugue Ouellette

1 All authors: Musculoskeletal Radiology, Massachusetts General Hospital, 55 Fruit St., YAW 6E, Boston, MA 02114.


Figure 1
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  		Fig. 1 —57-year-old woman with forefoot pain over third and fourth metatarsal heads. Sagittal T1-weighted MR image through third metatarsal shows subchondral low signal intensity in subchondral region consistent with subchondral fracture (arrowheads) without flattening. Radiographs (not shown) were unremarkable in this patient.

 

Figure 2
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  		Fig. 2 —62-year-old woman with forefoot pain for 6 weeks. Sagittal T1-weighted MR image through second metatarsal shows subchondral fracture involving all thirds of articular surface (arrow) without flattening.

 

Figure 3
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  		Fig. 3A —30-year-old woman with forefoot pain after wearing walking boot for 6 weeks after ankle surgery. Sagittal T1-weighted (A) and STIR (B) MR images through second metatarsal show metatarsal head flattening (arrowheads, A) and subchondral fracture (arrows) involving dorsal and central thirds of articular surface. There is severe soft-tissue and bone marrow edema-like pattern. Skin marker is present in dorsum of foot.

 

Figure 4
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  		Fig. 3B —30-year-old woman with forefoot pain after wearing walking boot for 6 weeks after ankle surgery. Sagittal T1-weighted (A) and STIR (B) MR images through second metatarsal show metatarsal head flattening (arrowheads, A) and subchondral fracture (arrows) involving dorsal and central thirds of articular surface. There is severe soft-tissue and bone marrow edema-like pattern. Skin marker is present in dorsum of foot.

 

Figure 5
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  		Fig. 4A —68-year-old woman with forefoot pain referred for evaluation of possible stress fracture. Axial T1-weighted (A) and sagittal STIR (B) MR images through second metatarsal show flattening, subchondral sclerosis, and rounded area of cystic change without surrounding marrow edema-like pattern (arrow).

 

Figure 6
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  		Fig. 4B —68-year-old woman with forefoot pain referred for evaluation of possible stress fracture. Axial T1-weighted (A) and sagittal STIR (B) MR images through second metatarsal show flattening, subchondral sclerosis, and rounded area of cystic change without surrounding marrow edema-like pattern (arrow).

 

Figure 7
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  		Fig. 5A —63-year-old woman with forefoot pain for 1 week. Sagittal T1-weighted (A) and STIR (B) MR images through second metatarsal show metatarsal head flattening with subchondral sclerosis and mild edema-like pattern (arrowheads). Acute stress fracture through base of same metatarsal (arrows) with severe soft-tissue and bone marrow edema-like pattern are noted.

 

Figure 8
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  		Fig. 5B —63-year-old woman with forefoot pain for 1 week. Sagittal T1-weighted (A) and STIR (B) MR images through second metatarsal show metatarsal head flattening with subchondral sclerosis and mild edema-like pattern (arrowheads). Acute stress fracture through base of same metatarsal (arrows) with severe soft-tissue and bone marrow edema-like pattern are noted.

 

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