Anatomic Features of Metatarsal Heads That Simulate Erosive Disease: Cadaveric Study Using CT, Radiography, and Dissection with Special Emphasis on Cross-Sectional Characterization of Osseous Anatomy
Hamid Torshizy1,2,
Tudor H. Hughes1,
Debra Trudell1,2 and
Donald Resnick1,2
1 Division of Musculoskeletal Radiology, Department of Radiology, University of
California, San Diego School of Medicine, 3350 La Jolla Village Dr., Mail Code
114, San Diego, CA 92161.
2 Department of Radiology, Veterans Affairs San Diego Healthcare System, San
Diego, CA.
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Fig. 1 —Frontal views of first through fifth metatarsal heads (from
left to right) show generalized quadrilateral contour. First metatarsal head
displays superoinferior flattening, whereas lesser metatarsal heads show
mediolateral flattening.
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Fig. 2A —First metatarsal head osseous anatomy. Three-dimensional
reformatted CT image (A) and corresponding gross specimen (B) of
dorsal aspect of first metatarsal head show elevated osseous crest (black
arrowheads) and osseous ridge (straight black arrows) separated
by intervening shallow concavity (curved arrow). Osseous crest and
ridge correspond to attachment sites for redundant joint capsule. Medial and
lateral tubercles are also evident (white arrows).
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Fig. 2B —First metatarsal head osseous anatomy. Three-dimensional
reformatted CT image (A) and corresponding gross specimen (B) of
dorsal aspect of first metatarsal head show elevated osseous crest (black
arrowheads) and osseous ridge (straight black arrows) separated
by intervening shallow concavity (curved arrow). Osseous crest and
ridge correspond to attachment sites for redundant joint capsule. Medial and
lateral tubercles are also evident (white arrows).
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Fig. 3A —Cross-sectional depiction of first metatarsal head at level
of first metatarsophalangeal joint. CT scan (A), high-resolution
radiograph (B), and gross specimen (C) show normal osseous
contours that simulate erosive change. These include sharp osseous groove (A)
between medial and lateral tubercles (B) and centralized medial and lateral
osseous concavities (C). Bilateral convex osseous prominences (D) provide
gradual transition from medial and lateral aspect to plantar surface.
Intersesamoidal ridge (E) separates medial and lateral plantar concavities,
which articulate with medial and lateral sesamoid bones, respectively. Note
smooth convex dorsal surface is devoid of osseous protuberances or
depressions.
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Fig. 3B —Cross-sectional depiction of first metatarsal head at level
of first metatarsophalangeal joint. CT scan (A), high-resolution
radiograph (B), and gross specimen (C) show normal osseous
contours that simulate erosive change. These include sharp osseous groove (A)
between medial and lateral tubercles (B) and centralized medial and lateral
osseous concavities (C). Bilateral convex osseous prominences (D) provide
gradual transition from medial and lateral aspect to plantar surface.
Intersesamoidal ridge (E) separates medial and lateral plantar concavities,
which articulate with medial and lateral sesamoid bones, respectively. Note
smooth convex dorsal surface is devoid of osseous protuberances or
depressions.
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Fig. 3C —Cross-sectional depiction of first metatarsal head at level
of first metatarsophalangeal joint. CT scan (A), high-resolution
radiograph (B), and gross specimen (C) show normal osseous
contours that simulate erosive change. These include sharp osseous groove (A)
between medial and lateral tubercles (B) and centralized medial and lateral
osseous concavities (C). Bilateral convex osseous prominences (D) provide
gradual transition from medial and lateral aspect to plantar surface.
Intersesamoidal ridge (E) separates medial and lateral plantar concavities,
which articulate with medial and lateral sesamoid bones, respectively. Note
smooth convex dorsal surface is devoid of osseous protuberances or
depressions.
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Fig. 4 —Cross-sectional schematic at level of first
metatarsophalangeal joint further illustrates normal osseous contours of first
metatarsal head that simulate erosive changes. Again, these include sharp
osseous groove (A) between medial and lateral tubercles (B) and centralized
medial and lateral osseous concavities (C) themselves. Bilateral convex
osseous prominences (D) provide gradual transition from medial and lateral
aspect to plantar aspect. Intersesamoidal ridge (E) separates medial and
lateral plantar concavities, which articulate with medial and lateral sesamoid
bones, respectively.
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Fig. 5A —Soft-tissue anatomy of first metatarsal head. Gross
cross-sectional (A) and gross sagittal (B) images of first
metatarsal head show medial and lateral metatarsophalangeal collateral
ligaments (white arrows) and more peripheral, fan-shaped medial and
lateral metatarsosesamoid ligaments (black arrows). Both ligaments
arise from medial and lateral dorsal tubercles (black arrowheads).
Note joint capsule (white arrowhead, B).
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Fig. 5B —Soft-tissue anatomy of first metatarsal head. Gross
cross-sectional (A) and gross sagittal (B) images of first
metatarsal head show medial and lateral metatarsophalangeal collateral
ligaments (white arrows) and more peripheral, fan-shaped medial and
lateral metatarsosesamoid ligaments (black arrows). Both ligaments
arise from medial and lateral dorsal tubercles (black arrowheads).
Note joint capsule (white arrowhead, B).
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Fig. 6A —Second metatarsal head osseous anatomy. Three-dimensional
reformatted CT image (A) and corresponding gross specimen (B) of
second metatarsal head illustrate medial and lateral plantar prominences
(white arrows), as well as intervening osseous concavity (black
arrows). Note that lateral prominence is larger than medial.
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Fig. 6B —Second metatarsal head osseous anatomy. Three-dimensional
reformatted CT image (A) and corresponding gross specimen (B) of
second metatarsal head illustrate medial and lateral plantar prominences
(white arrows), as well as intervening osseous concavity (black
arrows). Note that lateral prominence is larger than medial.
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Fig. 7 —Gross cross-sectional image of second metatarsal head shows
medial and lateral metatarsophalangeal collateral ligaments (white
arrows) and more peripheral, fan-shaped medial and lateral
metatarsoglenoid ligaments (black arrows). Both ligaments arise from
medial and lateral dorsal tubercles (arrowheads).
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Fig. 8A —Cross-sectional depiction of second metatarsal head at level
of metatarsophalangeal joint. CT scan (A), high-resolution radiograph
(B), and gross specimen (C) show several normal osseous contours
of lesser metatarsal heads that simulate erosive changes. These include sharp
osseous groove (A) between medial and lateral tubercles (B), centralized
medial and lateral osseous concavities (C), and plantar concavity (D) that
separates smaller medial plantar prominence (E) from more prominent lateral
prominence (F). Note smooth convex dorsal surface that is devoid of osseous
protuberances or depressions.
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Fig. 8B —Cross-sectional depiction of second metatarsal head at level
of metatarsophalangeal joint. CT scan (A), high-resolution radiograph
(B), and gross specimen (C) show several normal osseous contours
of lesser metatarsal heads that simulate erosive changes. These include sharp
osseous groove (A) between medial and lateral tubercles (B), centralized
medial and lateral osseous concavities (C), and plantar concavity (D) that
separates smaller medial plantar prominence (E) from more prominent lateral
prominence (F). Note smooth convex dorsal surface that is devoid of osseous
protuberances or depressions.
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Fig. 8C —Cross-sectional depiction of second metatarsal head at level
of metatarsophalangeal joint. CT scan (A), high-resolution radiograph
(B), and gross specimen (C) show several normal osseous contours
of lesser metatarsal heads that simulate erosive changes. These include sharp
osseous groove (A) between medial and lateral tubercles (B), centralized
medial and lateral osseous concavities (C), and plantar concavity (D) that
separates smaller medial plantar prominence (E) from more prominent lateral
prominence (F). Note smooth convex dorsal surface that is devoid of osseous
protuberances or depressions.
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Fig. 9 —Cross-sectional schematic of lesser metatarsal head at level
of metatarsophalangeal joint further illustrates normal osseous contours of
lesser metatarsal heads that simulate erosive changes. Again, these include
sharp osseous groove (A) between medial and lateral tubercles (B), centralized
medial and lateral osseous concavities themselves (C), and plantar concavity
(D) that separates smaller medial plantar prominence (E) from more prominent
prominence (F). Note smooth convex dorsal surface that is devoid of osseous
protuberances or grooves.
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