MRI of the foot

Muhammad Ali, MB BS; Tim S. Chen, MD; John V. Crues, III, MD

I
n an article published in the August
2006 issue of this journal, the authors
reviewed magnetic resonance imag-
ing (MRI) of the ankle. This article will
present a review of the use of MRI in the
evaluation of the foot, detailing bone and
cartilage abnormalities as well as sinus
tarsi pathology. The discussion will
address the evaluation of the foot in hind-
foot, midfoot, and forefoot subsections.

Foot MRI technique

Depending on the clinical question,
MRI of the foot should be tailored to
a hindfoot, midfoot, or forefoot exami-
nation. For hind- and midfoot, a 12- to
14-cm field of view is applied. For the For the evaluation of a mass or the medial talar margin is a more common
forefoot, a 10- to 12-cm field of view is diabetic foot, we add T1W sequences site than the posterior third. The MRI
used to image the smaller peripheral before and after intravenous (IV) con- classification of osteochondral injuries
joints in detail. trast (gadolinium chelate) administra- was presented by Hepple et al2 and
tion. On low-field-strength scanners, stages the talar injuries according to the
Positioning these are performed without fat satura- severity of the injury and the degree of
Similar to the ankle, the foot is placed in tion; on high-field-strength scanners, fat the osteochondral fragment instability.2,3
a neutral position for high-field-strength saturation is applied. Precontrast fat- Fluid between the osteochondral frag-
scanners and in approximately 30˚ plan- suppressed images are essential to avoid ment and the underlying bone, displace-
tar flexion for extremity scanners. the pitfall of pseudoenhancement of ment of the fragment, and a fragment
a mass on fat-saturated postcontrast size >1 cm are signs of an unstable
Pulse sequences images when compared with the non– osteochondral fragment. Unstable or
The pulse sequences for the mid- fat-suppressed precontrast images. This necrotic osteochondral fragments are
and forefoot are T1-weighted (T1W) in is because of a narrow dynamic range of treated surgically with drilling and curet-
the coronal and axial planes, short tau the contrast display on the fat-saturated tage. Conservative treatment is preferred
inversion recovery (STIR) in the coro- images when compared with those with- when the overlying cartilage is intact
nal and sagittal or axial planes, and T2- out fat saturation. and the fragment is stable.4
weighted (T2W) in the coronal plane. Talar neck fractures can lead to
Bone and cartilage abnormalities avascular necrosis (AVN) of the proxi-
Dr. Ali and Dr. Chen are Fellows in Mus- Trauma mal fragment. Stress fractures can oc-
culoskeletal Radiology, RadNet Manage- The talus is a relatively common site cur in the talus but are less common
ment, Los Angeles, CA. Dr. Crues is the for osteochondral injury (Figure 1). The than calcaneal stress injuries.
Medical Director of RadNet Management, middle third (in the sagittal plane) of the Calcaneus stress fractures can have a
and a Volunteer Clinical Professor of Medi- lateral border and the posterior third of diffuse or ill-defined geographic mar-
cine, University of California–San Diego the medial border of the talar dome are row edema pattern (Figure 2). A low-
School of Medicine, San Diego, CA. the common locations.1 In our anecdotal signal fracture line, usually in a vertical
experience, the middle third of the orientation, may be visible. Complex

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 MRI OF THE FOOT

A B C

FIGURE 1. A talar dome osteochondral injury. (A) A sagittal T1-weighted image shows a low-signal osteochondral injury in the talar dome. (B) A
sagittal short tau inversion recovery image shows high signal in the talar dome, which is compatible with granulation tissue in the osteochondral
defect. (C) A coronal T2-weighted image shows the medial talar dome osteochondral defect.

A B

FIGURE 2. A calcaneus stress fracture.

(A) A T1-weighted image shows ill-
defined low signal in the posterior cal-
caneus. No discrete fracture line is
noted. (B) A corresponding short tau
inversion recovery image clearly re-
veals marrow edema associated with
trabecular stress fracture.

FIGURE 3. Talocalcaneal coalition.

(A) A sagittal T1-weighted image A B C
shows eburnation and irregularity of
the articulating surfaces (arrow) in
the middle talocalcaneal facet joint
in this patient with fibrous coalition.
(B) A coronal proton-density fat-
saturated image shows that the joint
line slopes medially (arrow) instead
of the normal lateral downslope.
(C) An oblique coronal proton-
density image in another patient
shows bony coalition of the middle
talocalcaneal facet (arrow). Again,
medial downsloping of the joint
plane is seen.
calcaneal fractures secondary to a verti- lar coalition. Osseous, fibro-osseous, fibrous bridging. Medial downsloping
cal fall mechanism are best evaluated fibrous, and fibrocartilaginous forms of the sustentaculum tali articulating
with computed tomography (CT).4 have been described. MRI findings in- surface (Figure 3) instead of the normal
clude a direct bony connection or (in the lateral slope and presence of a dorsal
Congenital case of nonosseous coalition) irregular- talar spur (not to be confused with the
Coalition of the middle talocalcaneal ity and eburnation of the articulating physiologic, more proximal dorsal spur
joint is second only to calcaneonavicu- surfaces and visualization of low-signal at the capsular insertion) are useful

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MRI OF THE FOOT

FIGURE 4. Calcaneonavicular coali-

A B C tion. (A) A sagittal T1-weighted image
shows irregularity and eburnation of
the articulating surfaces in this patient
with fibrous coalition of the calcaneo-
navicular joint (arrow). (B) An axial
short tau inversion recovery image
shows marrow edema (arrow) in the
navicular adjacent to the fibrous
coalition. (C) An axial proton-density
image in another patient shows bony
coalition (arrow) between the anterior
process of the calcaneus and the
navicular.
in their second or third decade. They
occur in a subarticular location and have
A B high signal on T2W images and low sig-
nal on T1W images because of their car-
tilaginous nature. Low-signal foci of
chondroid calcifications and linear low-
signal septations may be present.

Miscellaneous pathology
Navicular osteochondrosis (Köhler’s
disease) is seen in younger patients (3 to
7 years of age). Fragmentation and low
signal on T1W and T2W images are seen.7
It must not be confused with the frag-
mented appearance of nonunited ossifica-
tion centers. In adults, AVN secondary
to trauma can occur (Muller-Weiss dis-
ease).8 There is collapse and low signal of
the bone on all pulse sequences. Bony
changes seen with subtalar instability
and inflammatory arthropathies are dis-
cussed with sinus tarsi pathology.

Sinus tarsi pathology

The sinus tarsi contain 3 ligaments
extending from the talus to the calcaneus.
The lateral-most is the continuation of the
FIGURE 5. Calcaneal lipoma. (A) An axial T1-weighted image shows a large fat-signal mass in inferior extensor retinaculum. The cervi-
the calcaneus (lipoma), with central low-signal fluid secondary to cystic change. (B) The fatty
component of the lipoma is not discernable on this axial short tau inversion recovery image
cal ligament has a striated appearance. It
because of fat nulling. Only the central fluid component is seen. extends from the talar neck to the body of
the calcaneus in an oblique anteroposte-
ancillary findings.5,6 Calcaneonavicular bone cysts, and chondroblastomas. Lipo- rior direction, providing stability to the
coalition (Figure 4) is the most common mas have characteristic fat signal. They subtalar joint. The interosseous ligament
of the tarsal coalitions.5,6 As with other can have central calcification or cystic is the most medial of the 3. It extends
sites, it can be osseous or nonosseous. focus that appears as signal void or fluid from the talus to the calcaneus in an
An elongated anterior process of the signal, respectively (Figure 5). Bone oblique mediolateral direction (Figure 6).
calcaneus (anteater nose sign) may be cysts in calcaneus are more common in The ligaments limit the inversion of the
present. the older age group (>20 years). They hindfoot and play an important role in
have fluid signal and are located in the maintaining the stability of the subtalar
Neoplastic calcaneus body more inferiorly as com- joint. The sinus tarsi is predominantly
Some of the more common masses in pared with the chondroblastomas. Chon- filled with fat and also contains blood
the calcaneus include lipomas, solitary droblastomas are more common in men vessels and nerve endings.9,10

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 MRI OF THE FOOT

A B C
FIGURE 6. Anatomy of sinus
tarsi ligaments. (A) This sagit-
tal T1-weighted image (T1WI)
shows the cervical ligament
(arrow) extending from the
talar neck to the calcaneus.
(B) A coronal T1WI of the inter-
osseous ligament (encircled) in
the sinus tarsi. Note the normal
fat in the sinus tarsi. (C) An
interosseous ligament (arrow)
is seen on this more medial
sagittal T1WI.

A B A

FIGURE 7. A patient with symptoms of sinus tarsi

syndrome. (A) This sagittal T1-weighted image
shows low-to-intermediate signal tissue replacing
the normal fat in the sinus tarsi. The ligaments
are not seen. (B) A coronal T2-weighted image
shows edema in the sinus tarsi (arrow). Normal
ligaments are not visible. This is compatible with FIGURE 8. Plantar fascitis. (A) A sagittal T1-
a tear of the sinus tarsi ligaments. (C) Another weighted image shows thickening and indis-
patient with sinus tarsi edema. In this case, the tinctness of the plantar fascia. (B) The more
short tau inversion recovery coronal image sensitive sagittal short tau inversion recovery
shows erosive changes in the talus and calca- image shows the same, with better depiction
neus in addition to edema. This patient has of the mild associated edema in the adjacent
rheumatoid arthritis. tissues (arrow).

The ligaments can be torn secondary subchondral sclerosis with or without sualization of the torn sinus tarsi liga-
to acute trauma or more commonly by subchondral edema can be seen. Poste- ments (Figure 7).
chronic recurrent microtrauma. This rior talocalcaneal facet is involved to a Ankle, subtalar, and tarsal joints can
can lead to subtalar instability with greater degree. Normal fat signal in the be affected by inflammatory arthrop-
resulting degenerative changes in the sinus tarsi is replaced with edema or athies (Figure 7), such as Reiter’s dis-
joint. Articular surface irregularity and fluid signal. There is associated nonvi- ease, or crystal deposition disease, such

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MRI OF THE FOOT

A B

FIGURE 9. Plantar fascia partial

tear. (A) A sagittal short tau inver-
sion recovery image shows partial
discontinuity in the plantar fascia
fibers (arrow) and waviness of the
torn fibers. The plantar fascia is
also thickened. (B) A coronal T2-
weighted image reveals that the
medial cord of the plantar fascia is
diffusely thick. There is focal fluid
replacing the torn fibers of the fas-
cia (arrow).

A B C

FIGURE 10. Plantar fibroma. (A) A coronal T1-weighted image shows a large low-signal mass that involves the medial cord of the plantar fascia
(arrows). (B) The mass is persistently low to intermediate in signal on this coronal T2-weighted image, which is typical for a plantar fibroma. (C) In
this sagittal short tau inversion recovery image, the mass shows intermediate signal.

adjacent subcutaneous edema. Edema

A B C may also be seen in the calcaneus at
the insertion site of the plantar fascia
(Figure 8). It is associated with a plantar
calcaneal spur in approximately 50%
of cases.
Tears of the plantar fascia occur most
commonly in the midportion of the fas-
cia. This is more distal to the typical loca-
tion of plantar fasciitis (Figure 9). They
can be partial or complete. Trauma is the
usual etiology. Discontinuity and wavi-
ness of the fascial cords with adjacent
FIGURE 11. Lisfranc ligament tear. (A) On this axial T2-weighted image, normal signal and ori-
soft tissue edema are seen on the MRI.11
entation of the Lisfranc ligament (arrow) can be seen. (B) An axial T1-weighted image in a patient Plantar fibromatosis is nodular
with a Lisfranc ligament tear shows an absence of the normal low-signal band (arrow). (C) An fibrous proliferation of the plantar fas-
axial short tau inversion recovery image at the same level as (B) shows marrow edema in the cia. The appearance can vary from a
base of the second metatarsal and the anterolateral corner of the medial cuneiform. Fluid is replacing well-circumscribed low-signal lesion on
the torn Lisfranc ligament (arrow).
all pulse sequences to a locally invasive
as gout. MRI can reveal inflamed syno- Hindfoot pathology lesion with ill-defined borders and inter-
vium in addition to the bony erosions and Plantar fasciitis is most pronounced mediate signal (Figure 10). This is a dif-
edema. Masses, such as ganglion cysts within 2 to 3 cm of the calcaneal attach- ficult lesion to treat because of its
and lipomas, can occur and lead to pain ment. It manifests as a smooth thicken- tendency to recur following local resec-
from compression of nerve endings.9,10 ing (>4 mm) of the plantar fascia, with tion.11-13 Differential diagnoses include

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MRI OF THE FOOT

A B

FIGURE 12. Synovial sarcoma. (A) A sagittal T1-weighted image shows a lobulated low-to-intermediate signal mass (arrows) that involves the tarsal
bones and the base of the metatarsal (arrowhead). (B) A sagittal T2-weighted image shows high signal in the same mass (arrows). Smooth, lobulated
margins underrepresent the aggressive nature of this neoplasm and can sometimes be misleading.

A B

FIGURE 13. Neuropathic changes. (A) A sagittal T1-weighted image shows disorganization of the talonavicular joint with fragmentation, sub-
chondral eburnation, and synovial thickening. There is mild inferior “sagging” of the talar head (arrow). Irregularity of the talar dome is also
noted. (B) A sagittal short tau inversion recovery image shows a subchondral cyst in the navicular. The marrow edema in this case is centered
on the joint, which supports the diagnosis of neuropathic joint over osteomyelitis in this diabetic patient.

soft tissue masses (such as giant cell corner of the medial cuneiform to the arthrodesis. Even with early interven-
tumor) and sarcomatous neoplasm (such plantar posteromedial corner of the tion, the success rate is <50%.
as synovial sarcoma and fibrosarcoma). base of the second metatarsal) is an The tarsal bones are a common site
A well-circumscribed appearance and important injury (Figure 11).17 It can of trabecular stress injury. Marrow ed-
homogenous low-signal characteristics lead to instability and progressive dis- ema with a lack of a clear fracture line is
suggest fibromatosis.14-16 organization of the Lisfranc joint. present.
Osseous abnormalities of the hind- Additionally, there can be loss of the The flexor hallucis longus (FHL)
foot were discussed earlier. medial longitudinal arch. The rupture tendon is prone to tendinosis and tears
of the ligament fibers is more common at the knot of Henry. The mechanism
Midfoot pathology than is the avulsion fracture at the bony is chronic repetitive friction with the
Trauma attachments.17-19 It is an important diag- flexor digitorum longus (FDL) tendon
A traumatic tear of the Lisfranc liga- nosis, since early internal fixation may from activities like jogging.20 This is
ment (a short bandlike ligament that give the ligament a chance to heal and analogous to the intersection syndrome
extends from the plantar anterolateral can help to avoid the need for future between the first and second extensor

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 MRI OF THE FOOT

compartment tendons in the wrist. The

A C medial plantar nerve branches can get
entrapped between the knot of Henry and
the abductor hallucis muscle, leading to
first and second toe plantar dysesthesias.

Neoplastic
Synovial sarcoma is a malignant neo-
plasm with predilection for the foot. It is
predominantly seen in patients between
the ages of 15 and 40 years. It is an ag-
gressive neoplasm with a posttreatment
5-year survival rate of approximately
FIGURE 14. Osteomyelitis. (A) A coronal short 55%.21,22 Local recurrence and pulmonary
tau inversion recovery (STIR) image shows focal and bone metastasis are common. On
B fluid signal in the deep soft tissues of this diabetic
MRI, it appears as a well-defined mass
patient (small arrow). This finding could be a
small abscess or just inflammatory tissue. A skin with a heterogeneous low signal on T1W
ulcer is barely visible (big arrow). (B) A contrast- images. On T2W images, it has a hetero-
enhanced coronal T1-weighted image (T1WI) geneous high signal (Figure 12). Cystic
shows enhancement in the inflammatory tissue. areas are common. Fluid-fluid levels can
A small nonenhancing area is consistent with an
be present in close to 20% of cases. Foci
abscess (small arrow). The ulcer (big arrow) is
also better visualized. This shows the value of of calcifications can lead to areas of low
intravenous contrast administration in the evalu- signal on T2W images. Heterogeneous
ation of a diabetic foot. (C) An axial STIR image enhancement is seen with IV contrast ad-
in the same patient shows high signal in the ministration. It usually displaces the adja-
metatarsal (arrow). The corresponding T1WI
cent structures rather than invading them.
(not shown) exhibited low signal. These findings
are consistent with osteomyelitis. Sometimes a small size, slow growth, and
well-circumscribed appearance can lead
to an erroneous diagnosis of a benign
A C
mass.23 Other soft tissue neoplasm, benign
and malignant primary bony neoplasm,
and, less commonly, metastasis can all
involve the midfoot.

Arthropathy
The Lisfranc and Chopart (intertarsal)
joints are commonly disrupted in neuro-
pathic arthropathy (Charcot joint). Rapid
destruction of the joints and bones is the
rule if protective measures are not taken
early in the process. Therefore, early
B detection of neuropathic changes is very
important. Signs on MRI include tear of
the Lisfranc ligament and edema in the
FIGURE 15. Anatomy of the plantar capsu-
tarsal and metatarsal bones adjacent to
loligamentous complex of the metatarsopha- the joints. Loss of normal bony relation-
langeal joint. (A) A sagittal short tau inversion ship and articular and osseous destruction
recovery (STIR) image shows the plantar are advanced findings (Figure 13).24-26
plate (arrow) attachment to the base of the A common clinical question is the dif-
proximal phalanx. (B) A sagittal STIR image in
a plane more lateral to the plantar plate
ferentiation between osteomyelitis and a
reveals the hallux sesamoid (arrows) in the neuropathic joint. Certain findings (such
flexor hallucis brevis tendon. (C) An axial T1- as the presence of more focal involvement
weighted image shows the two hallux sesa- of the bones, skin ulcers, sinus tracts, and
moids (arrows) with a normal marrow signal. abscess) are more suggestive of infection

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MRI OF THE FOOT

(Figure 14). In early neuropathic joint,

A B the signal abnormalities are centered on
the joint. However, a clear distinction be-
tween infection and neuropathic changes
is not always possible with imaging.
The midfoot is often involved in
arthropathies such as gout and rheuma-
toid arthritis. The findings on MRI in-
clude erosions, bone marrow edema,
and synovitis. In the absence of a correl-
ative history, these can be confused with
osteomyelitis. Degenerative changes
in the midfoot can be seen with altered
mechanics or can be posttraumatic.

Forefoot pathology
FIGURE 16. A metatarsophalangeal (MTP) collateral ligament injury. (A) An axial T1-weighted Trauma
image of the first MTP joint shows an indistinct and intermediate-signal medial collateral liga- “Turf toe” refers to a capsuloligamen-
ment (long arrow). Compare this with the normal low-signal lateral collateral ligament (small
arrow). (B) An axial short tau inversion recovery image shows a grade 2 sprain of the medial
tous injury of the metatarsophalangeal
collateral ligament (arrow). (MTP) joint of the first toe. The mecha-
nism of injury includes anterior thrust of
the metatarsal head in a hyperextended
A B joint with a relatively fixed great toe. This
is common in sports played on synthetic
turf, like football, hence the name turf
toe. There is stretching and tearing of the
plantar capsule and tearing of the plantar
plate. The plantar plate is a fibrocartilagi-
nous structure that extends from the
metatarsal neck to the base of the proxi-
mal phalanx. It reinforces the plantar
capsule and also attaches the hallux
sesamoid bones to the base of the proxi-
mal phalanx (Figure 15). Discontinuity
FIGURE 17. Freiberg’s infraction. (A) An axial T1-weighted image shows deformity and col- of the plantar plate and focal edema and
lapse of the second and third metatarsal heads (arrows). Repetitive microtrauma is the pro- fluid is seen. Associated proximal dis-
posed underlying etiology. (B) Axial short tau inversion recovery images show the marrow placement of the hallux sesamoids may
edema from trabecular bone injury in the second metatarsal head and the associated collapse be seen.27,28
of the second and third metatarsal heads (arrows).
Collateral ligament tears are also more
common in the great toe. Varus or valgus
A B force is the usual etiology. Edema and
discontinuity of the medial or lateral col-
lateral ligaments is present (Figure 16).
The MTP collateral ligament tear is
more common than that of the interpha-
langeal joints.29
Hallux sesamoids can be involved with
fractures, AVN, and sesamoiditis sec-
ondary to inflammatory arthropathies or
osteomyelitis. The medial sesamoid is
FIGURE 18. Pressure lesion. (A) A sagittal T1-weighted image shows a low-signal ill-defined more commonly involved with trauma,
soft tissue signal just below the metatarsophalangeal joint (arrow). It has a flat appearance
and does not have a masslike morphology. (B) A coronal T2-weighted image shows the same
and lateral sesamoid tends to get AVN.
lesion with intermediate signal and without a masslike contour. The location and MR charac- Replacement of the normal marrow fat
teristics in this diabetic patient are consistent with a pressure lesion. signal with edema signal can be seen.

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 MRI OF THE FOOT

A A

FIGURE 20. A giant cell tumor of the tendon

sheath. (A) A coronal T1-weighted image
shows a low-signal mass (arrow). The mass is
inseparable from the flexor tendons. (B) On a
coronal short tau inversion recovery image, the
mass is persistently low in signal (arrow)—
a finding that is consistent with a giant cell
FIGURE 19. Morton neuroma. (A) A coronal T1-weighted image (T1WI) without fat saturation tumor of the tendon sheath.
(low-field scanner) shows an intermediate-signal-intensity mass (arrows) in the plantar aspect “March fracture” is a stress fracture of
of the second web space. (B) A coronal T1WI without fat saturation after the administration of
the metatarsal neck.27 The name comes
intravenous contrast shows diffuse enhancement in the Morton neuroma (arrows). On high-
field scanners, fat saturation is desirable because it increases the conspicuity of the mass. from its common occurrence in military
recruits. It is predominantly seen with
activities that place excessive stress on the
A B metatarsals, such as ballet dancing and
gymnastics. Marrow edema and adjacent
soft tissue edema are seen in early stages.
Periosteal thickening is present in the
subacute stage as a healing response.

Neoplastic
Pressure lesions are fibrofatty lesions
that occur in the subcutaneous fat. These
typically develop at the load-bearing
bony prominences, including the plantar
aspects of the first and fifth metatarsal
heads or below the calcaneal tuberosity.
These lesions are of low signal on T1W
images and of variable signal (intermedi-
ate-to-high signal) on T2W images. They
can have fat in the interstices. Sometimes
FIGURE 21. Gout. (A) An axial T1-weighted image shows a low-signal gouty tophus eroding the they can develop central cystic changes.
adjacent bone (arrow) to form the typical punched-out erosion with an overhanging edge. (B) An They generally lack the well-defined
axial short tau inversion recovery (STIR) image at a slightly different slice position shows the morphology of a mass, and their appear-
bone erosions. The signal of the gouty tophus tissue is heterogeneously intermediate on STIR. ance is that of an ill-defined fibrotic
The signal of the tophi on fluid-weighted sequences is typically low to intermediate. tissue (Figure 18). The characteristic
Freiberg’s infraction of the metatarsal most popular theories of the etiology. It is location and interspersed fat in the lesion
heads is characterized by fissuring, osteo- more common in young women and may favor the diagnosis and help differentiate
necrosis, and eventual collapse of the be secondary to the wearing of high heels. it from a neoplasm.24
subchondral bone (Figure 17). The sec- In its acute stage, there is a marrow Morton neuroma is a focal perineural
ond and third metatarsal heads are most edema pattern. In its chronic phase, there fibrosis of the plantar interdigital nerves.
commonly affected.27 Repetitive micro- is deformity of the metatarsal head and It is not a true neuroma. The most com-
trauma and vascular compromise are the associated degenerative arthritis. mon location is the third and fourth web

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MRI OF THE FOOT

spaces between the plantar aspects of the Conclusion 15. Wetzel LH, Levine E. Soft-tissue tumors of the
foot: Value of MR imaging for specific diagnosis. AJR
metatarsal heads.30-32 It is more common MRI is the imaging modality of choice Am J Roentgenol. 1990;155:1025-1030.
in women, and, once again, the wearing for evaluation of musculoskeletal pathol- 16. Blume PA, Niemi WJ, Courtright DJ, Gorecki GA.
of high heels is implicated as a causative ogy, including the soft tissue and osseous Fibrosarcoma of the foot: A case presentation and
review of the literature. J Foot Ankle Surg. 1997; 36:
factor. Other etiologic possibilities in- trauma, neoplasms, and inflammatory 51-54.
clude the compression of the nerves by pathology. Compared with CT, MR pro- 17. Potter HG, Deland JT, Gusmer PB, et al. Magnetic
the intermetatarsal ligament or a dis- vides a superior contrast resolution and resonance imaging of the Lisfranc ligament of the foot.
Foot Ankle Int. 1998;19:438-446.
tended intermetatarsal bursa. Pain in the exquisite detail of soft tissue structures. It 18. Preidler KW, Peicha G, Lajtai G, et al. Conventional
web space with or without radiation to also surpasses CT in the evaluation of tra- radiography, CT, and MR imaging in patients with
the toes is the usual presenting symptom. becular bone injury. The strengths of MRI hyperflexion injuries of the foot: Diagnostic accuracy
in the detection of bony and ligamentous changes.
These are small lesions that are nearly in evaluating various foot pathologies AJR Am J Roentgenol. 1999;173:1673-1677.
isointense to the muscles on T1W have been briefly reviewed in this article. 19. Preidler KW, Brossmann J, Daenen B, et al.
images, are intermediate to high in signal MR imaging of the tarsometatarsal joint: Analysis of
injuries in 11 patients. AJR Am J Roentgenol. 1996;
on T2W images, and can be isointense
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