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Metatarsal Head Fracture Can Be Detected Using MRI of Foot

April 10, 2008
Written by: , Filed in: Musculoskeletal Radiology
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Background
Metatarsal head subchondral fractures are less common than metatarsal shaft fractures and are thought to be caused by overuse, or represent insufficiency fractures. They are similar to Freiberg’s infraction, an osteochondrosis of the metatarsal head, occurring in adolescents.

The objective of a recent study was to determine the MRI features of metatarsal head subchondral fractures in symptomatic adults.

The study has concluded that subchondral fracture and marrow edema-like pattern indicate early stages of metatarsal head fracture, while metatarsal head collapse and subchondral sclerosis suggest late-stage disease.

Methodology
In this retrospective review, foot MRIs were performed to detect cases of metatarsal head subchondral fractures and analyzed for presence of subchondral fracture, marrow edema-like pattern, metatarsal head flattening, and subchondral sclerosis.

MDCT and MR Update: Body and Musculoskeletal Imaging

University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. Click here to read more or order:

MDCT and MR Update: Body and Musculoskeletal Imaging

Results of the Study
Thirteen patients with 14 metatarsal head fractures were included. All patients were women aged 25 to 68 years. Only one patient had acute trauma. Mean symptom duration was 12 weeks (range, 1 to 35 weeks). Ten of the 14 fractures involved the second metatarsal head (71%) and two fractures each were in the third and fourth.

Ten of 14 cases had severe associated edema-like pattern, suggesting early stage changes, whereas the remaining four cases had subchondral sclerosis with metatarsal head flattening and mild or no edema pattern, suggesting late-stage changes. Cystic changes were seen in two cases. Eight had metatarsal head flattening (57%). Three cases had associated metatarsal shaft fractures (21%). Ten cases had a hallux valgus angle >15 degrees.

Conclusions
Metatarsal head fractures can be detected on MRI, and early stages can be distinguished from late stages by the degree of marrow edema. This may be useful in increasing specificity of MR interpretation in patients with forefoot pain.

Reviewer’s Comments
The increased hallux valgus angle may result in increased load to the metatarsal head, perhaps contributing to the development of metatarsal AD fractures. As previously reported by Jensen and de Carvalho, second metatarsal head flattening and a widened MTP joint space represents a normal finding, occurring in 10% of healthy volunteers, and should not be mistaken for a fracture or Freiberg’s infraction.

Author: Cornelia Wenokor, MD

Reference
Torriani M, Thomas BJ, et al. MRI of Metatarsal Head Subchondral Fractures in Patients With Forefoot Pain. AJR Am J Roentgenol; 2008; 190 (March): 570-575:

MDCT and MR Update: Body and Musculoskeletal Imaging

University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. Click here to read more or order:

MDCT and MR Update: Body and Musculoskeletal Imaging

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