Posts Categorized: Foot

What matters in this 58-year-old’s foot case?

This 58-year-old man has soft tissue masses in the foot. Let’s work through this case together, going through differential diagnoses from most to least likely. The abnormalities are indicated with blue arrows on image 1 (sagittal T1-weighted image without contrast), image 2 (sagittal proton density fat sat), image 3 (short axis T2-weighted image more proximally,… Read more »

The failure of T2 in foot imaging

This 14-year-old with prior fibular fracture now complains of ankle pain, swelling and locking symptoms 4-5 months after original injury. You are shown two sagittal sequences of the hind and midfoot. Image 1 is a proton density fat suppression using the technique known as STIR. Image 2 is a T2 fast-spin echo. What is the… Read more »

Why does this 11-year-old have a moving toe lump?

This 11-year-old female presents with a lump on the third digit of her foot that has been present for more than a year. The lump is mobile on exam, and is not growing or causing pain. She has no history of surgery or trauma. Evaluation of masses of the extremity usually begins with plain radiographs… Read more »

What is ProScan’s rule of heel/ankle MRI?

This 62-year-old has a heel ulcer (blue arrow). You are shown sagittal or lateral T1 fat-weighted (image 1) and T2 water-weighted (image 2) magnified pictures of the heel. This is followed by an axial T1 MRI (image 3) and a sagittal water-weighted SPIR (image 4). Is the edema reactive from soft tissue infection or invasive… Read more »

How does this foot case relate to a famous sports injury?

This 22-year-old injured his foot playing a sport. What sport was it and what exactly happened? A hint for those of you who know sports trivia: Clint Malarchuk’s injury 28 years ago was sustained by similar means. You are shown sagittal water-weighted images with a key structure highlighted (green arrow).   The sport is hockey…. Read more »

How does the tech industry help us answer this simple foot question?

This is a 35-year-old man with a complaint of dorsal cyst at the second interspace and pain. Simple question: Why is this not a ganglion? If you need a clue, think about the phrase ‘Intel Inside’ from the technology industry. There is debris, synovial hyperplasia or metaplasia “inside.” This can’t happen with a ganglion pseudocyst…. Read more »

Why is this 18-year-old having foot pain?

This 18-year-old female presents with a palpable soft tissue mass subjacent to the first metatarsophalangeal (MP) joint that she has noticed for 1-2 months. It is painful with shoes and ambulation, and you are evaluating her for a soft tissue tumor. What is the cause of her problem, and what pertinent negatives must you notice?… Read more »

What does this foot case have to do with a Bill Murray movie?

This 49-year-old presents with an ulcer, open wound and renal insufficiency. For some reason, this calls to mind Sergeant Hulka’s big toe. Which movie features Sergeant Hulka? What should you call this infection? Sergeant Hulka appears in the movie ‘Stripes,’ with a cast that includes Bill Murray and John Candy. As for this infection, it’s… Read more »

How should you repair this patient’s heel pain?

This 59-year-old presents with heel pain. Diagnosis is obvious on water-weighted sagittal MRI, but how do you repair this?   It’s an obvious plantar fasciitis with a tear. As for how to repair it, that’s a trick question. You put the patient in a boot and manage their pain. The surgical treatment for plantar fasciitis… Read more »

What is the underlying disease?

Sometimes the history can change everything when it comes to evaluating a case. I wanted to show you one such example. Before you look at my findings, be sure to come up with your own answer for what you think is this patient’s underlying disease. Case History: 74-year-old with swollen toe. What is the underlying… Read more »