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Forefoot Pain Involving the Metatarsal Region: Differential Diagnosis with MR Imaging¹

¹ From the Department of Radiology, Ohio State University Medical Center, S209 Rhodes Hall, Columbus, OH 43210. Presented as an education exhibit at the 2000 RSNA scientific assembly. Received March 16, 2001; revision requested April 3 and received June 19; accepted July 10. Address correspondence to C.J.A. (e-mail: cajaas@yahoo.com).

View larger version (112K): [in a new window]   Figure 1a.   (a-c) Turf toe in a 24-year-old professional football player who sustained an acute hyperextension injury at the first MTP joint. (a) Sagittal T1-weighted MR image shows a disrupted plantar plate (arrow) between the sesamoid bone and the base of the proximal phalanx of the great toe. (b) Sagittal short-inversion-time inversion recovery (STIR) MR image demonstrates edema in the region of the plantar plate (arrow). (c) Sagittal STIR MR image obtained adjacent to b demonstrates subchondral bone marrow edema (short arrow) and surface irregularity of the first metatarsal head (long arrow). (d) Intact plantar plate in an asymptomatic 30-year-old woman. Sagittal fat-suppressed fast spin-echo proton-density-weighted MR image shows the plantar plate (long arrow) as a low-signal-intensity band dorsal to the flexor tendons (short arrow).

View larger version (121K): [in a new window]   Figure 1b.   (a-c) Turf toe in a 24-year-old professional football player who sustained an acute hyperextension injury at the first MTP joint. (a) Sagittal T1-weighted MR image shows a disrupted plantar plate (arrow) between the sesamoid bone and the base of the proximal phalanx of the great toe. (b) Sagittal short-inversion-time inversion recovery (STIR) MR image demonstrates edema in the region of the plantar plate (arrow). (c) Sagittal STIR MR image obtained adjacent to b demonstrates subchondral bone marrow edema (short arrow) and surface irregularity of the first metatarsal head (long arrow). (d) Intact plantar plate in an asymptomatic 30-year-old woman. Sagittal fat-suppressed fast spin-echo proton-density-weighted MR image shows the plantar plate (long arrow) as a low-signal-intensity band dorsal to the flexor tendons (short arrow).

View larger version (105K): [in a new window]   Figure 1c.   (a-c) Turf toe in a 24-year-old professional football player who sustained an acute hyperextension injury at the first MTP joint. (a) Sagittal T1-weighted MR image shows a disrupted plantar plate (arrow) between the sesamoid bone and the base of the proximal phalanx of the great toe. (b) Sagittal short-inversion-time inversion recovery (STIR) MR image demonstrates edema in the region of the plantar plate (arrow). (c) Sagittal STIR MR image obtained adjacent to b demonstrates subchondral bone marrow edema (short arrow) and surface irregularity of the first metatarsal head (long arrow). (d) Intact plantar plate in an asymptomatic 30-year-old woman. Sagittal fat-suppressed fast spin-echo proton-density-weighted MR image shows the plantar plate (long arrow) as a low-signal-intensity band dorsal to the flexor tendons (short arrow).

View larger version (74K): [in a new window]   Figure 1d.   (a-c) Turf toe in a 24-year-old professional football player who sustained an acute hyperextension injury at the first MTP joint. (a) Sagittal T1-weighted MR image shows a disrupted plantar plate (arrow) between the sesamoid bone and the base of the proximal phalanx of the great toe. (b) Sagittal short-inversion-time inversion recovery (STIR) MR image demonstrates edema in the region of the plantar plate (arrow). (c) Sagittal STIR MR image obtained adjacent to b demonstrates subchondral bone marrow edema (short arrow) and surface irregularity of the first metatarsal head (long arrow). (d) Intact plantar plate in an asymptomatic 30-year-old woman. Sagittal fat-suppressed fast spin-echo proton-density-weighted MR image shows the plantar plate (long arrow) as a low-signal-intensity band dorsal to the flexor tendons (short arrow).

View larger version (126K): [in a new window]   Figure 2a.   Disrupted plantar plate at the second MTP joint in a 48-year-old woman who presented with foot pain. The patient had no history of acute trauma. (a) Coronal fat-suppressed fast spin-echo proton-density-weighted MR image shows edema in the region of the plantar plate. The lateral aspect of the plate is not visualized (arrow). (b, c) Sagittal gadolinium-enhanced fat-suppressed T1-weighted MR images obtained at the medial (b) and lateral (c) aspects of the second MTP joint show a thin, irregular, indistinct plantar plate medially (arrows in b). The plate appears to be disrupted laterally (arrow in c). Note the fluid accumulation and contrast material enhancement within the joint and the adjacent flexor tendon sheath, findings that indicate synovitis and tenosynovitis, respectively. The proximal phalanx is hyperextended.

View larger version (135K): [in a new window]   Figure 2b.   Disrupted plantar plate at the second MTP joint in a 48-year-old woman who presented with foot pain. The patient had no history of acute trauma. (a) Coronal fat-suppressed fast spin-echo proton-density-weighted MR image shows edema in the region of the plantar plate. The lateral aspect of the plate is not visualized (arrow). (b, c) Sagittal gadolinium-enhanced fat-suppressed T1-weighted MR images obtained at the medial (b) and lateral (c) aspects of the second MTP joint show a thin, irregular, indistinct plantar plate medially (arrows in b). The plate appears to be disrupted laterally (arrow in c). Note the fluid accumulation and contrast material enhancement within the joint and the adjacent flexor tendon sheath, findings that indicate synovitis and tenosynovitis, respectively. The proximal phalanx is hyperextended.

View larger version (133K): [in a new window]   Figure 2c.   Disrupted plantar plate at the second MTP joint in a 48-year-old woman who presented with foot pain. The patient had no history of acute trauma. (a) Coronal fat-suppressed fast spin-echo proton-density-weighted MR image shows edema in the region of the plantar plate. The lateral aspect of the plate is not visualized (arrow). (b, c) Sagittal gadolinium-enhanced fat-suppressed T1-weighted MR images obtained at the medial (b) and lateral (c) aspects of the second MTP joint show a thin, irregular, indistinct plantar plate medially (arrows in b). The plate appears to be disrupted laterally (arrow in c). Note the fluid accumulation and contrast material enhancement within the joint and the adjacent flexor tendon sheath, findings that indicate synovitis and tenosynovitis, respectively. The proximal phalanx is hyperextended.

View larger version (111K): [in a new window]   Figure 3a.   Sesamoiditis in a 21-year-old female kickboxer. (a) Coronal T1-weighted MR image shows the tibial and fibular sesamoid bones with low signal intensity (arrows). (b) Corresponding coronal STIR MR image shows the sesamoid bones with increased signal intensity (long arrows). Note the adjacent soft-tissue edema and joint effusion. Involvement of both sesamoid bones, joint effusion, and inflammatory changes in the adjacent soft tissues favor a diagnosis of sesamoiditis rather than stress response. However, the small amount of bone marrow edema within the first metatarsal head (short arrow) probably represents a stress response.

View larger version (110K): [in a new window]   Figure 3b.   Sesamoiditis in a 21-year-old female kickboxer. (a) Coronal T1-weighted MR image shows the tibial and fibular sesamoid bones with low signal intensity (arrows). (b) Corresponding coronal STIR MR image shows the sesamoid bones with increased signal intensity (long arrows). Note the adjacent soft-tissue edema and joint effusion. Involvement of both sesamoid bones, joint effusion, and inflammatory changes in the adjacent soft tissues favor a diagnosis of sesamoiditis rather than stress response. However, the small amount of bone marrow edema within the first metatarsal head (short arrow) probably represents a stress response.

View larger version (89K): [in a new window]   Figure 4a.   Stress fracture of the second metatarsal shaft in a 19-year-old male runner. The patient had no history of acute trauma. (a) Axial T1-weighted MR image shows cortical thickening, a low-signal-intensity horizontal band representing a fracture line spanning the width of the bone (arrows), and adjacent low-signal-intensity changes within the marrow. (b) Coronal T2-weighted MR image shows increased signal intensity within the marrow and adjacent soft tissues (arrows). (c) On a gadolinium-enhanced fat-suppressed T1-weighted MR image, the fracture line is more conspicuous (arrows). Note the intense contrast enhancement of the adjacent bone marrow and soft tissues.

View larger version (91K): [in a new window]   Figure 4b.   Stress fracture of the second metatarsal shaft in a 19-year-old male runner. The patient had no history of acute trauma. (a) Axial T1-weighted MR image shows cortical thickening, a low-signal-intensity horizontal band representing a fracture line spanning the width of the bone (arrows), and adjacent low-signal-intensity changes within the marrow. (b) Coronal T2-weighted MR image shows increased signal intensity within the marrow and adjacent soft tissues (arrows). (c) On a gadolinium-enhanced fat-suppressed T1-weighted MR image, the fracture line is more conspicuous (arrows). Note the intense contrast enhancement of the adjacent bone marrow and soft tissues.

View larger version (95K): [in a new window]   Figure 4c.   Stress fracture of the second metatarsal shaft in a 19-year-old male runner. The patient had no history of acute trauma. (a) Axial T1-weighted MR image shows cortical thickening, a low-signal-intensity horizontal band representing a fracture line spanning the width of the bone (arrows), and adjacent low-signal-intensity changes within the marrow. (b) Coronal T2-weighted MR image shows increased signal intensity within the marrow and adjacent soft tissues (arrows). (c) On a gadolinium-enhanced fat-suppressed T1-weighted MR image, the fracture line is more conspicuous (arrows). Note the intense contrast enhancement of the adjacent bone marrow and soft tissues.

View larger version (107K): [in a new window]   Figure 5a.   Osteomyelitis of the first metatarsal head and septic arthritis of the first MTP joint in a 30-year-old woman with systemic lupus erythematosus. (a) Axial T1-weighted MR image shows an area of diffuse low signal intensity within the marrow of the distal first metatarsal bone (arrows). Similar changes were also present within the base of the proximal phalanx of the great toe. (b) Coronal T2-weighted MR image demonstrates a dorsal cutaneous ulcer (arrowheads), dorsal sinus tract (short arrows), high-signal-intensity changes in the soft tissues representing cellulitis, increased signal intensity within the marrow of the metatarsal head (*), and joint effusion (long arrow). (c) Sagittal fat-suppressed T1-weighted MR image reveals intense contrast enhancement of the bone marrow, joint, and soft tissues. Note that the extensor tendon sheath dorsal to the first ray demonstrates both edema and enhancement (arrows), findings that indicate tenosynovitis.

View larger version (104K): [in a new window]   Figure 5b.   Osteomyelitis of the first metatarsal head and septic arthritis of the first MTP joint in a 30-year-old woman with systemic lupus erythematosus. (a) Axial T1-weighted MR image shows an area of diffuse low signal intensity within the marrow of the distal first metatarsal bone (arrows). Similar changes were also present within the base of the proximal phalanx of the great toe. (b) Coronal T2-weighted MR image demonstrates a dorsal cutaneous ulcer (arrowheads), dorsal sinus tract (short arrows), high-signal-intensity changes in the soft tissues representing cellulitis, increased signal intensity within the marrow of the metatarsal head (*), and joint effusion (long arrow). (c) Sagittal fat-suppressed T1-weighted MR image reveals intense contrast enhancement of the bone marrow, joint, and soft tissues. Note that the extensor tendon sheath dorsal to the first ray demonstrates both edema and enhancement (arrows), findings that indicate tenosynovitis.

View larger version (65K): [in a new window]   Figure 5c.   Osteomyelitis of the first metatarsal head and septic arthritis of the first MTP joint in a 30-year-old woman with systemic lupus erythematosus. (a) Axial T1-weighted MR image shows an area of diffuse low signal intensity within the marrow of the distal first metatarsal bone (arrows). Similar changes were also present within the base of the proximal phalanx of the great toe. (b) Coronal T2-weighted MR image demonstrates a dorsal cutaneous ulcer (arrowheads), dorsal sinus tract (short arrows), high-signal-intensity changes in the soft tissues representing cellulitis, increased signal intensity within the marrow of the metatarsal head (*), and joint effusion (long arrow). (c) Sagittal fat-suppressed T1-weighted MR image reveals intense contrast enhancement of the bone marrow, joint, and soft tissues. Note that the extensor tendon sheath dorsal to the first ray demonstrates both edema and enhancement (arrows), findings that indicate tenosynovitis.

View larger version (116K): [in a new window]   Figure 6.   Osteomyelitis in a 25-year-old diabetic man with burning foot pain. Sagittal gadolinium-enhanced fat-suppressed T1-weighted MR image demonstrates a low-signal-intensity fluid collection with peripheral enhancement representing an abscess plantar to the fifth metatarsal head (arrows). Note also the intense enhancement of the adjacent fifth metatarsal bone (*), a finding that indicates osteomyelitis.

View larger version (113K): [in a new window]   Figure 7a.   Early neuropathic osteoarthropathy in a 49-year-old diabetic man who complained of foot pain and swelling. The patient had no history of trauma or unusual activity. (a) Axial T1-weighted MR image shows a serpentine band of low signal intensity in the lateral cuneiform bone representing a subchondral fracture (short arrows). Adjacent low-signal-intensity bone marrow edema is also present within the proximal third metatarsal bone (long arrows). (b) Axial gadolinium-enhanced fat-suppressed T1-weighted MR image shows contrast enhancement of periarticular bone (arrows) and adjacent soft tissues.

View larger version (117K): [in a new window]   Figure 7b.   Early neuropathic osteoarthropathy in a 49-year-old diabetic man who complained of foot pain and swelling. The patient had no history of trauma or unusual activity. (a) Axial T1-weighted MR image shows a serpentine band of low signal intensity in the lateral cuneiform bone representing a subchondral fracture (short arrows). Adjacent low-signal-intensity bone marrow edema is also present within the proximal third metatarsal bone (long arrows). (b) Axial gadolinium-enhanced fat-suppressed T1-weighted MR image shows contrast enhancement of periarticular bone (arrows) and adjacent soft tissues.

View larger version (93K): [in a new window]   Figure 8.   Osteoarthritis at the first MTP joint in a 50-year-old man. Axial T1-weighted MR image shows a large marginal osteophyte (long arrow), ossicles at the lateral joint margin (short arrows), medial joint space narrowing, and subchondral low signal intensity within the first metatarsal head and proximal phalanx of the great toe.

View larger version (168K): [in a new window]   Figure 9a.   Tophaceous gout involving the intermetatarsal and tarsometatarsal region of the foot in a 56-year-old man with hyperuricemia who presented with foot pain and swelling. (a) Axial T1-weighted MR image shows low-signal-intensity tophi (long arrows) and adjacent periarticular erosions with characteristic overhanging edges (short arrows). The joint spaces are preserved, as is typical in gout. (b, c) Coronal proton-density-weighted (b) and T2-weighted (c) MR images obtained at the level of the tarsometatarsal joint reveal erosions (short arrows) and low-signal-intensity tophi (long arrows). (Fig 9b and 9c reprinted, with permission, from reference 24.) (d) Gadolinium-enhanced fat-suppressed T1-weighted MR image shows increased contrast enhancement of the tophi (arrows) and juxta-articular bone.

View larger version (177K): [in a new window]   Figure 9b.   Tophaceous gout involving the intermetatarsal and tarsometatarsal region of the foot in a 56-year-old man with hyperuricemia who presented with foot pain and swelling. (a) Axial T1-weighted MR image shows low-signal-intensity tophi (long arrows) and adjacent periarticular erosions with characteristic overhanging edges (short arrows). The joint spaces are preserved, as is typical in gout. (b, c) Coronal proton-density-weighted (b) and T2-weighted (c) MR images obtained at the level of the tarsometatarsal joint reveal erosions (short arrows) and low-signal-intensity tophi (long arrows). (Fig 9b and 9c reprinted, with permission, from reference 24.) (d) Gadolinium-enhanced fat-suppressed T1-weighted MR image shows increased contrast enhancement of the tophi (arrows) and juxta-articular bone.

View larger version (165K): [in a new window]   Figure 9c.   Tophaceous gout involving the intermetatarsal and tarsometatarsal region of the foot in a 56-year-old man with hyperuricemia who presented with foot pain and swelling. (a) Axial T1-weighted MR image shows low-signal-intensity tophi (long arrows) and adjacent periarticular erosions with characteristic overhanging edges (short arrows). The joint spaces are preserved, as is typical in gout. (b, c) Coronal proton-density-weighted (b) and T2-weighted (c) MR images obtained at the level of the tarsometatarsal joint reveal erosions (short arrows) and low-signal-intensity tophi (long arrows). (Fig 9b and 9c reprinted, with permission, from reference 24.) (d) Gadolinium-enhanced fat-suppressed T1-weighted MR image shows increased contrast enhancement of the tophi (arrows) and juxta-articular bone.

View larger version (158K): [in a new window]   Figure 9d.   Tophaceous gout involving the intermetatarsal and tarsometatarsal region of the foot in a 56-year-old man with hyperuricemia who presented with foot pain and swelling. (a) Axial T1-weighted MR image shows low-signal-intensity tophi (long arrows) and adjacent periarticular erosions with characteristic overhanging edges (short arrows). The joint spaces are preserved, as is typical in gout. (b, c) Coronal proton-density-weighted (b) and T2-weighted (c) MR images obtained at the level of the tarsometatarsal joint reveal erosions (short arrows) and low-signal-intensity tophi (long arrows). (Fig 9b and 9c reprinted, with permission, from reference 24.) (d) Gadolinium-enhanced fat-suppressed T1-weighted MR image shows increased contrast enhancement of the tophi (arrows) and juxta-articular bone.

View larger version (148K): [in a new window]   Figure 10a.   Rheumatoid arthritis in a 71-year-old woman with pain at the first MTP joint. (a) Axial T1-weighted MR image shows marginal erosions at the first metatarsal head (short arrows), low-signal-intensity synovial thickening (long arrows), and joint space narrowing. Note also the erosive changes at the interphalangeal joint of the great toe. (b) Coronal gadolinium-enhanced fat-suppressed T1-weighted MR image shows contrast enhancement of the synovium (long arrow) and subchondral bone (short arrow). The signal intensity changes in both a and b are nonspecific; however, a previously established diagnosis of rheumatoid arthritis in the hands, a lack of clinical indicators of infection, a normal serum urate level, and a positive response to steroids supported the diagnosis of rheumatoid arthritis at the first MTP and interphalangeal joints.

View larger version (117K): [in a new window]   Figure 10b.   Rheumatoid arthritis in a 71-year-old woman with pain at the first MTP joint. (a) Axial T1-weighted MR image shows marginal erosions at the first metatarsal head (short arrows), low-signal-intensity synovial thickening (long arrows), and joint space narrowing. Note also the erosive changes at the interphalangeal joint of the great toe. (b) Coronal gadolinium-enhanced fat-suppressed T1-weighted MR image shows contrast enhancement of the synovium (long arrow) and subchondral bone (short arrow). The signal intensity changes in both a and b are nonspecific; however, a previously established diagnosis of rheumatoid arthritis in the hands, a lack of clinical indicators of infection, a normal serum urate level, and a positive response to steroids supported the diagnosis of rheumatoid arthritis at the first MTP and interphalangeal joints.

View larger version (92K): [in a new window]   Figure 11a.   Tendon rupture due to laceration of the dorsum of the foot in a 25-year-old woman with inability to dorsiflex the great toe. (a) Sagittal fat-suppressed fast spin-echo proton-density-weighted MR image shows complete rupture of the extensor hallucis longus tendon (arrow). (b) Coronal T2-weighted MR image shows a fluid-filled gap at the expected location of the tendon at the level of the proximal first metatarsal bone (arrows).

View larger version (133K): [in a new window]   Figure 11b.   Tendon rupture due to laceration of the dorsum of the foot in a 25-year-old woman with inability to dorsiflex the great toe. (a) Sagittal fat-suppressed fast spin-echo proton-density-weighted MR image shows complete rupture of the extensor hallucis longus tendon (arrow). (b) Coronal T2-weighted MR image shows a fluid-filled gap at the expected location of the tendon at the level of the proximal first metatarsal bone (arrows).

View larger version (108K): [in a new window]   Figure 12.   Partial tendon rupture in a 45-year-old male softball player. Coronal proton-density-weighted MR image reveals a partial longitudinal tear in the flexor hallucis longus tendon (arrows).

View larger version (96K): [in a new window]   Figure 13a.   Dorsal ganglion in a 25-year-old woman who presented with a painful soft-tissue mass. (a, b) Sagittal (a) and coronal (b) T2-weighted MR images reveal a well-defined mass with high signal intensity and a mildly lobulated contour (short arrow) adjacent to the fourth extensor tendon (long arrows in a). (c) On a coronal gadolinium-enhanced fat-suppressed T1-weighted MR image, the mass demonstrates low signal intensity with peripheral enhancement (arrows).

View larger version (124K): [in a new window]   Figure 13b.   Dorsal ganglion in a 25-year-old woman who presented with a painful soft-tissue mass. (a, b) Sagittal (a) and coronal (b) T2-weighted MR images reveal a well-defined mass with high signal intensity and a mildly lobulated contour (short arrow) adjacent to the fourth extensor tendon (long arrows in a). (c) On a coronal gadolinium-enhanced fat-suppressed T1-weighted MR image, the mass demonstrates low signal intensity with peripheral enhancement (arrows).

View larger version (122K): [in a new window]   Figure 13c.   Dorsal ganglion in a 25-year-old woman who presented with a painful soft-tissue mass. (a, b) Sagittal (a) and coronal (b) T2-weighted MR images reveal a well-defined mass with high signal intensity and a mildly lobulated contour (short arrow) adjacent to the fourth extensor tendon (long arrows in a). (c) On a coronal gadolinium-enhanced fat-suppressed T1-weighted MR image, the mass demonstrates low signal intensity with peripheral enhancement (arrows).

View larger version (108K): [in a new window]   Figure 14a.   Submetatarsal bursitis in a 60-year-old woman with pain under the second metatarsal head. (a) Coronal T2-weighted MR image shows a well-defined mass with high signal intensity (arrows). (b) On a coronal gadolinium-enhanced fat-suppressed T1-weighted MR image, the mass demonstrates low signal intensity with peripheral enhancement (arrows).

View larger version (97K): [in a new window]   Figure 14b.   Submetatarsal bursitis in a 60-year-old woman with pain under the second metatarsal head. (a) Coronal T2-weighted MR image shows a well-defined mass with high signal intensity (arrows). (b) On a coronal gadolinium-enhanced fat-suppressed T1-weighted MR image, the mass demonstrates low signal intensity with peripheral enhancement (arrows).

View larger version (84K): [in a new window]   Figure 15a.   Foreign body granuloma in a 26-year-old man. (a) Coronal proton-density-weighted MR image reveals a low-signal-intensity nodular lesion in the subcutaneous fat at the plantar aspect of the ball of the foot (long arrows). A channel communicating with the skin surface is also seen (short arrows). (b) On a coronal T2-weighted MR image, the lesion demonstrates low signal intensity (arrows). (c) Coronal gadolinium-enhanced fat-suppressed T1-weighted MR image shows the mass with peripheral enhancement (arrows), a finding that indicates inflammation.

View larger version (81K): [in a new window]   Figure 15b.   Foreign body granuloma in a 26-year-old man. (a) Coronal proton-density-weighted MR image reveals a low-signal-intensity nodular lesion in the subcutaneous fat at the plantar aspect of the ball of the foot (long arrows). A channel communicating with the skin surface is also seen (short arrows). (b) On a coronal T2-weighted MR image, the lesion demonstrates low signal intensity (arrows). (c) Coronal gadolinium-enhanced fat-suppressed T1-weighted MR image shows the mass with peripheral enhancement (arrows), a finding that indicates inflammation.

View larger version (89K): [in a new window]   Figure 15c.   Foreign body granuloma in a 26-year-old man. (a) Coronal proton-density-weighted MR image reveals a low-signal-intensity nodular lesion in the subcutaneous fat at the plantar aspect of the ball of the foot (long arrows). A channel communicating with the skin surface is also seen (short arrows). (b) On a coronal T2-weighted MR image, the lesion demonstrates low signal intensity (arrows). (c) Coronal gadolinium-enhanced fat-suppressed T1-weighted MR image shows the mass with peripheral enhancement (arrows), a finding that indicates inflammation.

View larger version (110K): [in a new window]   Figure 16a.   Morton neuroma in a patient with pain at the level of the third MTP joint radiating into the toe. (a) Coronal T1-weighted MR image shows a large, teardrop-shaped mass with intermediate signal intensity at the third MTP interspace (arrows). (b) On a coronal gadolinium-enhanced fat-suppressed T1-weighted MR image, the lesion demonstrates diffuse enhancement (arrows).

View larger version (113K): [in a new window]   Figure 16b.   Morton neuroma in a patient with pain at the level of the third MTP joint radiating into the toe. (a) Coronal T1-weighted MR image shows a large, teardrop-shaped mass with intermediate signal intensity at the third MTP interspace (arrows). (b) On a coronal gadolinium-enhanced fat-suppressed T1-weighted MR image, the lesion demonstrates diffuse enhancement (arrows).

View larger version (100K): [in a new window]   Figure 17a.   Plantar fibromatosis in a 46-year-old man with a painful nodule in the foot. (a) Coronal proton-density-weighted MR image demonstrates a mass with intermediate to low signal intensity in the region of the medial plantar fascia at the proximal metatarsal level (arrows). (b) On a corresponding coronal T2-weighted MR image, the mass demonstrates low signal intensity (arrows). (c) Gadolinium-enhanced fat-suppressed T1-weighted MR image shows the lesion with marked enhancement (arrows).

View larger version (101K): [in a new window]   Figure 17b.   Plantar fibromatosis in a 46-year-old man with a painful nodule in the foot. (a) Coronal proton-density-weighted MR image demonstrates a mass with intermediate to low signal intensity in the region of the medial plantar fascia at the proximal metatarsal level (arrows). (b) On a corresponding coronal T2-weighted MR image, the mass demonstrates low signal intensity (arrows). (c) Gadolinium-enhanced fat-suppressed T1-weighted MR image shows the lesion with marked enhancement (arrows).

View larger version (123K): [in a new window]   Figure 17c.   Plantar fibromatosis in a 46-year-old man with a painful nodule in the foot. (a) Coronal proton-density-weighted MR image demonstrates a mass with intermediate to low signal intensity in the region of the medial plantar fascia at the proximal metatarsal level (arrows). (b) On a corresponding coronal T2-weighted MR image, the mass demonstrates low signal intensity (arrows). (c) Gadolinium-enhanced fat-suppressed T1-weighted MR image shows the lesion with marked enhancement (arrows).

View larger version (138K): [in a new window]   Figure 18a.   Leiomyosarcoma in an 18-year-old woman with progressive foot pain and an enlarging mass. (a) Axial fat-suppressed fast spin-echo proton-density-weighted MR image reveals a predominantly high-signal-intensity mass (long arrows) invading the fifth metatarsal bone (short arrow). (b, c) Coronal unenhanced (b) and gadolinium-enhanced (c) T1-weighted MR images show the mass with intermediate signal intensity (arrows in b) and diffuse enhancement (arrows in c), respectively. Note the associated infiltration and destruction of the fourth and fifth metatarsal bones (arrowheads), a finding that indicates an aggressive tumor. This case is atypical in that leiomyosarcoma generally occurs in older individuals.

View larger version (93K): [in a new window]   Figure 18b.   Leiomyosarcoma in an 18-year-old woman with progressive foot pain and an enlarging mass. (a) Axial fat-suppressed fast spin-echo proton-density-weighted MR image reveals a predominantly high-signal-intensity mass (long arrows) invading the fifth metatarsal bone (short arrow). (b, c) Coronal unenhanced (b) and gadolinium-enhanced (c) T1-weighted MR images show the mass with intermediate signal intensity (arrows in b) and diffuse enhancement (arrows in c), respectively. Note the associated infiltration and destruction of the fourth and fifth metatarsal bones (arrowheads), a finding that indicates an aggressive tumor. This case is atypical in that leiomyosarcoma generally occurs in older individuals.

View larger version (97K): [in a new window]   Figure 18c.   Leiomyosarcoma in an 18-year-old woman with progressive foot pain and an enlarging mass. (a) Axial fat-suppressed fast spin-echo proton-density-weighted MR image reveals a predominantly high-signal-intensity mass (long arrows) invading the fifth metatarsal bone (short arrow). (b, c) Coronal unenhanced (b) and gadolinium-enhanced (c) T1-weighted MR images show the mass with intermediate signal intensity (arrows in b) and diffuse enhancement (arrows in c), respectively. Note the associated infiltration and destruction of the fourth and fifth metatarsal bones (arrowheads), a finding that indicates an aggressive tumor. This case is atypical in that leiomyosarcoma generally occurs in older individuals.