Sage Journals: Discover world-class research

Abstract

Background

The capsuloligamentous complex injury of the first metatarsophalangeal joint (MTPJ) is a common cause of turf toe.

Purpose

To investigate whether high-resolution 3 T magnetic resonance imaging (MRI) could demonstrate all the normal anatomic structures and the MR features of the capsuloligamentous complex injury of the first MTPJ, and to evaluate the diagnostic performance of MRI in the diagnosis of the capsuloligamentous complex injuries of the first MTPJ.

Material and Methods

A total of 115 feet were included in this study, including 48 feet from 24 healthy volunteers and 67 feet from 67 patients with the capsuloligamentous complex of the first MTPJ injuries. All feet had MRI examination. The MRI features of the capsuloligamentous complex of the first MTPJ of the volunteers and patients were analyzed. Diagnostic sensitivity, specificity, and accuracy of MRI were calculated using the surgery as the standard of reference. The inter-observer agreement was assessed using kappa analysis.

Results

The central portion of the plantar plate and ligament injury manifested as discontinuity, with an indistinct appearance with hyperintense signal within the involved structures. The sensitivities, specificities, and diagnostic accuracy value of MRI for diagnosing most structures of the capsuloligamentous complex injuries of the first MTPJ were 67%–100%, 93%–100%, and 0.82–0.99, respectively, and overall good to perfect inter-observer agreements (kappa=0.63–0.95).

Conclusion

High-resolution MRI allows adequate visualization of normal anatomic structures of the first MTPJ. The best visualized structure is sesamoid phalangeal ligament and the most frequent injury is complete tear of the medial sesamoid phalangeal ligament.

Keywords

Anatomy injury high resolution magnetic resonance imaging capsuloligamentous complex first metatarsophalangeal joint foot

Get full access to this article

View all access options for this article.

References

Gorbachova

. Midfoot and forefoot injuries. Top Magn Reson Imaging 2015;24:215–221.

Theumann

Pfirrmann

Mohana Borges

, et al. Metatarsophalangeal joint of the great toe: normal MR, MR arthrographic, and MR bursographic findings in cadavers. J Comput Assist Tomogr 2002;26:829–838.

Crain

Phancao

Stidham

. MR imaging of turf toe. Magn Reson Imaging Clin N Am 2008;16:93–103. vi.

Lepage-Saucier

Linda

Chang

, et al. MRI of the metatarsophalangeal joints: improved assessment with toe traction and MR arthrography. AJR Am J Roentgenol 2013;200:868–871.

Coughlin

Kemp

Hirose

. Turf toe: soft tissue and osteocartilaginous injury to the first metatarsophalangeal joint. Phys Sportsmed 2010;38:91–100.

Allen

Flemming

Sanders

. Turf toe: ligamentous injury of the first metatarsophalangeal joint. Mil Med 2004;169:xix–xxiv.

Poppe

Reinhardt

Tarakemeh

, et al. Turf toe: presentation, diagnosis, and management. JBJS Rev 2019;7:e7.

McCormick

Anderson

. The great toe: failed turf toe, chronic turf toe, and complicated sesamoid injuries. Foot Ankle Clin 2009;14:135–150.

McCormick

Anderson

. Rehabilitation following turf toe injury and plantar plate repair. Clin Sports Med 2010;29:313–323. ix.

10.

De Maeseneer

Moyson

Lenchik

, et al. MR imaging-anatomical correlation of the metatarsophalangeal joint of the hallux: ligaments, tendons, and muscles. Eur J Radiol 2018;106:14–19.

11.

Srinivasan

. The hallucal-sesamoid complex: normal anatomy, imaging, and pathology. Semin Musculoskelet Radiol 2016;20:224–232.

12.

Waldrop

Zirkel

Wijdicks

, et al. Radiographic evaluation of plantar plate injury: an in vitro biomechanical study. Foot Ankle Int 2013;34:403–408.

13.

Crain

Phancao

. Imaging of turf toe. Radiol Clin North Am 2016;54:969–978.

14.

Wilson

Dimeff

Miniaci

, et al. Radiologic case study. First metarsophalangeal plantar plate injury (turf toe). Orthopedics 2005;28:344,417–419.

15.

Nery

Baumfeld

Umans

, et al. MR imaging of the plantar plate: normal anatomy, turf toe, and other injuries. Magn Reson Imaging Clin N Am 2017;25:127–144.

16.

Xian

Chen

Jin

. Magnetic resonance imaging in clinical medicine: current status and potential future developments in China. Chin Med J 2015;128:569–570.

17.

Bai RJ, Zhang HB, Zhan HL, et al. Sports injury-related fingers and thumb deformity due to tendon or ligament rupture. Chin Med J 2018;131:1051-1058.

18.

Dietrich

da Silva

FLF

de Abreu

, et al. First metatarsophalangeal joint- MRI findings in asymptomatic volunteers. Eur Radiol 2015;25:970–979.

19.

Ashimolowo

Dunham

Sharp

, et al. Turf toe. An update and comprehensive review. Radiol Clin North Am 2018;56:847–858.

20.

Capasso

Maffulli

Testa

. Rupture of the intersesamoid ligament of a soccer player's foot. Foot Ankle 1990;10:337–339.

21.

Ashman

Klecker

. Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging. Radiographics 2001;21:1425–1440.

22.

Hallinan

JTPD

Statum

Huang

, et al. High-resolution MRI of the first metatarsophalangeal joint: gross anatomy and injury characterization. Radiographics 2020;40:1107–1124.

23.

Watson

Anderson

Davis

. Periarticular injuries to the hallux metatarsophalangeal joint in athletes. Foot Ankle Clin 2000;5:687–6713.

24.

Douglas

Davidson

Robinson

, et al. Rupture of the medial collateral ligament of the first metatarsophalangeal joint in a professional soccer player. J Foot Ankle Surg 1997;36:388–390.

25.

Mullis

Miller

. A disabling sports injury of the great toe. Foot Ankle 1980;1:22–25.

26.

Clanton

Ford

. Turf toe injury. Clin Sports Med 1994;13:731–741.

27.

Wang JE, Bai RJ, Zhan HL, et al. High-resolution 3T magnetic resonance imaging and histological analysis of capsuloligamentous complex of the first metatarsophalangeal joint. J Orthop Surg Res 2021;16:638.

28.

Dedmond

Cory

McBryde

. The hallucal sesamoid complex. J Am Acad Orthop Surg 2006;14:745–753.

29.

Smith

Waldrop

. Operative outcomes of grade 3 turf toe injuries in competitive football players. Foot Ankle Int 2018;39:1076–1081.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.11 MB

The magnetic resonance imaging appearance of the normal anatomy and injury pattern of capsuloligamentous complex of the first metatarsophalangeal joint

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material