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Musculoskeletal Imaging

E1201. Non-Traumatic Foot Radiographs: What the Foot Specialist Wants to Know

Vossen J,  Patel T,  Haar P,  Hoover K,  Hayes C. Virginia Commonwealth University Medical Center, Richmond, VA

Address correspondence to J. Vossen (josephina.vossen@gmail.com)

Background Information: Forefoot pain is a common presenting complaint seen by foot and ankle surgeons with a significant impact on patient quality of life. Patients often have difficulty localizing the precise location of their pain. Therefore, radiology plays a vital role in the diagnosis and treatment.

Educational Goals/Teaching Points: Our aim is to explain the pathophysiology of forefoot pain and accurately quantify the extent of forefoot pathology using radiographs, CT and MRI. Viewers will understand the radiographic measurements associated with the forefoot and recognize the reconstructive surgical techniques for correcting forefoot pathology and normal and abnormal postoperative imaging appearance. Cases include orthopedic deformities (hammertoes, digital deformities, tailor’s bunion or bunionette), intermetatarsal neuroma, capsulitis, and accessory ossicles.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We present the pathophysiology of forefoot pain including anatomic review of the forefoot, etiologies of forefoot pain, and clinical symptoms predicting pain. We offer assessment of forefoot pain using radiographs, CT, and MRI, review of common clinical symptoms and the associated differential diagnoses of concern, and imaging findings of common diagnoses through case examples. Discussion of postoperative techniques and hardware used and attention to hardware complications, including loosening, hardware failure and periprosthetic fracture are shown.

Conclusion: Correct diagnosis and treatment of forefoot pathology is important in maintaining patient mobility. Awareness of specific anatomy exclusive to the forefoot and widely variable pathologic entities associated with forefoot pain helps the radiologist tailor an effective imaging approach. Familiarity with the imaging findings seen in forefoot pain may allow timely diagnosis and implementation of appropriate treatment strategies.