Normal MRI of the forefoot

Normal MRI of the forefoot

Normal MRI of the forefoot


Introduction

This anatomical module of e-Anatomy is dedicated to the anatomy of the forefoot and midfoot on MRI.The foot is divided into the hindfoot, midfoot and forefoot: the hindfoot includes the talus and calcaneus; the midfoot comprises the navicular, cuboid, medial, intermediate and lateral cuneiform bones and the forefoot is composed of the metatarsal bones and phalanges. 
This anatomy module focuses in particular on normal anatomical findings of the forefoot and toes, including bones, joints and ligaments (Lisfranc joint complex, MTJ joints, plantar hallux complex), tendons and muscles, synovial tendon sheaths , synovial bursae of the foot, arteries and veins of the forefoot, detailed anatomy of the nerve supply (plantar and dorsal digital nerves, medial and lateral plantar nerves).
This anatomy atlas of the foot has been designed to help MSK radiologists, rheumatologists and orthopedic surgeons in their daily practice, especially for the MR imaging of plantar plate disruption (turf toe), sesamoiditis, stress-fractures, bursitis and other diseases of the forefoot. 

 

Material and methods

This MR of the forefoot was carried out on a healthy male patient, using a Vantage Galan 3T MRI, by Gerald Retzl MD (Radiologist, Regensburg - Germany). 
High-resolution MR images of the forefoot have been obtained in three anatomical planes (axial, sagittal and coronal planes) with the use of a dedicated foot coil. Note that regarding the plane's terminology of the foot, there may be a confusion for identifying these imaging planes because positioning (prone versus supine) can influence the relative plane in relation to the long axis of the body. That’s why some authors prefer to use short and long axis terminology for axial and coronal planes respectively.
Although we chose a healthy volunteer for this MRI exam, we found some anatomical variations during the labeling, such as a fusion between middle and distal phalanx of the fifth toe and an intertendinous connection between flexor hallucis longus and flexor digitorum longus tendons.


MRI sequences were chosen to optimize visualization of anatomy (T1-weighted) and fluid (FS proton density–weighted).
The MRI parameters for foot imaging used for this exam are provided below:
 

MRI sequenceNumber of imagesSlice thickness (mm)TR (ms)TE (ms)FOV (mm)MatrixResolution
Axial PD FS34291444080256x2560.2x0.2x3
Axial T13426751280320x2560.2x0.2x3
Sagittal PD FS45291444080352x2560.2x0.2x3
Sagittal T14526751280320x2560.2x0.2x3
Coronal PD FS86291444080320x2560.2x0.2x3
Coronal T18626751280352x2560.2x0.2x3

The anatomical structures were labeled by Antoine Micheau MD (Radiologist, Montpellier – France), using the Terminologia Anatomica 2.

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