Skimboarder's Toe: Findings on High-Field MRI

Paediatric sand toe: radiographic, ultrasound and MRI findings of dorsomedial capsular injury

Hyperflexion injury to the metatarsophalangeal joint of the great toe, referred to as sand toe, can cause significant functional impairment. To our knowledge, there have been no radiological descriptions of this injury in the paediatric age group. Here, we report radiographic, sonographic and MRI findings in a male paediatric patient who sustained a sand toe injury, highlighting structural damage to the dorsomedial capsule and medial sagittal band, and discuss sand toe's favourable prognosis with conservative management.

Skimboarding: An Increasingly Recognized Cause of Life-Threatening Spinal Cord Injury

Skimboarding is a sport that combines elements from aquatic and terrestrial sports and has gained popularity with increased riskier maneuvers. Spinal cord injuries associated with this sport have rarely been reported. Here we present a case of a previously healthy 44-year-old male with a life-threatening C2/C3 fracture and dislocation after a skimboarding fall. Traumatic facet dislocations in the cervical spine are usually consequent to high-energy transmission injuries, so it is difficult to explain the mechanism of injury in this clinical case. As this sport’s practice continues to grow, our purpose is to emphasize that these injuries may occur with irreversible consequences as most of the damage occurs at the time of presentation, so the first step is to alert athletes and the community to prevent them.

High-Resolution MRI of the First Metatarsophalangeal Joint: Gross Anatomy and Injury Characterization

The first metatarsophalangeal joint (MTPJ) is vital to the biomechanics of the foot and supports a weight up to eight times heavier than the body during athletic activities. The first MTPJ comprises osseous and cartilaginous surfaces along with a complex of supporting structures, including the dorsal extensor tendons, collateral ligaments, and a plantar plate complex. In contradistinction to the lesser MTPJ plantar plates, a single dominant fibrocartilaginous capsular thickening does not exist at the first MTPJ. Instead, the plantar plate complex comprises a fibrocartilaginous pad that invests the hallux sesamoids and is inseparable from the plantar capsule, the intersesamoid ligament, paired metatarsosesamoid and sesamoid phalangeal ligaments (SPLs), and the musculotendinous structures. Acute injury at the first MTPJ is typically secondary to forced hyperextension-turf toe-and can involve multiple structures. During hyperextension, the resulting forces primarily load the distal SPLs, making these structures more susceptible to injury. SPL injuries are best seen in the sagittal plane at MRI. Radiography can also aid in diagnosis of full-thickness SPL tears, demonstrating reduced sesamoid excursion at lateral dorsiflexed (stress) views. Hallux valgus is another common condition, resulting in progressive disabling deformity at the first MTPJ. Without appropriate treatment, first MTPJ injuries may progress to degenerative hallux rigidus. The authors detail the anatomy of the first MTPJ in cadaveric forefeet by using high-resolution 3-T and 11.7-T MRI and anatomic-pathologic correlation. Injuries to the plantar plate complex, collateral ligaments, and extensor mechanism are discussed using clinical case examples. Online supplemental material is available for this article. ^©RSNA, 2020.

Mallet hallux injury: A case report and literature review

Mallet injury is associated with variable degrees of extensor hallucis longus tendon tearing, ultimately leading to the well-known mallet toe deformity; this entity, commonly described at the lesser toes and fingers, has rarely been reported at the hallux. We present a surgically proven case of mallet hallux injury with radiographic and magnetic resonance imaging assessment and review the literature, including clinical and radiological findings, along with basic treatment concepts.

Extreme Sports Injuries to the Pelvis and Lower Extremity

Extreme sports are growing in popularity, and physicians are becoming increasingly aware of injuries related to these activities. Imaging plays a key role in diagnosing and determining clinical management of many of these injuries. This article describes general imaging techniques and findings in various injuries specific to multiple extreme sports.

[Acute sports injuries and chronic overuse stress damage to the forefoot and midfoot]

Sports injuries of the foot can occur as sequelae of acute trauma or chronic overuse. Besides clinical examination, imaging plays a major role in the detection of structural abnormalities and the differential diagnostics. This article reviews the most important sports-related soft tissue and bone pathologies of the forefoot and midfoot together with their typical findings on radiography, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).

Turf toe and sesamoiditis: what the radiologist needs to know

The first metatarsophalangeal (MTP) joint complex is a critical weight-bearing structure important to biomechanics. An acute dorsiflexion injury, named "turf toe," is common among American football and soccer players. "Sesamoiditis" is a name often given for pain arising from the hallux sesamoids in the absence of acute trauma, and may result from a variety of causes. The first MTP joint complex can also be affected by degenerative or inflammatory arthritis, infarct, and infection. This review article will cover the anatomy and biomechanics of the first MTP joint complex, its patterns of injury and pathology, imaging techniques, and management.

Forefoot: a basic integrated imaging perspective for radiologists

Imaging of the forefoot is increasingly requested for patients with metatarsalgia. Awareness with specific anatomic arrangements exclusive for the forefoot and widely variable pathologic entities associated with metatarsalgia helps the radiologist to tailor a cost-effective imaging approach. This will enable reaching a specific diagnosis as much as possible with subsequent proper patient management. This pictorial review aims to provide basic understanding for the different imaging modalities used in studying the forefoot. After that, certain anatomic arrangements exclusive for the forefoot are discussed. The final section of this review describes the imaging findings of some common forefoot problems.

Orthopaedic injuries associated with skimboarding

BACKGROUND

Skimboarding is a beachside water sport that is enjoying increasing popularity among both dedicated enthusiasts and casual beachgoers. Although many consider this sport to be similar to its "sister" sport, surfing, the technique, the environment in which it is performed, and the skills required differ dramatically from that of surfing. Moreover, the pattern of injuries seen in skimboarders differs substantially from those sustained while surfing.

HYPOTHESIS

A better understanding of the injuries encountered in this sport will allow improved participant education and facilitate the implementation of preventative measures.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

A case series was generated by performing a single retrospective chart review of skimboarding injuries referred for orthopaedic evaluation over a 2-year period at 2 medical treatment facilities, one on the East Coast and one on the West Coast of the United States; demographic data, injury type, and treatments rendered were documented.

RESULTS

Sixty-one patients were identified and analyzed. Average patient age was 19.1 years. Fractures represented 93.4% of all acute injuries. The most common sites of injury were the ankle (41%) and wrist (36%). Rotation about a planted lower extremity was the most common mechanism of injury (30/61, 49%), followed by falls onto an outstretched hand (26/61, 43%).

CONCLUSION

Fractures of the ankle and wrist comprise a high proportion of skimboarding injuries. Knowledge of potential hazards associated with this sport should be made available to participants. To decrease the risk of orthopaedic injury, the use of protective equipment or instruction in proper techniques of the activity may be warranted.

Imaging of painful conditions of the hallucal sesamoid complex and plantar capsular structures of the first metatarsophalangeal joint

Numerous injuries and pathologic conditions can involve the hallucal sesamoidal complex and plantar capsular structures of the first metatarsophalangeal joint. Although clinical history and presentation are important in developing a reasonable differential diagnosis, there is often considerable overlap in the clinical presentation and physical findings between various pathologic entities. Imaging plays an important role in narrowing the differential diagnosis and in directing appropriate therapy. This article reviews the normal anatomy of the hallucal sesamoidal complex and the plantar capsular structures of the first metatarsophalangeal joint. Typical clinical presentations are discussed for various pathologic entities that involve this area of the hallux, followed by a summary of the various imaging findings that occur when using conventional radiography, nuclear medicine bone scan, CT and MR imaging. Finally, general treatment guidelines are discussed for each entity.

Skimboard injuries

BACKGROUND

Skimboarding is a recreational activity performed in shallow water in a beach setting.

METHODS

We reviewed patient records from our emergency department for a 52-month period and identified 79 patients with skimboard-related injuries.

RESULTS

Mean age of patients was 15.2 years; 73.4% presented with a fracture. Lower-extremity fractures were found 63.8% of the time, and upper extremity were found 36.2%. Distal radius fractures were the most common (61.9%) upper-extremity fracture, and ankle fractures were the most common (83.8%) lower-extremity fracture. The prevalence of fractures sustained while skimboarding was compared with that of other published series of recreational activities, including trampoline injuries, and was found to be higher.

CONCLUSIONS

Skimboarding is a sport in which injuries occur by the sudden deceleration of the board as it transitions from water to land or from falls into shallow water. The lower-extremity fracture prevalence is much higher than in similar sports such as skateboarding and surfing. The prevalence of fracture is also higher than that found in trampoline-related injury reports.