This pictorial essay explores the causes of metatarsalgia which can be broadly categorised as follows: Intermetatarsal bursitis Mortons neuroma. Degenrative Joint Disease Osteochondral lesion of 1st metatarsal head Osteoarthritis Freiberg infraction Sesamoiditis Medial and Lateral Trauma Soft tissue: Turf toe Osseous: Metatarsal stress response Fracture of proximal phalanx Inflammatory Tensoynovitis of flexor tendons Inflammtory arthropathy /synovitis Neoplastic lesions Fibroadenoma We aim to review the important anatomical features, clinical presentations and characteristic features on MRI.

Forefoot pain is a debilitating clinical complaintand a common reason for specialist consultation (1,2). There is often significant overlap between the various condtions affecting the forefoot in terms of symptoms and presentations. As such, clinical history and physical examination has limited accuracy in differentiating the various causes of forefoot pain. Plain film andsonographic evaluation are commonly used in theinitial evaluation offorefoot pain. Cross-sectional imaging, however, provides vitaldetail required foraccurate diagnoses (2,3). In particular MRI offers excellent contrast resolution and multiplanar capability, providing exquisite detail of...

BURSAE Anatomy: Bursae are fluid-filled sacs located near tendons, ligaments, skin, and muscles that prevent friction between moving structures. There are multiple bursae located at the base of the metatarsals and between the metatarsal bones in the intermetatarsal spaces located in the forefoot. Intermetatarsal Bursitis (IMB) Inflammation of the intermetarsal bursae (bursitis) can occur following trauma or secondary to systemic diseases such as rheumatoid arthritis, gout or local irritation (Morton's neuroma). Severe bursitis results in distension of the bursa causing fore foot pain and splaying...

Forefoot pain is a non-specific symptom caused by a plethora of pathologic processes. There is significant overlap between the signs and symptoms of forefoot pathology. There is also a potential overlap in the imagng features of these conditions. Given this conundrum both clinicians and musculoskeletal radiologists must work in tandem to achieve anaccurate diagnosis. The majority of forefoot pain can be managed conservatively. In problematic cases or those requiring intervention, MRI is especially useful as a problem solving tool.

Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a population-based study: the North West Adelaide health study.J Foot Ankle Res. 2008; 28(1):2. Ashman CJ,Klecker RJ,Yu JS. Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging. Radiographics.2001 Nov-Dec;21(6):1425-40. Ali M, Chen TS, Crues III JV. MRI of the foot. Applied Radiology 2006. 35(12): 10-20 Kijowski R, Smet A, Mukharjee R. Magnetic resonance imaging findings in patients with peroneal tendinopathy and peroneal tenosynovitis. Skeletal Radiol. 2006; 36 (2):...

S.B.Gagrani,Department of Radiology, Heart of EnglandNHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS. R.Bhatt, Department of Radiology ,University Hospitals of Leicester ,Leicester General Hospital,Gwendolen Rd, Leicester LE5 4PW. K.Arshad, Department of Radiology ,University Hospitals of Leicester,Infirmary square, Leicester LE1 5WW.