This 63F was referred by a podiatrist who reported pain on ambulation
(don’t know how long), and was looking for MT stress fracture or Morton
Neuroma.
There is subchondral fracture of the 3rd MT head with stress related marrow
and periosteal edema, but no articular flattening.
There is a 3rd webspace neuroma (3mm transverse) with 3rd IM bursitis
(white arrows).
But what interests me is the elongated Plantar Plate Proximal Phalanx
distance (PPPP) at the midline insertion of the 3rd MTPJ plantar plate in
the region of the capsular recess…the lateral insertions and capsule are
intact and there is no deformity of the toe.
In the short axis there is a thin tear (or neck of a ganglion) connecting
the enlarged capsular recess to a tiny lateral paracentral submetatarsal
ganglion (red arrows).
I don’t know if these isolated midline tears are clinically important; if
they predispose to MTPJ instability and deformity, or if this is related in
any way to the subchondral fracture.
But we see these submet ganglia all of the time and I suspect those are
residua of similar tears that fill in with dark scar.
[image: 63F pain on walking.jpg]
[image: 63F pain on walking (1).jpg]
[image: 63F pain on walking (2).jpg]
63F-pain-on-walking.pdf
