Foot MRI 1st Intermetatarsal Space Pain

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This is a 47F with pain and paresthesias centered in the 1st interspace. The referrer considered neuroma, which is exceptionally rare in the 1st webspace (I have seen one or two over many years). In this case there is severe hallux valgus, with associated marked fibular subluxation of both sesamoids. There is chronic, smooth remodeling of the crista flattening the plantar surface of the 1st MT head.
Clearly there is no webspace neuroma or mass, but I suspect the fibular sesamoid is impinging on the digital nerve in the 1st interspace. There is also fluid in the 1st intermetatarsal bursa and MTP joint. I have never seen this reported as a cause of digital nerve impingement, but it seems it should be common. Have you seen it?

If you are viewing this on the new website, I am curious which image format is preferable, which is why I have attached jpeg, ppt and pdf.
I encourage you to check out the new OCAD website<ocadmsk.com/> and register to gain access to the case archive (which we will be rebuilding moving forward) and video content on demand from case conferences and a new upcoming OCAD Lecture series.

Happy New Year!

Hilary

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