Turf toe.

(3a) In this dorsal 3D depiction of the metatarsophalangeal joint of the great toe, the metatarsal head has been removed and the proximal phalanx is flexed and distracted to better demonstrate the plantar plate and the embedded medial (M) and lateral (L) sesamoids. The sesamoid phalangeal ligaments (arrows) and intersesamoid ligament (asterisk) are seen as thickened regions of the plantar plate.

(4a) Medial (above) and lateral (below) views of the great toe metatarsophalangeal joint with the extensor hood structures removed depicts key structural elements of the plantar capsuloligamenotus-sesamoid complex. The main collateral ligament (MC) and accessory sesamoid ligaments (AS) comprise the collateral ligamentous complexes and are found medially and laterally. The abductor hallucis (Ab) tendon inserts on the medial sesamoid and blends with the capsular structures on the medial side of the joint. The transverse (AdT) and oblique (AdO) heads of the adductor hallucis muscle send fibers to the lateral sesamoid, capsule and plantar plate. The medial and lateral heads of the flexor hallucis brevis (FHB) insert on to the sesamoids found along the plantar surface of the metatarsal. The flexor hallucis longus tendon (FHL) is also depicted.

(5a) A 3D representation of the plantar aspect of the great toe demonstrates some of the key anatomic structures attaching to the plantar plate and sesamoids including the medial and lateral heads of the flexor hallucis brevis muscles (FHB), abductor hallucis tendon (Ab), and the oblique (AdO) and transverse (AdT) heads of the adductor hallucis muscle. The flexor hallucis longus tendon (FHL) traverses the metatarsophalangeal joint plantar to the plantar plate without an attachment to the sesamoids.

(6a) A T1-weighted sagittal view demonstrates the normal, thin low signal intensity plantar plate (arrow). The midline location is confirmed by the visualization of the underlying flexor hallucis longus tendon (arrowheads).

7a) A fat-suppressed T2-weighted sagittal image demonstrates the normal distal recess (arrow) that is frequently found at the phalangeal insertion of the plantar plate. Note the smooth, fairly small, and well defined appearance of this recess.

(8a) A proton density-weighted sagittal image lateral to midline reveals the thick, low signal intensity appearance of the normal lateral sesamoid phalangeal ligament (arrow).

(9a) A T1-weighted coronal view through the metatarsal head reveals normally positioned medial (M) and lateral (L) sesamoids. The flexor hallucis longus tendon (T) lies plantar to the intersesamoidal ligament (I). Normal medial and lateral attachments of the abductor and adductor hallucis tendons and the sesamoid accessory ligaments are also visible (arrowheads).

(9a) A T1-weighted coronal view through the metatarsal head reveals normally positioned medial (M) and lateral (L) sesamoids. The flexor hallucis longus tendon (T) lies plantar to the intersesamoidal ligament (I). Normal medial and lateral attachments of the abductor and adductor hallucis tendons and the sesamoid accessory ligaments are also visible (arrowheads).

Fat-suppressed T2-weighted (1a) sagittal and (1b) coronal (short axis)

Fat-suppressed T2-weighted (1a) sagittal and (1b) coronal (short axis)

A STIR sagittal image of collegiate football player with clinical signs of turf toe reveals edema and irregularity (arrows) at the posterior capsular attachment of the medial sesamoid and distal metatarsal.

A midline STIR sagittal image from a collegiate football player following hyperextension injury at the great toe reveals a fluid filled gap (arrow) at the typical distal insertion site of the plantar plate. The gap is too large and irregular to represent a normal recess, and fluid is seen to contact the underlying flexor hallucis longus tendon (arrowhead).

A fat-suppressed T2-weighted image of a 23 year-old elite soccer player was obtained at the level of the lateral sesamoid. A large fluid filled gap (arrow) is present at the distal attachment site of the sesamoid phalangeal ligament. The large effusion in this patient aids in detection of the abnormality.

A STIR coronal image in an NFL tight end injured during a game demonstrates diffuse soft-tissue thickening and edema (arrows) in the expected location of the medial sesamoid phalangeal ligament. The lateral sesamoid phalangeal ligament (arrowheads) maintains a normal low signal intensity appearance.

A corresponding proton density-weighted sagittal image reveals near complete absence of the normal medial sesamoid phalangeal ligament (arrow). The medial sesamoid (arrowhead) has migrated proximally relative to its normal position.

A STIR sagittal image from a 21 year-old collegiate football player demonstrates a large midsubstance rupture (arrow) of the plantar plate. The underlying flexor hallucis longus tendon (arrowheads) is evident.

Reference