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MRI and Forefoot Pain

Jimmy Leung, MD

QUESTION: What is SMIL’s experience regarding imaging of the foot and ankle?

ANSWER: Anterior foot pain is one of the most common conditions of patients referred to the Scottsdale Medical Imaging (SMIL) musculoskeletal radiology group, says Jimmy Leung, MD, a radiologist at SMIL.

“We have five radiologists specializing in musculoskeletal imaging,” Leung says. “Over the years, we have developed a considerable amount of experience in imaging of foot pain from our patient population and our professional relationships with podiatrists and orthopedic surgeons.”

The differential diagnosis for pain around the metatarsophalangeal joints (MTPJ) includes a Morton’s neuroma, capsulitis or a plantar plate tear. MRI is excellent for distinguishing among these.

The challenges of MRI imaging of the foot are that there are many small joints and a lot of anatomic structures in a small area, Leung says.

“You have to have good technical specifics to see small joints. There are many small details that need to be done right to intentionally maximize contrast and spatial resolution,” Leung says. “One of the ways to maximize spatial resolution is to use a 3T MRI. SMIL has three of these units, two in Scottsdale and one in Gilbert.”

The SMIL difference, however, boils down to care, Leung says. “We treat MRI as a tool to guide treatment, not to just image something that hurts. That really is an important difference.” •

Saurabh Verma, et al. MR imaging for evaluation of plantar pain. Contemporary Diagnostic
Radiology. 2014;37(10):3.