4b (Foot) - Answer: 17-year-old female woke up with a painful swollen right foot


This 17-year-old female woke up with a painful swollen right foot, and has a history of tarsometatarsal ligament sprain.


The patient's foot did not have a hemorrhage nor a full-thickness tear. Rather, a lacy low-grade muscle strain (i.e. abductor hallucis).

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


No talonavicular coalition. Marrow signal normal. Tenderness in the medial arch of the foot subjacent to the proximal diametaphysis of the 1st metatarsal is associated with longitudinal intramuscular strain nonhemorrhagic of the abductor hallucis. Lacy faint signal hyper-intensity best shown sagittal STIIR extends longitudinally 36mm and short-axis T2 series. 

No joint space edema or capsulitis. No evidence of sesamoiditis. Short-axis images without perineurial fibrosis. No Morton neuroma or inter-metatarsal bursal cyst.  

The visualized 1st and lesser plantar plates intact. Tiny focus of fibrosis plantar to the 2nd MTP head and intact plate.  


1. Low-grade muscle strain abductor hallucis. 

2. Lisfranc ligament intact. 

3. No overlying contusion to suggest acute compressive injury.