PMC7203536_01
An 11-year-old female soccer player with lateral ankle and foot pain following a soccer injury. Frontal view of the foot shows subtle widening (arrow) of the physis of the great toe metatarsal. The remainder of the imaging examination is normal.
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Radiographs of her right foot and ankle obtained on the day of injury were initially interpreted as normal, although in retrospect, they showed subtle widening of the lateral portion of the great toe metatarsal physis (Figure 1).
Cuboid contusion. Sagittal fast spin echo T2-weighted image (Repetition Time [TR]/Echo Time [TE] 3500/73 ms) of the lateral aspect of the foot shows focal oedema-like signal within the cuboid. No fracture line was evident. The finding presumably accounted for the patient's lateral foot pain at presentation.
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The MR imaging examination revealed marrow oedema in the proximal aspect of the cuboid without a discrete fracture line, compatible with an osseous contusion (Figure 2).
Chronic physeal stress on magnetic resonance imaging. (a) Sagittal gradient echo magnetic resonance image (959/14 ms, 20  flip angle) of the great toe in the same girl delineates abnormal widening of the dorsal physis (solid arrows) relative to the normal plantar physis (dotted arrows). The signal intensity is similar between the normal and the abnormal portions of the physis. (b) Sagittal volumetric gradient echo magnetic resonance image (13.9/5.2 ms, 30  flip angle) of the proximal right humerus of a 12-year-old male baseball player shows a focal region of abnormal widening (arrow) of the lateral aspect of the proximal humeral physis, with a configuration similar to the great toe metatarsal physis in the patient shown in Figure 2. This so-called 'Little Leaguer's shoulder' is another example of physeal stress change attributed to a chronic traction injury.
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Focal widening of the dorsal one half of the great toe metatarsal physis with normal physeal signal intensity was noted for all sequences, but was most easily identified on gradient echo images (Figure 3).