0:00

As you look at this set of MR Images long axis,

0:04

non-fat suppressed, you have the impression

0:07

that we do indeed have halek valgus alignment.

0:09

Of course, we'd wanna verify

0:11

that on a weight-bearing playing film.

0:14

When you're thinking about that hax valgus alignment,

0:17

what happens at the first MTP is

0:20

that there's mass effect often placed at the second MTP.

0:24

When you're dealing with podiatrists,

0:26

they're often asking you whether

0:27

or not as a result of the how valgus alignment,

0:31

you have a pre dislocation syndrome.

0:33

This is a term that many

0:35

of our orthopedic surgeons may not really understand,

0:38

but the podiatrist refer to this quite commonly.

0:42

So with that chronic mass effect that the second MTP,

0:46

we create abnormal stresses around the capsule of the MTP

0:50

that can result in inflammatory changes weakening

0:53

of the capsule, and ultimately, you can start

0:56

to get subluxation at the second MTP

0:59

with lateral subluxation

1:01

of the proximal phalanx on the metatarsal articular surface.

1:06

Here, an example, as you look in the short axis plane,

1:09

you can see the inflammatory changes, high signal intensity.

1:13

As you assess the capsule, you can see the attenuation,

1:16

attrition, or thinning of the capsule

1:19

as you look at the site adjacent to where

1:21

that mass effect would've been pushing on the second

1:24

metatarsal phalangeal joint in this case.

1:27

Also, a little bit of fluid in the inter metatarsal bursa.

1:30

So when you're looking at your hax valgus cases,

1:33

don't just assess the alignment, the degenerative changes,

1:36

but take a look at the mass effect in the second MTP

1:40

and determine on the plain thumb whether

1:42

or not there's any subluxation that has started to occur at

1:46

that MTP articulation.

1:48

Of course, on the mr, we'll look for the signing findings

1:51

of inflammatory changes.

1:55

As we think about MTP

1:57

and first MTP degenerative changes, of course,

2:00

that dorsal osteophyte

2:02

or large dorsal osteophyte formation is always

2:05

something that we're looking at.

2:06

In addition to the other findings of degenerative change,

2:09

joint space narrowing, subc chondral sclerosis,

2:12

in this case, you're seeing a little bit of subluxation

2:15

of the proximal phalanx on the metatarsal head, as well

2:19

as sesamoid arthropathy with Hal Rigidus.

2:22

This is a clinical entity with decreased range of motion.

2:26

The so-called stiff great toe, really attributed

2:29

to the presence of this dorsal osteophyte formation.