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Findings The frontal and lateral radiographs of the toe do not demonstrate any abnormality. On the MRI, the lateral collateral ligament of the great toe is disrupted from its distal attachment site and is seen to “sit” or be positioned outboard to a focally disrupted extensor hood. Edema is present along the medial aspect of the head of the great toe metatarsal related to recent trauma and varus force imparted to the great toe MTP. Other areas of edema are present about the lesser digits, but the case discussion is limited to the first ray.
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Diagnosis: Stener like Lesion of the Great Toe We have presented before and most of us are very familiar with the Stener lesion of the thumb. This case has a very similar appearance with the disrupted lateral collateral ligament of the toe being analogous to the thumb ucl and the extensor hood of the toe being analogous to the adductor aponeurosis. The interposition of one tissue between another tissue and its orthotopic position hinders adequate healing. The findings of MRI are shown in the case presentation. If no bone avulsion has been sustained radiographs may only be abnormal when a varus stress is applied and the lateral aspect of the joint widens. There is sparse reporting of this entity in the literature but it is quite understandable how surgical intervention could be warranted. At the time of this case, surgery was offered but the patient refused as he stated his pain had abated and his functional limitations were not great.
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References Stener-like lesion of the lateral collateral ligament of the first metatarsophalangeal joint. S. Braspenningx, W. Rezaie & P. Simons. Skeletal Radiology volume 47, pages413–417 (2018)
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