MR Imaging of the Forefoot

When I came to the Department of Radiology at Jefferson in 1991, I became passionately interested in the area of the foot and ankle. Both David and I worked closely with Drs. Keith Wapner and Paul Hecht, premier orthopedic foot surgeons, which resulted in our publication with them of many pertinent articles on this topic. I owe them a debt of gratitude for guiding me through the physical examination of many of the patients who underwent MR imaging and helping teach me what were normal variants from subtle symptom generators. Fifteen years later, my keen interest in this field has not diminished. The ankle and foot are fascinating articulations that are complex enough to be intellectually challenging, yet the correlation between patho-anatomy and symptomatology are consistent enough for it to be clinically rewarding.

Most often the foot and ankle are lumped together and, when this occurs, overemphasis is placed on the ankle. In this issue, we have separated out, to a significant degree, the foot from the ankle, with Dr. Zanetti providing an excellent overview of imaging of the foot. “Overview” is, however, probably not the correct word. This issue is too detailed and too intellectually rigorous for a word that at least infers a glossing over.

The issue begins with two chapters from Dr. Zanetti's group: one concerning the forefoot and one the midfoot. Both of these are underemphasized in the imaging literature, particularly the latter.

There is a chapter on MR of rheumatoid arthritis of the foot. This disorder, which affects up to 3% of the general population, is increasingly important clinically because of the development of disease-modifying medications. This issue continues with a discussion of stress fractures, a very common clinical indication, and soft tissue masses. In the hand and the foot, soft tissue masses are a disproportionate clinical indication.

The last two articles include a study of ultrasound. Ultrasound has been widely performed in Europe, in many articulations, particularly the foot, ankle, and hand. Until about 5 years ago, it had been underutilized, to some degree, in the United States; fortunately, it appears to have gained momentum and is now increasingly utilized. The final chapter, co-authored by one of our close and former colleagues at Jefferson and one of our former research fellows, is a particular favorite, dealing with what the clinician would like to know.

As I noted, this issue deals with one of my passions and, therefore, I have deep affection for what Dr. Zanetti has accomplished and for that I thank him.