fibular sesamoid of metatarsal head ( RID2990 ), metatarsal stress fracture
There are no prior/historical films. The DPM favors previous sesamoid AVN with fragmentation over traumatic fracture, based on the history. Note that the fragmented sesamoid is an insertion site for the lateral head of the FHB, the trans and obl head of the adductor hallucis and the lateral sesamoid-phalangeal ligament of the MPJ capsule. The referrer told me that Insurance wanted to deny this MRI as the patient had a previous MRI elsewhere 10 months ago. The 1st MT base stress fracture was not suspected clinically and was radiographically occult (outside XRs). As he plans to excise the fibular sesamoid, the post-operative non-weight-bearing should serve the dual purpose of healing the stress fracture.

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