4/5 TMT Foot

Hi Andrew,

You can certainly get 4th and 5th TMT arthritis and associated synovitis between the cuboid and the 4th / 5th metatarsal bases.
In your case the joint actually looks really nice with no evidence of osteophyte formation that would lead me to suspect significant OA changes. The x-ray could also be reviewed.
Pain at the base of the 5th metatarsal can be 5th TMT arthritis / synovitis, however a more common pathology is plantar fasciitis involving the lateral band of the plantar fascia distal insertion onto the 5th metatarsal base. You would expect the plantar fascia insertion to be on the plantar aspect of the 5th metatarsal base, however it is actually on the lateral aspect, with the peroneus brevis insertion occupying the more anterior aspect.
So scan the 5th MT base in long axis at the lateral aspect and you will see the fan shaped insertion of the plantar fascia and see if it has plantar fasciitis. It is often vascular with Doppler assessment.
The peroneus brevis insertion in my experience is usually well behaved and when we see an MRI report of high signal tendinosis involving peroneus brevis in this location, invariably it is the plantar fascia when we scan it carefully.
The other thing to consider is a Jones fracture or bone stress if the patient has had recent trauma.

In your case the joint looks pretty happy and there is just a few vessels. These vessels look large and there are branches from the dorsals pedis artery that run right over the 4th and 5th TMT joints so it is possible this could account for the vessels.

Steve.

My bet with a 6 month history of pain is that the lateral band of the plantar fascia insertion is playing up.

It is quite common!

Steve.

It’s easy to forget!