Skeletal Radiology

, Volume 38, Issue 5, pp 499–504

Does running cause metatarsophalangeal joint effusions? A comparison of synovial fluid volumes on MRI in athletes before and after running


  • Amy-Rose Kingston
    • Department of RadiologyNorfolk & Norwich University Hospital Trust
    • Department of RadiologyNorfolk & Norwich University Hospital Trust
  • Subhadip Ghosh-Ray
    • Department of RadiologyNorfolk & Norwich University Hospital Trust
  • Shelley Johnston-Downing
    • Department of RadiologyNorfolk & Norwich University Hospital Trust
Scientific Article

DOI: 10.1007/s00256-008-0641-2

Cite this article as:
Kingston, A., Toms, A.P., Ghosh-Ray, S. et al. Skeletal Radiol (2009) 38: 499. doi:10.1007/s00256-008-0641-2



The metatarsophalangeal joints (MTPJ) are the only joints that bear weight directly through synovium. The purpose of this study was to determine whether there is an association between synovial stresses during running and increases in volume of joint fluid.

Materials and methods

This was a prospective case controlled study (nine healthy athlete volunteers acting as own controls). High-resolution coronal 3D T2W magnetic resonance imaging of the MTPJs were obtained following 24 h rest and after a 30-min run. The volume of joint fluid in each MTPJ (n = 90) was measured by two independent observers using an automated propagating segmentation tool.


The median volume of synovial fluid in the MTPJs at rest was 0.018 ml (inter-quartile range (IQ) range 0.005–0.04) and after running 0.019 ml (IQ range 0.005–0.04, p = 0.34, 99% confidence interval (CI), 0.330.35). The volume of fluid in the MTPJs of the great toes was substantially larger than other toes (0.152 ml at rest, 0.154 ml after exercise, p = 0.903). Median volumes decrease from second to fifth MTPJs (0.032–0.007 ml at rest and 0.035–0.004 ml after exercise). Subset analysis for each toe revealed no significant difference in volumes before and after running (p = 0.39 to p = 0.9). The inter-rater reliability for observer measurements was good with an intra-class correlation of 0.70 (95% CI, 0.60 to 0.78).


It appears to be normal to find synovial fluid, particularly in the MTPJs of the great toes, of athletes at rest and after running. There does not appear to be an association between moderate distance running and an increase in the volume of synovial fluid.



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© ISS 2009