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Ankle/Foot MRI

Categories
  • Ankle Radiology
  • Education
Tags
  • Ankle
  • Ankle Radiology
  • Radiology
Ankle

Ankle/Foot MRI

Lower Limb/Ankle Anatomy

Lower limb/ankle anatomy
The Ankle Joint

The talocrural (ankle) joint is the junction of three bones: distal ends of tibia and fibular and the talus trochlear

The tibia and fibular are bound by the ligamentous structures that include the syndesmosis, anterior/posterior/transverse tibiofibular ligaments.

Collateral ligaments include the anterior and posterior fibulotalar ligaments, fibulocalcanear on the lateral side while the medial side is supported by the deltoid ligament and calcaneonavicular ligaments.

The ankle joint is not a pure hinge joint as there is some rotation around the helical axis of the joint due to the asymmetrical shape of the talus.

Turf Toe Anatomy
Medial aspect of left foot

Medial aspect of left foot

Lateral view

Lateral aspect of left foot

Dorsal aspect left foot

Dorsal aspect left foot

Plantar aspect left foot

Plantar aspect left foot

Accessory Muscles

Normal anatomy of foot anterolateral muscles

Normal anatomy of foot anterolateral muscles

Accessory soleus

  • 2-5%

Accessory FDL

  • 6-8%

Peroneus Quadratus

  • 10-25%

Peroneocalcaneus internus

  • 1%

Accessory Soleus

  • Exercise induced calf pain
    • Claudication
    • Compartment syndrome
  • Inserts medially onto calcaneus
  • MRI image greater advantage in diagnosis than US
  • DD: Low-lying soleus
Gastrocnemius
Ultrasound image demonstrating accessory Soleus muscle

Ultrasound image demonstrating accessory Soleus muscle

Accessory FDL

  • 6-8%
  • Symptomatic when passes through tarsal tunnel
  • Origin:
    • FHL/ flexor retinaculum
  • Insertion:
    • Blends with quadratus plantae
Accessory FDL
AFDL_accessory FDL muscle

AFDL: accessory FDL muscle

Accessory FDL

Peroneus Quartus

Peroneus Quartus

Peroneocalcaneus Internus

  • Noted between FHL and peroneals
  • Origin: Fibula
  • Insert: Calcaneus
  • Usually asymptomatic, but may be issue with arthroscopy and n/v injury.
Axial MRI image

Axial MRI image

Yellow: Peroneocalcaneus Internus site

Approach to Achilles Tendon Pain

  • Tendinosis
    • Insertional
    • Non-insertional
    • +/- tear
  • Paratendinosis
  • Bursa
    • Superficial
    • Retrocalcaneal
  • Bone marrow
Lateral aspect of left foot

Lateral view of left foot with Achilles tendon insertion on calcaneus bone

Calf muscle and Achilles tendon Anatomy

Posterior aspect of calf area: Gastrognemius muscle

Imaging Modalities of Achilles Tendon

  • XR
  • US
    • High-resolution
    • Operator-dependent
  • MRI
    • PD/PDFS
    • Sagittal and axial
Achilles tendon

Insertional Achilles Pathology

Haglund deformity:

  • Pressure from shoes
  • Distal insertional fibres affected
Insertional Achilles pathology

Ultrasound longitudinal image showing Achilles tendinopathy at insertional area of calcaneus.

Sagittal MRI scan with thickening of Achilles at calcaneus insertion

Sagittal MRI scan with thickening of Achilles at calcaneus insertion

Non-insertional Tendinosis

  • Older patient
  • Overuse
  • Degenerative
  • Medication
  • Upper 1/3
Achilles tendinosis
Longitudinal ultrasound image of Achilles tendinopathy

Longitudinal ultrasound image of Achilles tendinopathy with colour doppler demonstrating neovascularization.

Axial Achilles tendinopathy

Axial Achilles tendinopathy with ultrasound image demonstrating neovascularization.

Sagittal MRI scan

Sagittal MRI scan

Axial MRI image_Achilles tendinopathy

Axial MRI image. Achilles tendinopathy

Axial MRI fat suppression image

Axial MRI fat suppression image. Increased signal in Achilles tendon

Thickened Achilles tendon
Thickened Achilles tendon

Sagittal MRI scan: thickened Achilles tendon

X-ray lateral ankle image demonstrating calcification in the Achilles tendon

X-ray lateral ankle image demonstrating calcification in the Achilles tendon

Paratenonitis

  • Paratendinitis = paratenonitis
  • No tendon sheath
  • Paratenon
  • Posterior/medial/lateral
  • Thickened with adhesions
  • Crepitus
Sagittal MRI fat suppression scan

Sagittal MRI fat suppression scan image

Sagittal MRI image of the Achilles tendon, paratendinitis

Sagittal MRI image of the Achilles tendon, paratendinitis

Axial MRI image of Achilles tendon

Axial MRI image of Achilles tendon

Axial ultrasound image of the Achilles tendon

Axial ultrasound image of the Achilles tendon

Axial ultrasound image of the Achilles tendon with Achilles paratendinitis

Axial ultrasound image of the Achilles tendon with Achilles paratendinitis

Bursa

Bursa

Retrocalcaneal Bursitis

Longitudinal ultrasound image of the Achilles tendon

Longitudinal ultrasound image of the Achilles tendon with retrocalcaneus bursa swelling

Sagittal MRI fat suppression view of Achilles tendon

Sagittal MRI fat suppression view of Achilles tendon demonstrating retrocalcaneal bursitis

Superficial Achilles Bursitis

Longitudinal ultrasound image of Achilles tendon
Longitudinal ultrasound image of Achilles tendon

Longitudinal ultrasound image of Achilles tendon demonstrating superficial Achilles bursitis

Tears

  • Partial thickness
    • Younger
  • Full-thickness
    • Underlying tendinopathy
  • status of plantaris tendon
  • ? is there tissue interposition
    • Static/dynamic
Tendon rupture
Sagittal MRI image with partial Achilles tendon tear

Sagittal MRI image with partial Achilles tendon tear

Ankle MRI Tear
Ankle MRI Tear
Longitudinal ultrasound image of Achilles tendon with complete tendon tear

Longitudinal ultrasound image of Achilles tendon with complete tendon tear

Sagittal MRI image with complete Achilles tendon tear
Sagittal MRI image with complete Achilles tendon tear

Sagittal MRI image with complete Achilles tendon tear

Plantaris Tears

Plantaris Tears
Plantaris Tears
Plantaris Tears

Calcaneal Stress Fracture

Sagittal STIR
Sagittal STIR

Sagittal STIR:   Fracture line and bone oedema / superior aspect calcaneus ) in a long-distance runner.

Os Trigonum Syndrome

Sagittal MRI image with Os trigonum

Sagittal MRI image with Os trigonum

Sagittal fat suppression MRI image

Sagittal fat suppression MRI image with Os trigonum and associated inflammtion

Sagittal STIR:   Fracture line and bone oedema / superior aspect calcaneus ) in a long-distance runner.

Posterior Impingement

Xray ankle demonstrating posterior ankle Os trigonum

X-ray ankle demonstrating posterior ankle Os trigonum

Xray ankle in plantar flexion demonstrating posterior ankle impingement

X-ray ankle in plantar flexion demonstrating posterior ankle impingement

Plantar Fasciitis

  • Overuse
  • Associations with inflammatory arthropathies e.g. psoriasis

NOT associated with bony spur !

Differential diagnosis: fibromatosis/ tear

Plantar Fasciitis
Sagittal MRI showing plantar fasciitis
Sagittal MRI showing plantar fasciitis

Sagittal MRI showing plantar fasciitis

Ligaments of the Ankle

  • Lateral collateral complex
  • Syndesmosis
  • Spring
  • Deltoid
  • Calcaneocuboid
The Ankle Joint
Ankle Sprains

Partial Tear

Sagittal MRI showing partial plantar fascia tear

Sagittal MRI showing partial plantar fascia tear

Heel Pad Scar

Heel pad scar
Heel pad scar

Anterior and Posterior Talofibular Ligament

Anterior and Posterior Talofibular Ligament
Anterior and Posterior Talofibular Ligament
Anterior and Posterior Talofibular Ligament

Calcaneofibular Ligament

Calcaneofibular Ligament

MRI: axial and coronal images

Lateral Ankle Ligament Complex

Lateral complex

  • Anterior talofibular
  • Calcaneofibular
  • Post. talofibular

ATFL Ultrasound

ATFL Ultrasound
ATFL Ultrasound

Syndesmotic ligament Complex

Syndesmotic ligament complex

Weber C/Maisonneuve fracture

Weber C/Maisonneuve fracture
X-ray of right ankle demonstrating torn syndesmosis

X-ray of right ankle demonstrating torn syndesmosis with tibia and fibular diastasis

Syndesmosis Complex Tear

Axial MRI image demonstrating torn syndesmosis ligament complex

Axial MRI image demonstrating torn syndesmosis ligament complex

Syndesmosis: AITFL tear

Syndesmosis_AITFL tear

Syndesmosis: PITFL tear

Syndesmosis_PITFL tear

Syndesmosis Tear & Deltoid Avulsion

Syndesmosis tear & deltoid avulsion

Posterior Malleolar Fracture

X-ray lateral ankle demonstrating posterior malleolar fracture

X-ray lateral ankle demonstrating posterior malleolar fracture

Posterior malleolar fracture (red arrows)

Axial MRI scan:

Posterior malleolar fracture (red arrows)

Chronic Scar Syndesmosis

Chronic scar syndesmosis

Contributor:

Dr R de Villiers

Learn More

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