Ankle and foot Saggital slice mri

Standard Ankle Series AP Ankle Medial Oblique Ankle Lateral Ankle

AP Ankle Projection requires 5o of internal rotation and dorsiflexion Without internal rotation, overlap of structures

Medial Oblique Ankle Requires approximately 15-30° of internal rotation

Lateral Ankle Achilles tendon Kager’s Triangle - the fat pad anterior to the Achilles

Accessory Views of the Ankle Inversion and Eversion Stress views Inversion stress view

Lateral collateral ligament sprain in a 13 y/o girl.

Sprain of lateral collateral ligaments in 31 y/o actress.

Sprain of lateral collateral ligaments in a 20 y/o woman.

Normal Variants of the Ankle

Talar Beak an osseous projection of the talar neck

Kager’s Triangle Calcaneal Apophysis a fragmented and sclerotic appearance to the calcaneal apophysis given the name Sever’s Disease

Tarsal Coalition a fibrous or osseous union between two tarsal bones

Os Peroneum located adjacent to the cuboid Accessory bone

Os Tibiale Externum located just medial to the navicular

Os Trigonum located posterior to the ankle joint

Os Supranavicular located superior to the navicular

Standard Foot Series AP Foot Medial Oblique Foot Lateral Foot

AP Foot

Medial Oblique Foot 30o of internal rotation

Lateral Foot Projection

Accessory Views of the Foot

Tangential Calcaneus 45o cephalad tube tilt

Anatomic Regions of the Foot Forefoot metatarsals and phalanges Midfoot navicular, cuboid, and cuneiforms Hindfoot calcaneus and talus

Metatarsal Growth Centers epiphyseal growth centers: distal aspect of the 2nd to 5th metatarsals proximal aspect of the 1st metatarsal

5th Metatarsal Styloid Process Secondary Ossification Center

Normal Variants of the Foot

Phalangeal Synostosis aka sypmphalangism

Hallux Valgus Denotes the valgus position of the 1st toe and the medial plateau-like protrusion of the 1st metatarsal head. may be developmental or congenital. Associated with sagging of the transverse and longitudinal arches with sideways splaying of the forefoot. may have enlargement of the bursa medial to the 1st metatarsal head.

Hallux Rigidus a stiff painful 1st metatarsalphalangeal joint may later result in degenerative joint disease

Morton’s Syndrome an abnormally short first metatarsal AKA metatarsus atavicus the second metatarsal experiences excess stress and has an increase in transverse diameter of its shaft and in the thickness of its cortical wall. can be associated with a shot 1st cuneiform. can be responsible for metatarsalgia. this syndrome may be complicated by stress fractures of the 2nd and 3rd metatarsal shafts

Polydactyly an increase in the number of fingers and toes

Bilateral Bipartite Sesamoid Bones most commonly involves the sesamoids at the 1st MTP joint

Tripartite Medial Sesamoid of the 1st MTP

An area of lucency that may be visualized within the anterior calcaneus due the the appearance of the normal trabecular pattern

Heel Spurs Osteophyte formation at the insertion sites of the plantar aponeurosis and the Achilles tendon

Duplication of the 1st Digit of the Foot

Brachymetatarsia usually involves the 4th metatarsal bilateral 25 times more common in females

Foot Lines of Measurement

Heel Pad Thickness should not exceed 25 mm in men or 23 mm in women

Boehler’s Angle the normal measurement is between 28 to 40 degrees

Review of Normal Foot and Ankle Variants

Normal Variant ?

Anomaly?

Normal Variant ?

Name of this Normal Appearance ?

Normal Variant ?

Normal Variant ?

Tarsal Coalition a fibrous or osseous union between two tarsal bones

Abnormality

Normal Variant ?

Normal Variants?

Thank You