A coronal T1-weighted image includes most of the cervical ligament coursing from superomedial to inferolateral, surrounded by fat signal. Superior to the cervical ligament, 3 hypointense foci correspond to the medial, intermediate, and lateral roots of the inferior extensor retinaculum. Pisani et al. had stated that MRI is the best method to visualize the structure within the sinus tarsi, especially the interosseous and cervical ligaments. This is in agreement with the study by Corazza et al. , who stated that alteration of the tarsal sinus fat with diffuse, low-signal-intensity infiltration on both T1WI and T2WI was observed in a cadaveric study with a history of foot pain. The transverse planes were of limited value in the evaluation of the tarsal sinus ligaments; they were essential to the identification of the adjacent supporting structures. Preoperative MRIs of 23 STI patients treated with arthroscopic subtalar reconstruction were compared to MRIs of 23 age- and sex-matched control subjects without STI.
Due to its position relative to the ankle joint and subtalar axis, the PTT plantar flexes, adducts, and supinates the foot, and it supports the talar head and prevents it from descending. Failure of the PTT disrupts the normal biomechanics of the foot and leads to pes planus , forefoot abductus, and hindfoot valgus. The talar head becomes uncovered by the navicular curtain bangs black girl bone and loses its osseous support. Hindfoot valgus leads to lateral hindfoot impingement that encompasses talocalcaneal and subfibular impingement . Medial ankle pain is a typical presenting symptom in the early stages of the PTT dysfunction; however, with the development of hindfoot valgus and lateral impingement, lateral symptoms tend to predominate.
Even though ligaments might appear intact, they could be thinned or thickened by prior partial tears without being detected. Last, due to the retrospective nature of the study, clinical information and radiological evaluation might have introduced a bias. Case 5 – Acute injury in a 52 year-old female, s/p fall 1 week ago with lateral hindfoot pain.
There are relatively few MRI studies involving STI and subtalar ligaments. Previous cadaver studies and MRI studies in asymptomatic models have described normal appearances of subtalar ligaments. According to a pediatric study using 3D isotropic proton density MRI , ITCL was striated in appearance in all study population with distinct fascicular bundles. Three roots of the IER were distinguishable in all study populations. CL, ITCL, and IER were well visualized in 3D isotropic proton density MRI. Each ligament had a unique orientation and dimensions with certain variations.
MRI can also be used in detection of osseous injuries like bone contusions, stress and insufficiency fractures, osteonecrosis, osteochondral defects, and transient bone marrow edema. In this pictorial essay, we aim to study the normal anatomy of ankle joint as well as demonstrate a spectrum of common pathologies affecting the ankle joint with their salient imaging features on MRI. The sinus tarsi is a lateral anatomical space located between the talus superiorly and the calcaneus inferiorly.
Sagittal T1-weighted and fat suppressed fast spin-echo T2 , along with axial T1-weighted images demonstrate hypointense soft tissue material occupying the sinus tarsi on all imaging sequences, consistent with fibrosis. Stability of the subtalar joint is assessed with medial and lateral subtalar joint glides performed by moving the calcaneus over a stabilized talus in the transverse plane and with subtalar joint distraction. In passive examination, the range of motion of the ankle may be limited in pronation and supination, but pain over the sinus tarsi at the end range of plantar flexion combined with supination is a typical sign for STS. Furthermore the muscle force has to be evaluated for a weakness of the peroneal and plantar flexor muscles. Plain radiographs are usually normal in early stages; however, in advanced cases changes of degenerative arthritis may be evident. Subtalar arthrography was a modality used before the advent of MRI but the sensitivity is low.
Results of this are reported very favourably, with most or all patients relieved of pain. Taillard et al summarise results from the literature as showing 88 cases treated surgically . Half of these were in O’Connor’s original paper and none of the papers describe outcome criteria in any detail. CT scans can better identify cystic changes and sclerosis iwhen compared to plain radiographs.
In posterior ankle impingement syndrome, the posterior talus and adjacent soft tissues are compressed between the tibia and calcaneus. 52 year-old female with direct trauma to the left foot 2 days ago. The cervical ligament is thickened and increased in signal with surrounding soft tissue edema on sagittal T1-weighted , sagittal fast spin-echo T2-weighted , and coronal fat suppressed fast spin-echo T2-weighted images.