This document provides an overview of ankle and foot anatomy, imaging, and common injuries. It describes:
1) The bones and joints of the ankle and foot, including the tibiotalar, subtalar, and tarsometatarsal joints.
2) Common ankle and foot injuries like fractures of the distal tibia and fibula, talus, and calcaneus. As well as ligament tears and dislocations.
3) Imaging techniques used to evaluate the ankle and foot, including standard radiographs, stress views, and arthrography. Key anatomical angles and measurements are also outlined.
8. Movements
Adduction: medial deviation of the forefoot
Abduction: lateral deviation of the forefoot,
motions occurring in the tarsometatarsal
(Lisfranc) joint
adduction of the heel: inversion of the
calcaneus
abduction of the heel: eversion of the
calcaneus
motions occurring in the subtalar joint
Plantar flexion: caudad (downward) foot
motion
Dorsiflexion: cephalad (upward) foot motion
motions occurring in the ankle (tibiotalar) joint
9. Movements
Supination:
Adduction & inversion of the forefoot
(motion in the tarsometatarsal and
midtarsal joints)
inversion of the heel (motion in subtalar
joint)
slight plantar flexion of the ankle
(tibiotalar) joint
Pronation:
abduction and eversion of the forefoot
(motion in the tarsometatarsal and
midtarsal joints)
eversion of the heel (motion in the
subtalar joint)
slight dorsiflexion (or dorsal extension)
of the ankle
10. Movements
Varus and valgus should not be used to describe motion
but should be reserved for the description of ankle or foot
position in case of deformity
20. Imaging of Ankle: Xray
Lateral view
Boehler angle: determined by the intersection
of a line
(a) drawn from the posterosuperior margin
of the calcaneal tuberosity (bursal
projection) through the tip of the posterior
facet of the subtalar joint, and a second line
(b) drawn from the tip of the posterior facet
through the superior margin of the anterior
process of the calcaneus.
Normally, this angle ranges between 20 and 40
degrees.
Calcaneal pitch is described by the
intersection of a line drawn tangentially to
the inferior surface of the calcaneus and one
drawn along the plantar surface of the foot.
21. Imaging of Ankle: Xray
angle of Gissane: The greater values
suggest a fracture of the posterior
facet of the subtalar joint
26. Imaging of Ankle: Arthography
Single contrast:
Ligament injury
OCD
Osteo-cartilaginous bodies
localization
Chondral and osteochondral fractures
Double contrast:
articular cartilage
27. Imaging of Ankle: Tenography
evaluating tendon tears, particularly
tears of the Achilles tendon, peroneus
longus and brevis, tibialis posterior,
flexor digitorum longus, and flexor
hallucis longus
Tear is indicated by the extravasation
of contrast agent from the tendon
sheath, abrupt termination of the
contrast-filled tendon sheath, or leak
of contrast into the adjoining
articulations
flexor hallucis longus
peroneus longus and brevis
28. Trauma : overview
10% of all fractures Bone
Ligaments
Tendons
Muscle
Neurovascular bundle
29. Trauma : overview
type of fracture (Kleiger)
position of the foot
the direction and intensity of the
applied force
the resistance of the structures
history taking and clinical examination
radiologic examination (site and
extent of injury)
types of ankle trauma:
inversion injuries
eversion injuries
complicated by internal or external
rotation, hyperflexion or
hyperextension, and vertical
compression forces
30. Trauma : overview
Modes of injury:
direct trauma (blow or a fall from a
height)
indirect forces (abnormal stress or
strain of muscles or tendons)
41. Fractures of the Distal Tibia: Pilon #
Pilon (Pylon) Fracture when it involves
the tibio-talar articulation
predominant force is vertical
compression
42. Pilon #
associated fracture of the distal fibula,
talus, and subluxation in the ankle joint
severe damage to the soft-tissue sleeve
of the distal leg
confused with trimalleolar fractures
Look for:
the presence of profound comminution
of the distal tibia,
intraarticular extension of tibial fracture
through the dome of the plafond
usual association of fracture of the talus
usual preservation of tibiofibular
syndesmosis
44. Müller's widely accepted classification
of pilon fractures divides these injuries
into three groups, depending on the
displacement of the fragments and
the incongruity of the joint
45. Tillaux Fracture
ankle fracture resulting from
abduction and external-rotation injury
avulsion of the lateral margin of the
distal tibia
fracture line is vertical and extends
from the distal articular surface of the
tibia upward to the lateral cortex
48. Tillaux Fracture
If the fracture fragment is laterally
displaced more than 2 mm or if there
is an irregularity of the articular
surface of the distal tibia (a step-off),
then surgical rather than conservative
treatment is indicated
CT is the best method
50. Wagstaffe-LeFort fracture
the medial portion of the fibula
becomes detached and the anterior
tibiofibular ligament remains intact
51.
52. Triplanar (Marmor-Lynn) Fracture
Fractures involving the lateral aspect
of the distal tibial epiphysis
complicated by extension of the
fracture line into two other planes
MOI: plantar flexion and external
rotation
combination of the juvenile Tillaux
fracture and a Salter-Harris type II
fracture
should not be mistaken for a Salter-
Harris type IV fracture
58. Fractures of the Fibula: Pott Fracture
It is now recognized that this type of
fracture usually occurs as a result of
the disruption of the tibiofibular
syndesmosis.
59. Fractures of the Fibula: Dupuytren
Fracture
fracture of the fibula occurring 2 to 7
cm above the distal tibiofibular
syndesmosis and including disruption
of the medial collateral ligament
associated tear of the syndesmosis
leads to ankle instability
60. Fractures of the Fibula: Maisonneuve
Fracture
eversion-type injury
# in the proximal half of the bone
tibiofibular syndesmosis is always
disrupted
either tear of the tibiofibular ligament
or fracture of the medial malleolus is
also present
The more proximal the location of the
fibular fracture, the more is the
damage to the interosseous
membrane
62. Weber classification
based on the level of fibular fracture
and therefore on the type of
syndesmotic ligament injury
The higher the fibular fracture, the
more extensive the damage to the
tibiofibular ligaments and, thus, the
greater the risk of ankle instability
66. Fractures of the Foot: Fractures of the
Calcaneus
sustained in falls from heights
sometimes called lover's fractures
whether the fracture line involves the
subtalar joint
Determination of the Boehler angle
and angle of Gissane
70. Fractures of the Calcaneus
fall from a height, a radiograph of the
thoracolumbar spine is essential
associated finding of compression
fracture of one of the vertebral bodies
73. Fractures of the talus
neck of the talus is the most
vulnerable site
forced dorsiflexion of the foot
dislocation in the subtalar and
talonavicular joints
Hawkins classification
76. Osteochondritis Dissecans of the Talus
Cause: familial, trauma, ischemia
lesion involving the talar dome
located in the anterolateral (inversion
and dorsiflexion injury) or in the
posteromedial (plantar flexion and
external rotation) aspect of the talar
dome
associated with lesions of the lateral
collateral ligament complex
77. Osteochondritis Dissecans of the Talus
Berndt and Harty classification of OCD
lesions:
Stage I: Subchondral lesion with no
involvement of the subchondral bone
plate or articular cartilage
Stage II: Partial osteochondral lesion
with one side of the lesion remaining
attached to the adjacent bone
Stage III: Completely separated
osteochondral lesion with the
fragment in situ
Stage IV: Completely separated
osteochondral lesion with a displaced
fragment
84. Dislocations in the Subtalar Joint
Two major types
peritalar dislocation of the foot
total dislocation of the talus
85. Peritalar dislocation of the foot
simultaneous dislocations in the
talocalcaneal and talonavicular joints
with normal maintenance of the
tibiotalar relationship
Four subtypes: medial, lateral,
posterior, and anterior
look for associated fractures,
particularly of both malleoli, the
articular margin of the talus, and the
navicular and fifth metatarsal bones
86. Total Talar Dislocation
complete disruption of both the ankle
(tibiotalar) and the subtalar joints
serious of all talar injuries
complicated by osteonecrosis
87. Tarsometatarsal Dislocation
Also termed Lisfranc fracture-dislocation
most common dislocation in the foot
association with various types of
fractures (# base of the second MT)
two basic forms of injury:
homolateral— dislocation of the first to
the fifth metatarsal
divergent—lateral displacement of the
second to the fifth metatarsals with
medial or dorsal shift of the first
metatarsal
most common complications of ankle
and foot fractures are nonunion and
posttraumatic arthritis
91. Posttraumatic Joint Effusion
assessed on the lateral radiograph of
the ankle by
appearance of focal soft-tissue density
anteriorly to the joint
Encroachment of the Kager triangle,
also known as pre-Achilles fat pad
93. Tear of the Medial Collateral Ligament
eversion force
associated with a tear of the
tibiofibular ligament and lateral
subluxation of the talus
Xray: lateral shift of the talus in the
absence of a spiral fracture of the
fibula
94. Ligaments: Medial Ankle Ligaments
It has several components—
Tibiotalar
Tibiocalcaneal
talonavicular
the spring ligament (between the
sustentaculum of the calcaneus and
navicular bone)
98. Tear of the Lateral Collateral Ligament
Xray: No fibular # with inversion-
stress film of the ankle by an increase
in talar tilt to 15 degrees or more
99. Tear of the Lateral Collateral Ligament:
Arthography
• Leakage around the tip of the fibula
indicates a tear of the anterior talofibular
ligament
• filling of the peroneal tendon sheath
indicates a tear of the calcaneofibular
ligament
• leak of contrast into the tibiofibular
syndesmosis indicates a tear of the distal
anterior tibiofibular ligament
• Filling of the posterior facet of the subtalar
joint indicates a tear of the posterior
talofibular ligament
100. Tear of the Lateral Collateral Ligament:
Arthography
101. Lateral Collateral Ligament
Superior Group
Anterior and posterior tibiofi bular
ligaments
Seen at top of ankle joint on axial images
Inferior Group
Anterior to posterior: Anterior
talofibular, posterior talofibular, (Seen
on axial images at level of malleolar
fossa of fibula) calcaneofibular
(coronal)
104. Lateral ankle ligament tears
association with sinus tarsi syndrome, anterolateral impingement syndrome, and
longitudinal split tears of the peroneus brevis tendon
106. Tendon Ruptures: Tendo Achilles
severe tenderness at the tendon's
insertion
limitation of plantar flexion
Avulsion of this tendon from its
calcaneal insertion
113. Achilles
largest tendon in the body
confluence of tendons from the
gastrocnemius and the soleus muscles
No tendon sheath - it cannot have changes of
tenosynovitis, but only of paratendinitis
paratenon present on the dorsal, medial, and
lateral aspects of the Achilles tendon that
allows smooth gliding of the tendon
flat or concave anterior margin on axial
images
posterior margin of the Achilles has a convex
contour
7 mm AP diameter
anterior and posterior margins are parallel on
true sagittal images through the tendon
114. Achilles and Plantaris
plantaris tendon lying anteromedial to
the Achilles tendon, which inserts
onto the Achilles tendon, or to the
posterior calcaneus, or to the flexor
retinaculum
116. Haglund’s deformity
AKA “pump bumps”
ill-fi tting footwear, and from
inflmmatory arthropathies
triad of retro-Achilles bursitis,
retrocalcaneal bursitis, and thickening
of the distal Achilles tendon
117. Posterior Tibial Tendon
attaches to the medial navicular bone,
the three cuneiforms, and the bases of
the first to fourth metatarsals
attachment to the navicular bone is
generally the only portion of the
attachment identified by MRI
Normal high signal on T2 near the
attachment
119. Posterior Tibial Tendon
loss of the longitudinal arch, resulting
in a flat foot deformity
Middle-aged or older women and
rheumatoid arthritis
Tears of this tendon also are
associated with the sinus tarsi
syndrome and degenerative joint
disease of the posterior subtalar joint
and abnormal spring ligament
120. Flexor Hallucis Longus
attach to the base of the distal
phalanx of the great toe
synovial tendon sheath is in
communication with the ankle joint in
20% of individuals
fluid surrounding the tendon is
common and may have no
significance if an ankle joint effusion
also is present
121. Flexor Hallucis Longus
Focal, asymmetric pooling of fluid
within the tendon sheath is indicative
of stenosing tenosynovitis
associated with the os trigonum
syndrome
123. Peroneal Tendons
share a common tendon sheath
proximally, but have separate sheaths
distally
Brevis anterior or medial to longus
brevis eventually attaches to the base of
the fifth metatarsal
longus has a broad-based insertion on
the plantar surface of the base of the
firrst metatarsal and medial cuneiform,
after traversing the plantar aspect of the
foot
Flat is acceptable (for many things), but
if the brevis becomes C-shaped, it is
considered abnormal.
124. Peroneal Tendons
Calcaneal fractures can be associated
with entrapment of the peroneal
tendons between bone fragments,
tendon tears, tendon displacement, or
impingement on tendons by fracture
fragments
125. Peroneus brevis splits
Asymptomatic in old age
Pain and swelling in youngs
Peroneus brevis longitudinal tears occur
during dorsiflexion, when the brevis tendon is
wedged between the lateral malleolus and
the peroneus longus tendon
torn or lax superior peroneal retinaculum, a
flat or convex (rather than normal concave)
posterior aspect of the lateral malleolus, low-
lying peroneus brevis muscle belly (extending
to the tip of the lateral malleolus), and the
presence of an accessory muscle called the
peroneus quartus.
A sharp posterolateral fibular spur may be
seen
127. Peroneal tendons: dislocation.
shallow or hypoplastic retromalleolar
groove of the fibula may predispose
to subluxation of the peroneal
tendons
inversion injury with plantar flexion
135. Tarsal Tunnel Syndrome
Even if MRI shows no abnormality affecting the tarsal tunnel, it is valuable
because it means that surgery is not indicated and would not benefit the patient
136. Morton Neuroma
previously was believed to represent a
neoplastic process of the nerve
but now is thought to be secondary to
chronic nerve entrapment
with subsequent perineural fibrosis,
neural degeneration, and often
adjacent intermetatarsal bursitis
around the plantar digital nerve of the
second or third intermetatarsal space
140. Morton Neuroma
Treatment may consist of modifcation
of footwear, percutaneous neurolysis,
surgical release by dividing the
transverse metatarsal ligament, or
excision.
141. Baxter Neuropathy
caused by compression of the inferior
calcaneal nerve (known as Baxter
nerve)
entrapment by a hypertrophied
abductor hallucis muscle particularly
in runners, compression by inferior
calcaneal enthesophyte/ thickened
plantar fascia, and stretching
secondary to a hypermobile pronated
foot
MR imaging findings include
denervation edema or fatty atrophy of
the abductor digiti minimi muscle
143. Sinus Tarsi Anatomy
The sinus tarsi, or tarsal sinus, is a
cone-shaped space formed between
the calcaneus and talus
The narrow end of the cone is located
medially, whereas the large end is
located laterally, beneath the lateral
malleolus.
The sinus tarsi contains fat, several
ligaments, neurovascular structures,
and portions of the joint capsule of
the posterior subtalar joint
Nerve endings in the sinus tarsi are
important for proprioception of the
hindfoot
slips from the lateral extensor
retinaculum;
cervical ligament
most medial is the interosseous
ligament
147. Sinus Tarsi Syndrome
If only part of the fat has been
replaced, it is unlikely to be associated
with the sinus tarsi syndrome
One must not confuse a large joint
effusion of the ankle or subtalar joint
extending into the sinus tarsi as
evidence of an abnormal sinus tarsi.
The fat in the sinus tarsi can be
obscured by fl uid or hemorrhage in
acute ankle sprains; a diagnosis of
sinus tarsi syndrome should not be
made in the setting of acute trauma.
Alawys correlate clinically that patient
has symptoms
Treated by steroid injection,
reconstruction of the ligaments of the
sinus tarsi, surgical débridement, and,
rarely, triple arthrodesis
151. Painful Accessory Navicular Bone
Syndrome
os navicularis or os tibiale externum is
present in about 10% of the
population
It is united to the medial aspect of the
navicular bone with a synchondrosis
Athletic activities may lead to
inflammation of this accessory ossicle
and associated tendinosis of the
posterior tibialis tendon.
MRI is the imaging technique of
choice to demonstrate the signal
alterations of the bone and the
morphologic changes of the posterior
tibialis tendon
152. Painful Os Peroneum Syndrome
os peroneum is a sesamoid bone
located within the peroneus longus
tendon just proximal to the entrance of
the tendon into the cuboid tunnel
Pain in the lateral aspect of the foot
acute or chronic fracture or diastasis of a
bipartite or multipartite os peroneum;
tendinosis or tear of the peroneus
longus tendon or presence of a large
peroneal tubercle in the lateral aspect of
the calcaneus
MRI can demonstrate fragmentation
and edema of the os peroneum and
associated pathology of the peroneus
longus tendon
153. Plantar Fasciitis
plantar fascia originates on the plantar
aspect of the calcaneus
It extends over the intrinsic muscles of
the foot, the abductor digiti minimi
(lateral cord), the flexor digitorum brevis
(central cord), and the abductor hallucis
(medial cord)
present with pain in the plantar aspect
of the heel on weight bearing
Predisposing factors include obesity,
enthesopathy, pes cavus, systemic
disease (inflammatory arthritis), overuse,
altered gait, and trauma
155. BONE ABNORMALITIES: Tarsal
Coalition
6% of the population
failure of proper segmentation of the
tarsal bones
acquired secondary to rheumatoid
arthritis or trauma
The two most common types are
calcaneonavicular & talocalcaneal
limited motion in the subtalar joint >
increased stresses elsewhere in the
tarsus > spasm of the peroneals and
extensors, with an associated flatfoot
deformity
156. Tarsal Coalition
Coalitions may be osseous, fibrous,
cartilaginous, or a combination.
MRI:
presence of the coalition, which type,
and how extensive it is
surrounding structures for
impingement by the hypertrophic
bony mass, such as displacement of
the tibialis posterior and flexor hallucis
longus tendons in the tarsal tunnel
Secondary degenerative joint disease
in the posterior subtalar joint is
common and can be documented with
MRI.
MRI shows narrowing and irregularity,
or osseous fusion, of the middle facet
of the subtalar joint. The angle of this
joint is often abnormal, with a
coalition being directed inferiorly
159. Os Trigonum Syndrome
Clinical: Repetitive plantar flexion (ballet,
basketball, kicking football, running on hills)
Etiology: Os trigonum/trigonal process and flexor
hallucis tendon trapped between calcaneus and
tibia
Pathology: Marrow edema/fracture of trigonal
process or synchondrosis of os trigonum; flexor
hallucis longus irritation (stenosing
tenosynovitis)
MRI:
T1W: Low signal in marrow of posterior talus
T2W:
High signal marrow in talus
High signal fracture of synchondrosis, os trigonum
Focal, loculated high signal fluid around flexor
hallucis (stenosing tenosynovitis)
Loose bodies
161. Accessory Navicular
Large cornuate process of navicular or
accessory navicular bone
Marrow edema, overlying bursitis,
degenerative joint disease between
accessory bone and navicular,
associated posterior tibial tendon
tears
T2W MRI shows high signal of all
abnormalities
much higher incidence of posterior
tibial tendon tears in the presence of
an accessory navicular bone, caused
by altered stresses
162. Hallux Sesamoids
Located in flexor hallucis brevis tendons
at first metatarsal head
Abnormalities: Acute or stress fractures,
osteonecrosis, infection, sesamoiditis
(inflammation), dislocation, participate
in inflammatory and degenerative joint
disease
MRI is sensitive, but nonspecific; low
signal on medial sesamoid more likely
to be traumatic in origin; lateral
sesamoid is more likely osteonecrosis
Turf Toe: hyperdorsifl exion of the fi rst
metatarsophalangeal joint with
disruption of the plantar capsular tissues
164. Osteonecrosis of the Foot and Ankle
Navicular (unrecognized fracture)
Metatarsal heads, especially second
and third (repetitive stresses,
highheeled shoes)
Talar dome (talar neck fracture)
Lateral hallux sesamoid
serpiginous low signal intensity lines
creating a geographic pattern, or
diffuse low signal on T1W images that
may or may not become higher signal
on T2W images
168. BONE MARROW EDEMA SYNDROME
young patients
generalized pain not attributable to
any source
Bilateral, selflimiting
Patchy increased T2 signal is often
seen scattered about multiple bones
in the foot and ankle
169. Soft tissue tumors
MRI is useful to confirm the
presence and extent of a soft
tissue mass, and to
determine the precise
anatomic location, which aids
in surgery; in some cases, the
appearance is specific for a
particular lesion
170. Plantar Fibromatosis
benign proliferation of fi brous tissue along
the plantar aspect of the foot
arising in the plantar fascia
manifests as a nodule on the sole of the foot,
usually medial in location
Painless
a single or multiple small nodular thickenings
of the plantar fascia that appear as low to
intermediate signal intensity on T1W and
T2W sequences, enhance with intravenous
gadolinium
The upper margin: infiltrative and can grow
into the deeper compartments of the foot,
the lower margin usually is well defined and
outlined by the subcutaneous fat
lesions often are not biopsied or surgically
removed, unless they are large.
171. Synovial Sarcoma
most common
extraarticular soft tissue mass
Xray : scattered calcifications,
infiltrative and destroy adjacent bone
well defined and benign by imaging
criteria, sometimes creating a pressure
erosion on adjacent bone
MRI: Necrosis and haemorrhage &
T1C+ heterogeneous enhancement
172. Accessory soleus
anatomic normal variant
pain
secondary to ischemia that occurs
during exercise as a form of a
localized compartment syndrome
may compress the posterior tibial
nerve in the tarsal tunnel, resulting in
tarsal tunnel syndrome
173. Peroneus quartus muscles
lies in the posterior ankle, just anterior and
lateral to the Achilles tendon
Asymptomatic or lateral ankle pain and ankle
joint instability
predispose to subluxation of the peroneal
tendons because of its mass effect within the
confi ned space created by the peroneal
retinaculum and subsequent stretching and
laxity of the retinaculum
manifest as a mass or be an incidental finding
on MRI
The peroneus quartus runs posteromedial to
the peroneus longus and brevis tendons and
usually attaches to the retrotrochlear
eminence on the calcaneus, which is located
posterior to the peroneal tubercle.
174. Accessory flexor digitorum longus
compressive neuropathy of the
posterior tibial nerve in the tarsal
tunnel
The tendon from another accessory
muscle, the peroneocalcaneus
internus, runs parallel to a portion of
the fl exor hallucis longus tendon and
may simulate a longitudinal split of
that tendon
175. Pressure Lesions
Usually asymptomatic, occasionally
painful
Probably related to adventitious bursa
formation
Common locations:
Plantar to first and fifth metatarsal heads
Plantar to plantar fascia at calcaneal
tuberosity
Posterior to distal Achilles (bursa of
Achilles tendon)
Medial to metatarsal head in hallux
valgus
transfer lesions: after operation, stresses
have been transfer to new site
MRI: Low signal all sequences, usually
mimic a soft tissue tumor, especially
before developing cystic changes
Typical locations, the MRI characteristics
are not entirely typical of a true mass
lesion, and fat often is intermixed
177. Diabetic Foot
multifactorial etiology: small vessel
ischemia, neuropathic arthropathy,
fractures, and infections
usually have developed a soft tissue
ulcer over a pressure area in the foot
differentiating osteomyelitis from soft
tissue infection
Differentiation is difficult clinically, but
is important and affects the therapy
the patient receives, including the
length of antibiotic treatment and the
decision for surgical débridement
role of imaging:
detect osteomyelitis or soft tissue
abscesses
assess the extent
useful in the planning of any surgical
procedure or biopsy
MRI to be more cost-effective than
the standard three-phase radionuclide
bone scan and indium-labeled white
blood cell scans
MRI can detect sinus tracts, cellulitis,
abscesses, and tendon abnormalities.
183. Foreign bodies
not radiopaque and cannot be seen
on radiographs.
Small foreign bodies often migrate
from the site of entry through the skin
to a distant site
Most foreign bodies are linear and
low signal intensity on T1W and T2W
sequences
Surrounded by high signal intensity
on T2W sequences
central beam (red broken line) is directed vertically to the ankle joint at the midpoint between both malleoli
fibular (lateral) malleolus is longer than the tibial (medial) malleolus
central beam (red broken line) is directed vertically to medial malleoli
tibiotalar and subtalar joints are well demonstrated
third malleolus
Effusion
Coronally oriented #
central beam is directed perpendicular to the lateral malleolus
tibiofibular syndesmosis and the talofibular joint
lateral malleolus and the anterior tibial tubercle
degree of talar tilt
tears of the lateral collateral ligament
comparison studies of the contralateral ankle should be obtained
amount of transposition of the talus in relation to the distal tibia can be determined
Need comparison
central beam is directed vertically to the base of the first metatarsal bone
first intermetatarsal angle: quantify the amount of metatarsus primus varus associated with hallux valgus.
central beam is directed vertically to the midtarsus
Boehler angle: decrease in # calcaneum
Calcaneal pitch: Higher values indicate a cavus foot deformity (pes cavus), and lower values indicate a flat foot deformity (pes planus)
The lateral border of the foot is elevated about 40 to 45 degrees (inset) so that the medial border
of the foot is forced against the film cassette. The central beam is directed vertically to the base of the third
metatarsal.
The central beam is usually angled 45 degrees toward the midline of the heel
the middle facet of the subtalar joint is seen, oriented horizontally;
the sustentaculum tali projects medially
The foot rests on the film cassette, dorsiflexed to 90 degrees, and, together with the leg, rotated medially approximately 45 degrees (inset). The central beam is directed toward the lateral malleolus. Films may be obtained at 10, 20, 30, and 40 degrees of cephalad angulation of the tube posterior facet of the subtalar joint.
The central beam is directed vertically to the head of the first metatarsal bone
metatarsal heads and the sesamoid bones of the first metatarsal.
flexor hallucis longus and flexor digitorum longus opacify
No tendon on lateral side
No contrast agent should be seen in this area except for normal opacification of the syndesmotic recess.
Unimalleolar
Bimal
tri
Complex fractures, known also as pilon fractures
distal fibula and medial malleolus associated with posterior dislocation in the ankle joint
Trimalleolar Fractures with dislocations
posttraumatic arthritis
Post dislocation with navicular #
Tear of the calcaneofibular and anterior talofibular ligaments
Tear of the distal anterior tibiofibular ligament
Achilles tendon at its insertion on the posterior aspect of the os calcis and prominent soft-tissue swelling.
Multiple calcifications are seen at the site of the tendon's insertion
The tenogram demonstrates a
tear of the tendon approximately 5 cm proximal to the insertion by the abrupt termination of contrast filling
the tendon sheath.
Normal, not to confused with split TA
Grade III TA tear
Achilles tendon: xanthoma, stippled appearance
Tendinosis
Vertical split tear
Partial tear
Atrophy: tear
distal tenosynovitis
Axial t1
FSE-T2W axial image of the ankle. There is a longitudinal tear or split of the peroneus brevis (arrow).