11/11/2016

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Imaging: Foot and Ankle

Joseph J. Blake, M.D.

Chief, MRI services, Kettering Health Network

Member, Society for Skeletal RadiologyNovember 11, 2016

http://www.ohri.ca/emerg/cdr/docs/cdr_ankle_poster.pdf

https://www.youtube.com/watch?v=BjkTf4PCYgMwww.eci-sa.org

11/11/2016

2

https://www.youtube.com/watch?v=Dqq09sR0vuc Ottawa Ankle Rules by Dr. Ian Stiell

Application of rules = 30% Decrease in Radiographs

11/11/2016

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Joseph Yu’s checklist for low-energy ankle trauma: Medial malleolus (1) Lateral malleolus (2) Anterior tibial tubercle (3) Posterior tibial malleolus (4) Talar dome (5) Lateral talar process (6) Posterior talar process (7) Dorsal to talonavicularjoint (8) Anterior calcaneus process (9) Calcaneal site of ext dig brev (10) Base of 5th MT (11) Emergency Radiology (2009) 16: 309-318

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5th MT

http://ajs.sagepub.com/content/39/6/1295/F1.expansion.html

Sakellariou VI, Kyriakopoulos S, Sofianos IP, Papagelopoulos PJ (2014) Fractures of the Proximal Part of the 5th Metatarsal. J

Trauma Treat S2:005. doi: 10.4172/2167-1222.S2-005

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Ann Surg. 1902 Jun; 35(6): 697–700.2.

https://radiopaedia.org/cases/base-of-5th-metatarsal

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5th MT Avulsion

Plantar Flexion with inversion

Peroneus Brevis

Lateral Cord Plantar Fascia

Different than “Jones”, Don’t

Lisfranc

1815

https://www2.aofoundation.org

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https://www2.aofoundation.org

“Since ER x-rays (which are often non-weight bearing) may not show the extent of the Lisfranc injury, subsequent weight-bearing x-rays in the office or clinic are highly recommended.”—AO Foundation

Harris, JH Jr, Harris WH, Novelline, RA, The Radiology of Emergency Medicine Third Ed. p986 Willams and Wilkins, 1981

Lisfranc

Joint vs. Ligament

Importance of Weight-bearing or Cross-sectional Imaging

Keystone

Failure to Diagnose

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Calcaneus Fracture

http://pubs.rsna.org/doi/full/10.1148/rg.2015140156

Biography.com

Lateral Talar Process Fracture

“Snowboarder’s Fracture”

Failure to diagnose

Axial Impact with Dorsiflexion

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9

1153,081

= 3.7%

False Negative Radiographs

Insufficient Views

Poor positioning or technique

Non-displaced Occult Fractures

Subtle Fractures, Tricky Locations, and Blind Spots

Satisfaction of Search

Foreign Bodies

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Articular Cartilage

Articular Cartilage Injury Osteochondral Lesion Grading

http://www.opnews.com/2016/04/osteochondral-lesions-of-the-talus-and-the-role-of-ankle-arthroscopy/12266Radiopedia.org

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Ligament Injury

Tendon Injury

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MTP injury

Turf Toe

http://img.medscape.com/pi/emed/ckb/orthopedic_surgery/1230552-1236962-1641.jpg

http://radsource.us/clinic-turf-toe/

Stress

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Bone Stress Injuries

X-Rays

Susepcted Stress Fracture

X-Rays Negative?

Treat as Stress Fracture

SignsNo, Positive

MRI

$$$

10-14 Days: Repeat X-Rays(Or MRI)

X-Rays Negative?

MRI +?Alternative Dx

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High Risk Stress Fractures

Medial Malleolus

Talus

Navicular

Proximal 5th MT

Hallux Sesamoids

http://radiologykey.com/embryology-anatomy-and-normal-findings-4/

Tarsal Coalition

Bilateral in up to 50%

Osseous or Fibrocartilaginous

Calcaneonavicular and Talocalcaneal

Beware of the Frequent Ankle Sprainer

The End