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MRI is the imaging modality of choice for evaluation of musculoskeletal pathology of the ankle and foot, including soft tissue, osseous trauma, neoplasms, and inflammatory pathology. Syndrome examples include: Anterolateral Impingement syndrome, Sinus Tarsi syndrome, Compressive neuropathies (Tarsal tunnel syndrome, Morton neuroma), and synovial disorders.
MRI imaging has also been shown to be highly sensitive in the detection and staging of a number of infections including: Cellulitis, Soft-Tissue abscesses, and Osteomyelitis. MRI imaging is excellent for the early detection and assessment of a number of osseous abnormalities such as bone contusions, stress and insufficiency fractures, osteochondral fractures, osteonecrosis, and transient bone marrow edema. The foot and ankle are the hardest area to image due to area ordered, positioning and imaging plane for hindfoot(ankle), midfoot and forefoot.
Diagnosis of other abnormalities including fracture, calcaneal pain, os trigonum syndrome, subtalar coalition, talar dome OCD and Achilles insertion issues. Depending on the patient population, common diagnoses include metatarsal stress fractures or neuropathic arthropathy often with a question of osteomyelitis. The flexor hallucis longus (FHL) occasionally becomes entrapped in the midfoot due to lesions about the Knot of Henry (“jogger’s foot”). The most frequently diseased tendons in the ankle are the Achilles, posterior tibial, and peroneal. All-American Teleradiology provides rapid, accurate decisive musculoskeletal MRI interpretations performed by highly experienced, fellowship trained Musculoskeletal Radiologists. Use the form below to delete this Ics Rx Tobillo Pie Leccion 2 Osteonecrosis Del Tarso I image from our index. Use the form below to delete this Ics Rx Tobillo Pie Leccion 3 Coalicciones Tarsales Ii Haga image from our index. Use the form below to delete this Ricerche Correlate A Quebradura De Tobillo Tibia Y Perone image from our index. Use the form below to delete this Anatomia Del Ginocchio Legamenti Menisco E OssaFisioterapia image from our index.
Use the form below to delete this Fractura De Tibia Y Perone Pantorrilla image from our index. Use the form below to delete this Pin El Hueso Escafoides O Navicular Forma De Barco Se Ubica En image from our index.
Use the form below to delete this Fractura Del A?ngulo Posterosuperior CalcA?neo Caso 2 image from our index. Clinical History: A 60 year-old female presents with foot and ankle pain with swelling for 3 months.
Figure 2:The axial proton density-weighted fat-suppressed image demonstrates lateral subluxation and fragmentation of the second and third metatarsal bases with diffuse marrow edema (arrows). Figure 3:A sagittal fat-suppressed T2-weighted image demonstrates disruption of the longitudinal arch of the foot, with plantar flexion of the talus (T) and navicular (N), and relative dorsal subluxation of the first metatarsal (asterisk). Figure 4:A sagittal fat-suppressed T2-weighted image demonstrates plantar angulation of the cuboid (C) with an underlying fluid collection (arrow) and thinning of the subcutaneous fat. In 1868, Jean-Martin Charcot gave the first detailed description of a progressive destructive arthropathy due to neuropathic disease in a patient with syphilis.1 For many years syphilis was considered to be the most common etiology of Charcot neuroarthropathy, but now diabetes mellitus is far and away the most common cause, involving primarily the joints of the foot and ankle.
The lifetime risk for developing foot ulcers among diabetic patients is 25% and up to 50% may develop infections.5 Chronic stages of Charcot foot are characterized by visible foot deformity, crepitus, limited range of motion and palpable loose bodies.
MR imaging is the modality of choice for imaging both Charcot arthropathy and infection in diabetics.
The greatest challenge for the clinician and the radiologist is determining whether the red hot swollen foot is from Charcot arthropathy or from osteomyelitis.
Figure 6:Sagittal STIR (6a) and T1-weighted (6b) images in a patient with previous amputation and rocker bottom foot deformity, who developed a large skin ulcer (asterisk) over the load bearing cuboid (arrows).
Osteomyelitis can also occur at the tarsal-metatarsal joints, and this is a diagnostic challenge.

A recent study outlines the use of dynamic contrast enhanced MRI for the evaluation of treatment in acute Charcot foot in diabetic patients. MRI imaging, with or without intravenous contrast, is the most specific and accurate means for diagnosing Charcot neuroarthropathy and for assessing potential complications or the presence of infections. MRI provides superior resolution and exquisite detail of soft tissue structures using multiplanar capabilities.
It is increasingly being recognized as the modality of choice for assessment of pathologic conditions of the ankle and foot.
Positioning of the ankle and foot correctly is the second step to an accurate diagnosis, along with correct imaging sequences, markers and the use of contrast materials. This precludes optimizing scan planes, pulse sequences, and positioning for specific structures, and spatial resolution will be inadequate. A traumatic tear of the Lisfranc ligament can lead to instability and progressive disorganization of the Lisfranc joint. The mechanism is chronic repetitive friction with the flexor digitorum longus (FDL) tendon. The mechanism of injury includes anterior thrust of the metatarsal head in a hyperextended joint with a relatively fixed great toe.
MRI can be used to diagnose most disorders of these tendons, as well as stage these disorders to allow appropriate therapy. The high cost of healthcare often puts the patient in the difficult position of determining if a diagnostic test makes economic sense. Our value added consultative MRI services, to include our providing free MRI accreditation assistance and a Medical Director can help ensure appropriate reimbursement and the highest level of clinical performance. The navicular (N) is rotated such that its lateral cortex articulates with the second metatarsal base (asterisk), and its distal cortex with the medial cuneiform.
It can also be seen in other neurologic disorders with sensory loss in the foot such as leprosy, spinal cord injuries, alcoholic neuropathy, and congenital insensitivity to pain. Surgery is contraindicated in the presence of acute inflammation or possible infection, but it can be performed in the chronic stages to stabilize the foot and reduce the risk of ulceration or further osseous destruction due to altered weight bearing from osseous deformities. Location is the most important consideration, since osteomyelitis nearly always develops from the contiguous spread of infection.
The T1-weighted image also clearly demonstrates the presence of gas (arrowheads) due to the open wound. Careful inspection will often reveal a meandering sinus tract travelling in from a more peripheral location. This study revealed that a reduction in the rate of contrast uptake was a reliable indicator of improvement and that mean healing time was directly related to the baseline contrast uptake rate. The detailed osseous anatomy allows evaluation of the precise location and extent of bony destruction associated with both Charcot foot and osteomyelitis. Sur quelaques arthropathies qui paraissent depender d’une lesion du cerveau ou de la moele epiniere. Role of Dynamic MRI in the follow-up of acute Charcot foot in patients with diabetes mellitus. However, MRI of the foot and ankle can be challenging for time consuming for radiologists as the foot contains 28 bones and 30 joints.
To help ensure that the referring physician and their patients get true value from the MRI, consult with the ordering Physician and Musculoskeletal Radiologist prior to exam.
She has managed MRI centers utilizing a wide range of MRI equipment, which includes: Hitachi, Phillips, GE, Siemens, Toshiba and Esaote.
Axial proton density fat-suppressed and sagittal T2-weighted fat-suppressed images are provided. The clinical presentation is often indistinguishable from infection which is a common complication of Charcot arthropathy, suggested by the presence of skin ulcers or draining sinus tracts.

MRI has surpassed nuclear medicine imaging due to the greater specificity of MRI and its ability to delineate osseous anatomy as well as discrete abscesses and sinus tracts diagnostic of infection.6 MRI is commonly ordered in the diabetic patient to rule out infection in the presence of an ulcer, to evaluate the severity of Charcot arthropathy, or to distinguish between Charcot arthropathy and infection.
It often occurs in predictable, more peripheral locations, which tend to be at pressure points. Advanced underlying Charcot changes are evident, with osseous loose bodies and extensive fragmentation of midfoot bones and the remaining metatarsal bases. The multiplanar capacity of MRI is useful in this regard, since the longitudinal nature of the tract may only be appreciated in one plane, and may be too small to detect in cross section. While not widely used clinically, it may be valuable as a reproducible parameter to evaluate therapeutic options.8 It should also be noted that due to the presence of concomitant renal disease in some diabetic patients, contrast may be contraindicated because of potential gadolinium-induced nephrogenic systemic fibrosis. The multiplanar soft tissue detail unique to MRI enables detection of abscesses and sinus tracts which are essential in the distinction between Charcot changes and superimposed osteomyelitis. Proper positioning, protocol consultation with an experienced Musculoskeletal Radiologist, and consultation with the referring physician can improve the performance of MRI as a diagnostic tool. A tear of the plantar fascia most commonly occur in the midportion of the fascia being partial or complete and are common from a traumatic injury.
The rupture of the ligament fibers is more common than is the avulsion fracture at the bony attachments.
The right imaging techniques, outstanding image quality and a clinically specific report will ensure optimal diagnosis and treatment for patients. The neurotraumatic theory holds that osseous destruction results from loss of pain sensation and proprioception leading to repetitive unperceived trauma to the foot.
The vast majority of diabetic foot infections are from direct inoculation rather than hematogenous spread, and are most commonly seen as contiguous spread from a skin ulcer. The addition of intravenous gadolinium contrast often renders an abscess or sinus tract more conspicuous, since only the periphery of the collection will enhance, leaving a low signal intensity center on fat-suppressed T1-weighted post-contrast images.
All-American Teleradiology provides MRI technologist consultation, MRI accreditation assistance and a team of Musculoskeletal Radiologists readily available for accurate interpretations.
Radabaugh has worked as a MRI Applications Specialist with Hitachi and Consultant to GE Medical and Bayer Healthcare. The neurovascular theory holds that joint destruction is secondary to an autonomically stimulated vascular reflex causing hyperemia and resulting in mismatch in bone resorption and synthesis.2 Charcot arthropathy is widely thought to result from a combination of both processes. The most commonly involved joints in neuroarthropathy are the tarsal-metatarsal joints, and the metatarsophalangeal joints, while osteomyelitis occurs distal to the tarsal-metatarsal joints, and at the calcaneus and at the cuboid in the case of the rocker bottom foot.
The most reliable way to diagnose osteomyelitis is to track the ulcer or sinus tract to the underlying bone and evaluate for the presence of marrow edema, as evidenced by low signal intensity on T1-weighted images. Abnormally decreased signal intensity on T1-weighted images is a more specific indicator of marrow edema than increased signal intensity on T2-weighted images alone, which may indicate osteitis, or reactive marrow change rather than osteomyelitis.7 Figures 5a-5c demonstrate a case of osteomyelitis with an overlying ulcer and draining sinus tract at the dorsal lateral aspect of the 5th toe. In the neuroarthropathic foot the ghost sign is absent because bones are destroyed, not just edematous. The plantar plate is a fibrocartilaginous structure that extends from the metatarsal neck to the base of the proximal phalanx.
Diabetic foot ulcers, and therefore underlying osteomyelitis, develop at the site of pressure points, either from weight bearing or constrictive shoes in the ambulatory patient, or at dorsal and lateral points of the externally rotated foot in the bed ridden patient. If midfoot or forefoot is desired, these will generally need to be ordered and scheduled as separate studies.
It reinforces the plantar capsule and also attaches the hallux sesamoid bones to the base of the proximal phalanx.

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