Imaging in the Assessment and Management of Overuse Injuries in the Foot and Ankle

James Teh; Ravi Suppiah; Robert Sharp; Julia Newton

doi:10.1055/s-0031-1271962

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2011; 15(1): 101-114
DOI: 10.1055/s-0031-1271962

Imaging in the Assessment and Management of Overuse Injuries in the Foot and Ankle

James Teh¹ , Ravi Suppiah² , Robert Sharp³ , Julia Newton²

¹Department of Radiology, Nuffield Orthopaedic Centre NHS Trust, Headington, Oxford, United Kingdom
²Department of Sports and Exercise Medicine, Nuffield Orthopaedic Centre NHS Trust, Headington, Oxford, United Kingdom
³Department of Foot and Ankle Surgery, Nuffield Orthopaedic Centre NHS Trust, Headington, Oxford, United Kingdom

Abstract

ABSTRACT

Overuse injuries of the ankle and foot are common in the general and athletic populations. The wide spectrum of overuse injuries includes ligamentous injuries, soft tissue and osseous impingement, osteochondral lesions, tendon injuries, and stress fractures. Some conditions such as impingement syndromes and stress fractures may be missed on initial physical examination, and patients with such injuries often present to a sports or orthopedic clinic with persistent symptoms. With the increasing participation in sports, health-care professionals involved in the care of athletes at all levels must have a thorough understanding of overuse conditions of the foot and ankle, and the use of imaging in the management of these conditions. This article covers the clinical presentation, pertinent anatomy, imaging features, and management of overuse injuries of the foot and ankle.

KEYWORDS

Overuse - stress fracture - impingement - tendinopathy - foot - ankle

Full Text

References

REFERENCES

1 Liu S H, Nuccion S L, Finerman G. Diagnosis of anterolateral ankle impingement. Comparison between magnetic resonance imaging and clinical examination. Am J Sports Med. 1997; 25(3) 389-393
2 Robinson P. Impingement syndromes of the ankle. Eur Radiol. 2007; 17(12) 3056-3065
3 Robinson P, Bollen S R. Posterior ankle impingement in professional soccer players: effectiveness of sonographically guided therapy. AJR Am J Roentgenol. 2006; 187(1) W53-58
4 Peace K A, Hillier J C, Hulme A, Healy J C. MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases. Clin Radiol. 2004; 59(11) 1025-1033
5 Koulouris G, Connell D, Schneider T, Edwards W. Posterior tibiotalar ligament injury resulting in posteromedial impingement. Foot Ankle Int. 2003; 24(8) 575-583
6 Messiou C, Robinson P, O'Connor P J, Grainger A. Subacute posteromedial impingement of the ankle in athletes: MR imaging evaluation and ultrasound guided therapy. Skeletal Radiol. 2006; 35(2) 88-94
7 van Dijk C N, Tol J L, Verheyen C C. A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement. Am J Sports Med. 1997; 25(6) 737-745
8 Farooki S, Yao L, Seeger L L. Anterolateral impingement of the ankle: effectiveness of MR imaging. Radiology. 1998; 207(2) 357-360
9 McCarthy C L, Wilson D J, Coltman T P. Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging. Skeletal Radiol. 2008; 37(3) 209-216
10 Robinson P, White L M, Salonen D, Ogilvie-Harris D. Anteromedial impingement of the ankle: using MR arthrography to assess the anteromedial recess. AJR Am J Roentgenol. 2002; 178(3) 601-604
11 Klein M A, Spreitzer A M. MR imaging of the tarsal sinus and canal: normal anatomy, pathologic findings, and features of the sinus tarsi syndrome. Radiology. 1993; 186(1) 233-240
12 Anderson M W, Kaplan P A, Dussault R G, Hurwitz S. Association of posterior tibial tendon abnormalities with abnormal signal intensity in the sinus tarsi on MR imaging. Skeletal Radiol. 2000; 29(9) 514-519
13 Oloff L M, Schulhofer S D, Bocko A P. Subtalar joint arthroscopy for sinus tarsi syndrome: a review of 29 cases. J Foot Ankle Surg. 2001; 40(3) 152-157
14 Erickson S J, Quinn S F, Kneeland J B et al.. MR imaging of the tarsal tunnel and related spaces: normal and abnormal findings with anatomic correlation. AJR Am J Roentgenol. 1990; 155(2) 323-328
15 Saupe N, Mengiardi B, Pfirrmann C W, Vienne P, Seifert B, Zanetti M. Anatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles. Radiology. 2007; 242(2) 509-517
16 O'Donnell P, Saifuddin A. Cuboid oedema due to peroneus longus tendinopathy: a report of four cases. Skeletal Radiol. 2005; 34(7) 381-388
17 Schweitzer M E, Eid M E, Deely D, Wapner K, Hecht P. Using MR imaging to differentiate peroneal splits from other peroneal disorders. AJR Am J Roentgenol. 1997; 168(1) 129-133
18 Sobel M, Pavlov H, Geppert M J, Thompson F M, DiCarlo E F, Davis W H. Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot Ankle Int. 1994; 15(3) 112-124
19 Brigido M K, Fessell D P, Jacobson J A et al.. Radiography and US of os peroneum fractures and associated peroneal tendon injuries: initial experience. Radiology. 2005; 237(1) 235-241
20 Neustadter J, Raikin S M, Nazarian L N. Dynamic sonographic evaluation of peroneal tendon subluxation. AJR Am J Roentgenol. 2004; 183(4) 985-988
21 Gluck G S, Heckman D S, Parekh S G. Tendon disorders of the foot and ankle, part 3: the posterior tibial tendon. Am J Sports Med. 2010; 38(10) 2133-2144
22 Balen P F, Helms C A. Association of posterior tibial tendon injury with spring ligament injury, sinus tarsi abnormality, and plantar fasciitis on MR imaging. AJR Am J Roentgenol. 2001; 176(5) 1137-1143
23 Mengiardi B, Zanetti M, Schöttle P B et al.. Spring ligament complex: MR imaging-anatomic correlation and findings in asymptomatic subjects. Radiology. 2005; 237(1) 242-249
24 Mansour R, Teh J, Sharp R J, Ostlere S. Ultrasound assessment of the spring ligament complex. Eur Radiol. 2008; 18(11) 2670-2675
25 Lawson J P, Ogden J A, Sella E, Barwick K W. The painful accessory navicular. Skeletal Radiol. 1984; 12(4) 250-262
26 Miller T T, Staron R B, Feldman F, Parisien M, Glucksman W J, Gandolfo L H. The symptomatic accessory tarsal navicular bone: assessment with MR imaging. Radiology. 1995; 195(3) 849-853
27 Mengiardi B, Pfirrmann C W, Vienne P et al.. Anterior tibial tendon abnormalities: MR imaging findings. Radiology. 2005; 235(3) 977-984
28 Jeswani T, Morlese J, McNally E G. Getting to the heel of the problem: plantar fascia lesions. Clin Radiol. 2009; 64(9) 931-939
29 Berkowitz J F, Kier R, Rudicel S. Plantar fasciitis: MR imaging. Radiology. 1991; 179(3) 665-667
30 Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003; (3) CD000416
31 Berndt A L, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 2004; 86-A(6) 1336
32 De Smet A A, Ilahi O A, Graf B K. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol. 1996; 25(2) 159-163
33 Mesgarzadeh M, Sapega A A, Bonakdarpour A et al.. Osteochondritis dissecans: analysis of mechanical stability with radiography, scintigraphy, and MR imaging. Radiology. 1987; 165(3) 775-780
34 O'Loughlin P F, Heyworth B E, Kennedy J G. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med. 2010; 38(2) 392-404
35 Anderson M W, Greenspan A. Stress fractures. Radiology. 1996; 199(1) 1-12
36 Kiuru M J, Pihlajamaki H K, Hietanen H J, Ahovuo J A. MR imaging, bone scintigraphy, and radiography in bone stress injuries of the pelvis and the lower extremity. Acta Radiol. 2002; 43(2) 207-212
37 Gaeta M, Minutoli F, Scribano E et al.. CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology. 2005; 235(2) 553-561
38 Fredericson M, Bergman A G, Hoffman K L, Dillingham M S. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med. 1995; 23(4) 472-481
39 Kiss Z S, Khan K M, Fuller P J. Stress fractures of the tarsal navicular bone: CT findings in 55 cases. AJR Am J Roentgenol. 1993; 160(1) 111-115
40 Sormaala M J, Niva M H, Kiuru M J, Mattila V M, Pihlajamäki H K. Stress injuries of the calcaneus detected with magnetic resonance imaging in military recruits. J Bone Joint Surg Am. 2006; 88(10) 2237-2242
41 Burne S G, Mahoney C M, Forster B B, Koehle M S, Taunton J E, Khan K M. Tarsal navicular stress injury: long-term outcome and clinicoradiological correlation using both computed tomography and magnetic resonance imaging. Am J Sports Med. 2005; 33(12) 1875-1881
42 Saxena A, Fullem B. Navicular stress fractures: a prospective study on athletes. Foot Ankle Int. 2006; 27(11) 917-921
43 Redd R A, Peters V J, Emery S F, Branch H M, Rifkin M D. Morton neuroma: sonographic evaluation. Radiology. 1989; 171(2) 415-417
44 Karasick D, Schweitzer M E. Disorders of the hallux sesamoid complex: MR features. Skeletal Radiol. 1998; 27(8) 411-418
45 Fleischli J, Cheleuitte E. Avascular necrosis of the hallucial sesamoids. J Foot Ankle Surg. 1995; 34(4) 358-365
46 Mintz D N, Tashjian G S, Connell D A, Deland J T, O'Malley M, Potter H G. Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy. 2003; 19(4) 353-359

James TehM.R.C.P. F.R.C.R.

Department of Radiology, Nuffield Orthopaedic Centre NHS Trust, Windmill Road

Headington, Oxford OX3 7LD, UK

Email: jamesteh1@googlemail.com