Ultrasound Imaging Guide for Assessment of the Intrinsic Ligaments Stabilizing the Subtalar and Midtarsal Joints

Abstract

Ligament injuries around the subtalar, talocalcaneonavicular, and calcaneocuboid joints are often underestimated on clinical and imaging findings during investigation of patients with ankle and foot injuries. Because a delayed diagnosis of midtarsal ligament tears may lead to chronic pain and functional disability, an in-depth knowledge of the complex regional anatomy and of the appropriate ultrasound scanning technique is a prerequisite for evaluating these structures and avoiding misdiagnoses. The objective of this article is twofold: to describe the relevant anatomy and biomechanics related to the ligaments that stabilize the subtalar, talocalcaneonavicular, and calcaneocuboid joints, and to illustrate reasoned landmark-based scanning techniques to provide a systematic examination of these ligaments and thus make ultrasound an effective tool for assessment of patients with suspected subtalar or midtarsal sprain.

Keywords

calcaneocuboid joint ligaments - inferior extensor retinaculum - subtalar joint ligaments - talocalcaneonavicular joint ligaments - ultrasound

• References

• 1 Taser F, Shafiq Q, Ebraheim NA. Anatomy of lateral ankle ligaments and their relationship to bony landmarks. Surg Radiol Anat 2006; 28 (04) 391-397
• 2 Mann RA. Functional anatomy of the ankle joint ligaments. Instr Course Lect 1987; 36: 161-170
• 3 Linklater J, Hayter CL, Vu D, Tse K. Anatomy of the subtalar joint and imaging of talo-calcaneal coalition. Skeletal Radiol 2009; 38 (05) 437-449
• 4 Mittlmeier T, Wichelhaus A. Subtalar joint instability. Eur J Trauma Emerg Surg 2015; 41 (06) 623-629
• 5 Karlsson J, Eriksson BI, Renström PA. Subtalar ankle instability. A review. Sports Med 1997; 24 (05) 337-346
• 6 Aynardi M, Pedowitz DI, Raikin SM. Subtalar instability. Foot Ankle Clin 2015; 20 (02) 243-252
• 7 Meyer JM, Garcia J, Hoffmeyer P, Fritschy D. The subtalar sprain. A roentgenographic study. Clin Orthop Relat Res 1988; (226) 169-173
• 8 Benirschke SK, Meinberg E, Anderson SA, Jones CB, Cole PA. Fractures and dislocations of the midfoot: Lisfranc and Chopart injuries. J Bone Joint Surg Am 2012; 94 (14) 1325-1337
• 9 Baker JC, Hoover EG, Hillen TJ, Smith MV, Wright RW, Rubin DA. Subradiographic foot and ankle fractures and bone contusions detected by MRI in elite ice hockey players. Am J Sports Med 2016; 44 (05) 1317-1323
• 10 Kutaish H, Stern R, Drittenbass L, Assal M. Injuries to the Chopart joint complex: a current review. Eur J Orthop Surg Traumatol 2017; 27 (04) 425-431
• 11 Ludolph E, Hierholzer G, Gretenkord K, Ryan U. Research into the anatomy and X-ray diagnostics of the fibular ligaments at the ankle joint. Arch Orthop Trauma Surg 1984; 103 (05) 348-352
• 12 Søndergaard L, Konradsen L, Hølmer P, Jørgensen LN, Nielsen PT. Acute midtarsal sprains: frequency and course of recovery. Foot Ankle Int 1996; 17 (04) 195-199
• 13 Durall CJ. Examination and treatment of cuboid syndrome: a literature review. Sports Health 2011; 3 (06) 514-519
• 14 Walter WR, Hirschmann A, Alaia EF, Garwood ER, Rosenberg ZS. MRI evaluation of midtarsal (Chopart) sprain in the setting of acute ankle injury. AJR Am J Roentgenol 2018; 210 (02) 386-395
• 15 Lee SH, Jacobson J, Trudell D, Resnick D. Ligaments of the ankle: normal anatomy with MR arthrography. J Comput Assist Tomogr 1998; 22 (05) 807-813
• 16 Klauser AS, Tagliafico A, Allen GM. , et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. Eur Radiol 2012; 22 (05) 1140-1148
• 17 Aliprandi A, Sconfienza LM, Randelli F, Bandirali M, Di Leo G, Sardanelli F. Magnetic resonance imaging of painful total hip replacement: detection and characterisation of periprosthetic fluid collection and interobserver reproducibility. Radiol Med (Torino) 2012; 117 (01) 85-95
• 18 Martinoli C, Bianchi S. Ankle. In: Bianchi S, Martinoli C. , eds. Ultrasound of the Musculoskeletal System. Heidelberg, Germany: Springer; 2009: 773-834
• 19 Sizer Jr PS, Phelps V, James R, Matthijs O. Diagnosis and management of the painful ankle/foot part 1: clinical anatomy and pathomechanics. Pain Pract 2003; 3 (03) 238-262
• 20 Epeldegui T, Delgado E. Acetabulum pedis. Part I: Talocalcaneonavicular joint socket in normal foot. J Pediatr Orthop B 1995; 4 (01) 1-10
• 21 Seringe R, Wicart P. ; French Society of Pediatric Orthopaedics. The talonavicular and subtalar joints: the “calcaneopedal unit” concept. Orthop Traumatol Surg Res 2013; 99 (06) S345-S355
• 22 Leardini A, Stagni R, O'Connor JJ. Mobility of the subtalar joint in the intact ankle complex. J Biomech 2001; 34 (06) 805-809
• 23 Kelikian AS. , ed. Sarrafian's Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011: 556-562
• 24 Bonnel F, Teissier P, Maestro M, Ferré B, Toullec E. ; AFCP. Biometry of bone components in the talonavicular joint: a cadaver study. Orthop Traumatol Surg Res 2011; 97 (06) S66-S73
• 25 Bonnel F, Teissier P, Colombier JA, Toullec E, Assi C. Biometry of the calcaneocuboid joint: biomechanical implications. Foot Ankle Surg 2013; 19 (02) 70-75
• 26 Golanó P, Vega J, de Leeuw PAJ. , et al. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 2010; 18 (05) 557-569
• 27 Stella SM, Ciampi B, Orsitto E, Melchiorre D, Lippolis PV. Sonographic visibility of the sinus tarsi with a 12 MHz transducer. J Ultrasound 2014; 19 (02) 107-113
• 28 Entrekin RR, Porter BA, Sillesen HH, Wong AD, Cooperberg PL, Fix CH. Real-time spatial compound imaging: application to breast, vascular, and musculoskeletal ultrasound. Semin Ultrasound CT MR 2001; 22 (01) 50-64
• 29 Jotoku T, Kinoshita M, Okuda R, Abe M. Anatomy of ligamentous structures in the tarsal sinus and canal. Foot Ankle Int 2006; 27 (07) 533-538
• 30 Cahill DR. The anatomy and function of the contents of the human tarsal sinus and canal. Anat Rec 1965; 153 (01) 1-17
• 31 Lektrakul N, Chung CB, Lai Ym. , et al. Tarsal sinus: arthrographic, MR imaging, MR arthrographic, and pathologic findings in cadavers and retrospective study data in patients with sinus tarsi syndrome. Radiology 2001; 219 (03) 802-810
• 32 Helgeson K. Examination and intervention for sinus tarsi syndrome. N Am J Sports Phys Ther 2009; 4 (01) 29-37
• 33 Stoller DW, Ferkel RD. The ankle and foot. In: Stoller DW. , ed. Magnetic Resonance Imaging in Orthopaedics and Sports Medicine. Vol 1, 3rd ed. Baltimore, MD: Lippincott William & Wilkins; 2007: 931-943
• 34 Yamaguchi R, Nimura A, Amaha K. , et al. Anatomy of the tarsal canal and sinus in relation to the subtalar joint capsule. Foot Ankle Int 2018; 39 (11) 1360-1369
• 35 Kim TH, Moon SG, Jung HG, Kim NR. Subtalar instability: imaging features of subtalar ligaments on 3D isotropic ankle MRI. BMC Musculoskelet Disord 2017; 18 (01) 475
• 36 Huson A. Ein Ontleedkundig-Functioneel Onderzoek van de Voetwortel [An anatomical and functional study of the tarsal joint]. Leiden, Netherlands: Drukkerij; 1961
• 37 Testut L, Latarjet A. Trattato di anatomia umana [Textbook of Human Anatomy]. Vol 1, 5th ed. Torino, Italy: UTET; 1975: 246-253
• 38 Kjaersgaard-Andersen P, Wethelund JO, Helmig P, Søballe K. The stabilizing effect of the ligamentous structures in the sinus and canalis tarsi on movements in the hindfoot. An experimental study. Am J Sports Med 1988; 16 (05) 512-516
• 39 Tochigi Y, Amendola A, Rudert MJ. , et al. The role of the interosseous talocalcaneal ligament in subtalar joint stability. Foot Ankle Int 2004; 25 (08) 588-596
• 40 Fantino O, Borne J, Bordet B, Posont A. Echographie de l'espace talocalcanée: actualité en échographie de l'appareil locomoteur [Ultrasound of the talocalcaneal space: musculoskeletal ultrasound update]. In: Brasseur JL, Bercy F, Monzani Q, Fustier A, Billard AS. , eds. Actualités en échographie de l'appareil locomoteur [Musculoskeletal Ultrasound Update]. Vol 16. Montpellier, France: Sauramps Médical; 2019: 133-151
• 41 Saltzman C, Marsh JL. Hindfoot dislocations: when are they not benign?. J Am Acad Orthop Surg 1997; 5 (04) 192-198
• 42 Lasanianos NG, Lyras DN, Mouzopoulos G, Tsutseos N, Garnavos C. Early mobilization after uncomplicated medial subtalar dislocation provides successful functional results. J Orthop Traumatol 2011; 12 (01) 37-43
• 43 Zimmer TJ, Johnson KA. Subtalar dislocations. Clin Orthop Relat Res 1989; (238) 190-194
• 44 Grantham SA. Medical subtalar dislocation: five cases with a common etiology. J Trauma 1964; 4: 845-849
• 45 Melão L, Canella C, Weber M, Negrão P, Trudell D, Resnick D. Ligaments of the transverse tarsal joint complex: MRI-anatomic correlation in cadavers. AJR Am J Roentgenol 2009; 193 (03) 662-671
• 46 Tafur M, Rosenberg ZS, Bencardino JT. MR imaging of the midfoot including Chopart and Lisfranc joint complexes. Magn Reson Imaging Clin N Am 2017; 25 (01) 95-125
• 47 De Dea M, , L Loizou C, Allen GM. , et al. Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function. Br J Radiol 2017; 90 (1071): 20160816
• 48 Dorn-Lange NV, Nauck T, Lohrer H, Arentz S, Konerding MA. Morphology of the dorsal and lateral calcaneocuboid ligaments. Foot Ankle Int 2008; 29 (09) 942-949
• 49 Hermel MB, Gershon-Cohen J. The nutcracker fracture of the cuboid by indirect violence. Radiology 1953; 60 (06) 850-854
• 50 Czajka CM, Tran E, Cai AN, DiPreta JA. Ankle sprains and instability. Med Clin North Am 2014; 98 (02) 313-329
• 51 Main BJ, Jowett RL. Injuries of the midtarsal joint. J Bone Joint Surg Br 1975; 57 (01) 89-97
• 52 Acevedo J, Vora A. Anatomical reconstruction of the spring ligament complex: “internal brace” augmentation. Foot Ankle Spec 2013; 6 (06) 441-445
• 53 Gazdag AR, Cracchiolo III A. Rupture of the posterior tibial tendon. Evaluation of injury of the spring ligament and clinical assessment of tendon transfer and ligament repair. J Bone Joint Surg Am 1997; 79 (05) 675-681
• 54 Mengiardi B, Zanetti M, Schöttle PB. , et al. Spring ligament complex: MR imaging-anatomic correlation and findings in asymptomatic subjects. Radiology 2005; 237 (01) 242-249
• 55 Toye LR, Helms CA, Hoffman BD, Easley M, Nunley JA. MRI of spring ligament tears. AJR Am J Roentgenol 2005; 184 (05) 1475-1480
• 56 Lee SW, Kim DD, Buskanets A, Oh-Park M. Mid-tarsal sprain misdiagnosed as ankle sprain: role of ultrasonography in diagnosis. Am J Phys Med Rehabil 2016; 95 (03) e44-e45
• 57 Zwipp H, Rammelt S, Grass R. Ligamentous injuries about the ankle and subtalar joints. Clin Podiatr Med Surg 2002; 19 (02) 195-229 , v
• 58 Andermahr J, Helling HJ, Maintz D, Mönig S, Koebke J, Rehm KE. The injury of the calcaneocuboid ligaments. Foot Ankle Int 2000; 21 (05) 379-384