Role of magnetic resonance imaging in the diagnosis of ankle impingement El-Zawawi MS, Ebied OM, Abdou Sileema ER Menoufia Med J


There are relatively few MRI studies involving STI and subtalar ligaments. Previous cadaver studies and MRI studies in asymptomatic models have described normal appearances of subtalar ligaments. According to a pediatric study using 3D isotropic proton density MRI , ITCL was striated in appearance wet mop haircut in all study population with distinct fascicular bundles. Three roots of the IER were distinguishable in all study populations. CL, ITCL, and IER were well visualized in 3D isotropic proton density MRI. Each ligament had a unique orientation and dimensions with certain variations.

In agreement with the findings of Lambert et al. , tarsal tunnel syndrome is a compressive neuropathy of the tibial nerve with multiple causes. This syndrome is difficult to diagnose and can be missed because of its subjective symptomatology. MRI can provide supplementary information to the electromyography and contribute to positive and etiologic diagnosis of peripheral nerve lesions. Ankle impingement is defined as a painful mechanical limitation of full ankle range of motion secondary to an osseous or soft-tissue abnormality ,. Non-surgical management includes control of pain and inflammation with analgesics, an inflammatory medication and steroid injections into the sinus tarsi with about 90% improved with this treatment.

Absence or complete tear of the ACL was significantly more common in the STI patient group compared to that in the control group. In the control group, the prevalence of ACL was 91.3%, consistent with previously reported prevalence range of ACL . Ligament dimensions were measured in the plane that best represented the structure. For ACL, thickness and width were measured on sagittal and axial isotropic 3D T2 weighted images, respectively (Fig.3).

Contrast enhancement is useful in identifying hypertrophied synovium but is non-specific. MRI of the left ankle revealed effacement of the normal fat in the tarsal canal and sinus tarsi at the level of the subtalar joint with loss of definition of the sinus tarsi ligaments. Hypointensity on T1W and ill defined hyperintensity on T2W images was noted in the sinus tarsi. Post contrast images revealed minimal enhancement in the sinus tarsi. Degenerative changes were noted in the inferior talus and superior calcaneus with subchondral cysts.

At the insertion on the medial malleolus, it blends with the periosteum of the medial malleolus and the flexor retinaculum. When it is injured, there has to be injury to the other lateral ligaments. The patient on the left has subtle edema around the ATFL-ligament, while the ligament itself looks normal.

Athletes needing to perform pivoting or cutting maneuvers can begin these activities at a slow speed maintaining good alignment of the foot and leg and avoiding excessive motions through the rearfoot. Operative treatment is also very effective in most cases, but needs to be considered as a last resort if conservative treatment fails.

In posterior ankle impingement syndrome, the posterior talus and adjacent soft tissues are compressed between the tibia and calcaneus. 52 year-old female with direct trauma to the left foot 2 days ago. The cervical ligament is thickened and increased in signal with surrounding soft tissue edema on sagittal T1-weighted , sagittal fast spin-echo T2-weighted , and coronal fat suppressed fast spin-echo T2-weighted images.

Case 3- Normal anatomy of the sinus tarsi ligaments in a 39 year-old female. Coronal and axial T1-weighted images through the tarsal canal and sinus tarsi visualize most of the interosseous talocalcaneal ligament on single slices. The cervical ligament is visible anterior to the roots of the inferior extensor retinaculum on Images 5G through 5I.

CT is superior to MRI in detection of cortical fractures, in particular small fracture fragments, while MRI has the greatest advantage in evaluation soft-tissue and ligamentous injuries and bone contusions . Abnormalities of ITCL, CL, and IER characterized by complete or partial tear were not significantly different between the two groups. In most subjects of both groups, the CL was observed in the shape of a fan or band. In the control group, the CL was best visualized in the coronal plane with 100% rate of detection, similar to the detection rate previously reported in normal pediatric population . Three roots of the IER were distinguished in all subjects except two in the present study. The medial root penetrated the tarsal sinus and blended with fibers of the ITCL to form a common insertion.