ARRS 2022 Abstracts


E1056. Pre- and Post-Operative Imaging of Common Midfoot/Hindfoot Abnormalities
  1. Alvaro Bravo-Martinez; Stony Brook Medicine
  2. Elaine Gould; Stony Brook Medicine
  3. Max Hao; Stony Brook Medicine
  4. Kathleen Finzel; Stony Brook Medicine
  5. Martin Bernard; Stony Brook Medicine
  6. Daichi Hayashi; Stony Brook Medicine
The midfoot and hindfoot have a biomechanically complex anatomy that makes them susceptible to an array of pathologic conditions, both traumatic and degenerative. Commonly encountered entities include plantar fasciitis, Achilles tendon tear, peroneal tendinosis, Lisfranc injury, and foot deformities such as pes planovalgus and pes cavovarus. Many of these injuries can lead to chronic pain, instability, and ultimately early osteoarthrosis. For this reason, a great variety of surgical procedures exist to repair the underlying complex soft tissue and osseous pathologies in the midfoot and hindfoot. Radiographs are the modality of choice to evaluate the general postoperative appearance, offering an overview of the original injury, surgical correction, and osseous or hardware complications. Advanced imaging such as CT and MRI provide a better assessment of the anatomy and are also helpful in the evaluation of any suspected complication. Therefore, the radiologist must have a clear understanding of underlying pathologic processes, surgical techniques, and expected evolution of postoperative findings. The aim of this exhibit is to illustrate the most common pathologic processes and their respective corrective surgeries in the midfoot and hindfoot, by comparing their preoperative and postoperative imaging appearance. Relevant intra-operative images are also included for surgical-radiological correlation.

Educational Goals / Teaching Points
Goals include reviewing the imaging appearance of the most common pathological entities encountered in the midfoot and hindfoot; familiarizing radiologists with the post-operative imaging appearance of the corrective surgeries for each pathologic condition; and correlating intra-operative images with the pre-operative and post-operative imaging features.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit includes overview of midfoot and hindfoot pathologic conditions (prevalence, clinical presentation and essential diagnostic imaging findings); pictorial surgical-radiological correlation to better understand the underlying pathologic process and corrective surgery; and pictorial review of different preoperative and postoperative images of a variety of midfoot and hindfoot procedures (Kidner procedure, calcaneal slide osteotomy, Broström procedure, Lisfranc arthrodesis, Achilles tendon repair, flexor digitorum longus tendon transfer, and plantar fascial release).

Reparative and reconstructive interventions around midfoot and hindfoot have become more prevalent, given the emerging focus on joint preservation by the increasing demands among athletes. Thus, thorough knowledge of the radiological signs of pathologic conditions involving the midfoot and hindfoot may help clinicians choose appropriate corrective surgeries for patients. The large number of surgical techniques can present a confounding picture to the radiologist who is unfamiliar with their postoperative imaging appearance. Thus, having a solid understanding of these typical procedures and being able to recognize hardware, postoperative changes and possible complications is critical for accurate imaging interpretation.