ARRS 2022 Abstracts

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E2031. Going to be an Easy Walk: Trainee’s Guide to Magnetic Resonance Imaging Evaluation of Foot Pathology
Authors
  1. V. Dhanalakshmi; Stanley Medical College
  2. Sakthimeena Ramanathan; Stanley Medical College
  3. V. Ramalakshmi; Stanley Medical College
  4. C. Amarnath ; Stanley Medical College
  5. Murali Logudoss; Fortis Hospital
  6. Anand Parimalai; Fortis Hospital
Background
MRI of the foot is increasingly utilized as foot diseases are disabling and inhibit patients’ day to day activities. MRI provides an opportunity for early as well as accurate diagnosis and helps in patients management.

Educational Goals / Teaching Points
The goals of this exhibit are as follows. Discuss normal MRI anatomy of foot essential for diagnosis of various osseous and soft tissue pathology and classification of foot diseases into forefoot, midfoot, and hindfoot pathology based on the location. We will review imaging features of various foot pathologies including Morton’s neuroma, sesamoiditis, plantar fasciitis, stress fractures, Freiberg’s disease, Kohler’s disease, calcaneal apophysitis (Severs disease), maduramycosis, osteomyelitis, tenosynovitis, bursitis, Achilles xanthoma, other abnormalities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Foot pathology can be classified into forefoot, midfoot and hindfoot diseases based on their location. Forefoot pathology includes stress fracture, Freiberg, arthritis like gout, plantar plate disruption, sesamoiditis, tenosynovitis, bursitis, and Morton neuroma. Midfoot pathology includes diseases involving the navicular, cuneiform, cuboid, and lisfranc joint like charcots arthritis and Kohlers disease. Hindfoot pathology includes calcaneal pathology (calcaneal stress fracture, apophysitis), plantar fascitis, tarsal tunnel syndrome, Achilles tendinitis and tear, bursae (retrocalcaneal and retroachilis bursitis), and haglung deformity. Kohler’s disease is spontaneous osteochondrosis of the navicular bone in childhood. In adults it is called Mueller Weiss syndrome. Radiography shows navicular sclerosis and fragmentation/collapse. MRI shows bone marrow edema. It is usually self-limiting. Sesamoiditis is inflammation of sesamoids usually resulting from repetitive stress. MRI shows bone marrow oedema and associated reactive changes in adjacent soft tissues. Freiberg disease isosteochondrosis of metatarsal heads, typically the 2nd metatarsal. MRI shows hyperintense signals initially. As the disease progresses, flattening of the heads with T2 hypointense signals develop, signifying bone sclerosis. Morton’s neuroma is due to mechanical compression of the intermetatarsal nerve against transverse metatarsal ligament causing nerve swelling and fibrosis. There are different names for 1st web space (Heuter neuroma) and 4th metatarsal space (Iselin neuroma). MRI shows ovoid-shaped soft tissue mass in intermetatarsal space, isointense on T1, low to intermediate signal on T2 images. Severs disease is calcaneal apophysitis or avascular necrosis involving unossified apophysis. MRI shows edema involving calcaneal apophysis and in adjacent soft tissue structures.

Conclusion
MRI plays a role in the evaluation of foot diseases to aid in arriving at an early and accurate diagnosis. Residents should be aware of relevant foot anatomy and imaging features of various foot diseases, thus helping in patient management.