Long Plantar Ligament Sprain

Ankle MRI Approach

http://www.raddaily.com/whitepaperarticle.php?articleTitle=Ankle+MRI+Approach

Calcaneal Osteomyelitis

Pearls from Stoller Macau April 2011 - 4. Ankle

1. NB: anterior process talus; lateral process calcaneus (snowboarders)
2. Subtalar joint - anterior, middle, posterior facets
3. Lateral gutter -- a 3D space between AITFL/PITFL and ATFL/PTFL
4. Posterior ankle ligaments - Transverse Tib-Fib Lig, PITFL, Tibial Slip, PTFL
5. Anterolateral impingement (soft tissue related to antero-lat gutter) vs Ant. impingement (bony)
6. Soft Tissue Impingement
• Anterolateral (ATFL and  AITFL related to partial or completer tear)
• Syndesmotic
• Posterior (PTFL -- myxoid)
7. Spring (Calcaneonavicular ligament)
• Lateral/Intermediate/Superomedial
• Axial - int. and lat.; slice up - superomedial
• Coronal - next to TP
8. POP Syndrome
• # or displacement of Os peroneum
• Ass. Peroneus Longus Tear
9. Tarsal Tunnel Syndrome
• Post. Tibial N. compression
10. 4 Plantar Muscles -  (Med) Ab. Hallucis, Fl. Dig. Brevis, Quadratus Plantae, Ab. Digiti Minimi
11. Subtalar ligaments
• subtalar interosseus - medial (coronal)
• cervical - lateral and anterior (coronal and sag)
• intermediate root extensor retinaculum - post. to cervical (sag)
12. OLT Stages
13. Tennis Leg - ruptured crura; fascia

Os Peroneum Fracture

Haglund's Syndrome

Salter Harris I

Lateral and Medial Ankle Ligaments

Lateral Ligaments

Deltoid Ligament Complex 

Deep Components (2)

1. ATTL -- attached to anterior colliculus of MM - thin

2. PTTL -- attached to posterior colliculus of MM (fan shaped, striated(cf AITFL), lower 2/3's often bright)

Superficial Components (3)

1. TNavL

2. TSpringL - most important - coronal plane best

3. TCalcL

All blend with Superomedial component of Spring Ligament

Spring (Calcaneonavicular) Ligament

3 Components:

1. Superomedial CNL - most important -- abN if >5mm

2. Medioplantar oblique

3. Inferopalntar longitudinal - as thick as little finger

Periosteal apposition -- new periosteal bone superficial to cortex. Sign of chronic injury. Best on axial. With or without ossicles

References (Radsource):

1. http://www.radsource.us/clinic/1301

2. http://www.radsource.us/clinic/0801

3. http://www.radsource.us/clinic/0308

4. http://www.radsource.us/clinic/1007

Rheumatoid Ankle

Haglund's Deformity and Syndrome

BPNST -- deep peroneal (fibular) nerve

+C

Peroneus Quartus

Peroneus quartus muscle and tendon.

Prevalence: 12-22%

Originates at the distal lateral portion of the fibula and descends medial and posterior to the peroneal tendons.

Insertion is variable and includes the retrotrochlear eminence of the calcaneus, the phalanx or the metatarsal bone of the fifth toe, the peroneal tendons, the lateral retinaculum of the ankle, and the cuboid bone.

Also: incidental Achilles Tendinosis

POPS (Painful Os Peroneum Syndrome) ;Os Peroneum Stress Reaction with associated PL Tendinopathy and tenosynovitis

30 year old male. Lateral ankle symptoms.