Imaging Evaluation of Chronic Ankle and Hindfoot Pain in Athletes
Section snippets
Occult Fractures
The sports clinician's differential diagnosis for osseous pathology in these patients includes occult traumatic fractures of the tibial plafond, the lateral and posterior processes of the talus, the anterior process of the calcaneus, and the base of the fifth metatarsal. These fractures may be very difficult to detect on the initial radiographs and may be overlooked during the initial evaluation. If the clinical and imaging differential is limited to occult fracture, high-resolution,
Osteochondral injuries
Posttraumatic chondral or osteochondral injuries of the talar dome, otherwise known as an “osteochondral lesion of the talus” (OLT), may be radiographically occult and may present with persistent vague ankle pain in athletes. An OLT also may coexist with other osseous and soft tissue pathology. Brown and colleagues28 demonstrated the presence of osteochondral lesions in 28% of 59 patients who had distal tibiofibular syndesmotic injuries documented by MR imaging. Traumatic torsional forces
Ligament Injuries
The clinical differential diagnosis for soft tissue injuries in sports participants who have chronic ankle and hindfoot pain despite negative radiographs and appropriate conservative management includes complex ligamentous injuries, such as syndesmotic sprains, deltoid ligament injury, and multiple ligament instability; impingement syndromes; and sinus tarsi syndrome.
Routine lateral ankle sprains do not require advanced imaging, except in professional athletes, who may require immediate imaging
Summary
Persistent ankle and hindfoot pain in athletes who do not respond to conservative management may be attributed to many different clinical diagnoses including soft tissue, chondral, or osseous pathology that is not immediately apparent at the time of initial clinical evaluation and imaging. Subsequent imaging evaluation should begin with repeat conventional radiographs looking for occult traumatic fractures, osteochondral injuries, loose bodies, osteophytes, accessory ossicles, and periarticular
References (64)
Epidemiologic perspective
Clin Sports Med
(1982)- et al.
Tibiofibular syndesmosis and ossification. Case report: sequelae of ankle sprain in an adolescent football player
J Emerg Med
(2000) - et al.
Problematic fractures and dislocations in the foot and ankle of athletes
Clin Sports Med
(1990) - et al.
Iselin's disease: a case presentation of nonunion and review of the differential diagnosis
J Foot Ankle Surg
(1999) - et al.
Imaging of stress fractures in the athlete
Radiol Clin North Am
(2002) - et al.
Magnetic resonance imaging of pediatric disorders of the ankle and foot
Magn Reson Imaging Clin N Am
(1994) - et al.
Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation
Arthroscopy
(2003) - et al.
Imaging sports injuries of the foot and ankle
Magn Reson Imaging Clin N Am
(2003) Foot, ankle and calf
- et al.
Ankle sprains in young athletes. Relation of severity and disability
Clin Orthop Relat Res
(1974)
Persistent disability associated with ankle sprains: a prospective examination of an athletic population
Foot Ankle Int
The ankle ligaments: consideration of syndesmotic injury and implications for rehabilitation
J Orthop Sports Phys Ther
Syndesmosis sprains of the ankle
Foot Ankle
Ankle lesions
Acta Orthop Scand
Syndesmotic ankle sprains
Am J Sports Med
Osteochondral lesions of the talus
Am J Sports Med
MR contrast arthrography (MRA) in osteochondrosis dissecans
J Comput Assist Tomogr
Anteromedial impingement of the ankle: using MR arthrography to assess the anteromedial recess
AJR Am J Roentgenol
Indirect MR arthrography: optimization and clinical applications
Radiology
Snowboarder's talus fracture: treatment outcome of 20 cases after 3.5 years
Am J Sports Med
Injuries among competitive snowboarders at the national elite level
Am J Sports Med
Iselin's disease
J Pediatr Orthop
Wheeless' textbook of orthopaedics
Posterior ankle impingement syndrome: MR imaging findings in seven patients
Radiology
Magnetic resonance imaging of sports injuries of the ankle
Top Magn Reson Imaging
Tibialis posterior tendon abnormalities in feet with accessory navicular bone and flatfoot
Acta Orthop Scand
The symptomatic accessory tarsal navicular bone: assessment with MR imaging
Radiology
The relative incidence of tarsal coalition
Clin Orthop Relat Res
“Absent middle facet”: a sign on unenhanced radiography of subtalar joint coalition
AJR Am J Roentgenol
MRI findings associated with distal tibiofibular syndesmosis injury
AJR Am J Roentgenol
Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions
Foot Ankle
Osteochondral lesions of the talus
J Bone Joint Surg Am
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