Foot and Ankle Imaging

 

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One evening, while sitting in front of the blank screen of my home computer wondering what to write for this preface, I was interrupted by my 3-year-old son who wanted me to read him a bedtime book. By a strange coincidence, the book he had chosen was The Foot Book by Dr. Seuss, and as I read to him, I was struck by the sentence ``Oh, how many feet you meet.''

We radiologists certainly do encounter all kinds of feet, but it is the painful foot that we encounter most often. In this issue, a group of well-known radiologists from around the country discuss various topics dealing with the painful foot and ankle.

Drs. Yu and Tanner begin with an overview of the different causes of forefoot pain, such as plantar plate injury, stress fracture, and osteonecrosis, followed by Dr. Theodorou and colleagues discussing abnormalities of the plantar fascia. As we move into the hindfoot and ankle, Dr. Tuite reviews injuries of the tendons, and Dr. Umans outlines impingement syndromes. Dr. Gentili et al. discuss the many soft-tissue masses that can occur in the foot, of which some are painful, and I review some commonly occurring bony variants that can be painful.

Plain radiography is the first step in any imaging evaluation, and in some cases is the only modality needed; however, MRI has become the workhorse of musculoskeletal imaging, complemented by CT scanning and sonography. Sonography is slowly making its way into the armamentarium of the musculoskeletal radiologist; it is wonderful for the focused evaluation of a specific clinical question, such as whether a mass is present and if so, whether it is cystic or solid, whether a tendon or ligament is ruptured, whether the plantar fascia is abnormal, and for guiding therapy.

We conclude with a chapter by Drs. Sofka and Adler on sonographically-guided interventions in the foot and ankle. After six chapters which describe various painful conditions, this final chapter provides an overview of some of the therapeutic procedures that we can offer clinicians to help treat their patients. Sonography can provide real-time guidance for placing a needle into an inflamed tendon sheath, adjacent to an impinged ligament, and into a gangion cyst.

I hope that orthopedic surgeons, podiatrists, and many other clinicians who treat conditions of the foot will also find this issue of Seminars in Musculoskeletal Radiology useful and informative. His feet, her feet, trick feet, sick feet, how very many feet we meet.