MR IMAGING OF TENDON ABNORMALITIES OF THE FOOT AND ANKLE

Prediction of clinical response to corticosteroid or platelet-rich plasma injection in plantar fasciitis with MRI: A prospective, randomized, double-blinded study

PURPOSE

The purpose of this study was to identify association between magnetic resonance imaging (MRI) features and clinical data at baseline and six months following platelet-rich plasma (PRP) or corticosteroid (CS; cortivazol) injection in patients with plantar fasciitis, and to identify initial MRI criteria associated with a favorable clinical response to treatment.

MATERIAL AND METHODS

The study was registered on ClinicalTrials.gov (NCT03857334). MRI examinations of 36 patients with plantar fasciitis lasting more than 3 months who were randomly assigned to receive ultrasound-guided PRP (PRP group, 20 patients) or CS (CS group, 18 patients) injection were quantitatively and qualitatively analyzed with respect to plantar fascia thickness, plantar fascia hyperintensity on T2-weighted STIR (HSTIR) images, calcaneal bone marrow and surrounding soft tissues. Clinical evaluation including visual analytic scale (VAS) assessment and MRI examinations were obtained before and 6 months after treatment. Good clinical response was defined as pain VAS decrease > 50% at 6 months. ROC curves with AUC measurements were used to determine cut-off points.

RESULTS

In the whole study population, an association was found between MRI features (deep soft tissue and calcaneal bone marrow HSTIR) and pain VAS scores for the first steps of the day (P = 0.028 and P = 0.007, respectively). No significant radioclinical associations on post-treatment MRI examinations were found in either group. Initial coronal thickness of plantar fascia was associated with a good clinical response in the CS group (P < 0.01). ROC curve analysis found that 7-mm or thicker plantar aponeurosis at initial MRI was predictive of good clinical response in patients with CS treatment (Youden index = 0.6). PRP infiltrations were effective regardless of fascia thickness (73% of patients with ≤ 7 mm aponeurosis and 67% for thicker ones).

CONCLUSION

Initial facia thickness (> 7 mm) is predictive of good clinical response six months after CS injection, whereas PRP injection shows effectiveness regardless of fascia thickness.

Sonographic and radiographic findings of posterior tibial tendon dysfunction: a practical step forward

The purpose of this article is to describe the sonographic and radiographic findings in the diagnosis and treatment of posterior tibial tendon dysfunction. Ultrasound and radiographs play a crucial role in the diagnosis of posterior tibial tendon dysfunction and in imaging the postoperative changes related to posterior tibial tendon dysfunction. Early detection and diagnosis of posterior tibial tendon dysfunction is important in helping to prevent further progression of disease, obviating the need for more invasive and complex procedures.

Tarsal tunnel disease and talocalcaneal coalition: MRI features

OBJECTIVE

To assess, utilizing MRI, tarsal tunnel disease in patients with talocalcaneal coalitions. To the best of our knowledge, this has only anecdotally been described before.

MATERIALS AND METHODS

Sixty-seven ankle MRIs with talocalcaneal coalition were retrospectively reviewed for disease of tendons and nerves of the tarsal tunnel. Interobserver variability in diagnosing tendon disease was performed in 30 of the 67 cases. Tarsal tunnel nerves were also evaluated in a control group of 20 consecutive ankle MRIs.

RESULTS

Entrapment of the flexor hallucis longus tendon (FHL) by osseous excrescences was seen in 14 of 67 cases (21 %). Attenuation, split tearing, tenosynovitis, or tendinosis of the FHL was present in 26 cases (39 %). Attenuation or tenosynovitis was seen in the flexor digitorum longus tendon (FDL) in 18 cases (27 %). Tenosynovitis or split tearing of the posterior tibial tendon (PT) was present in nine cases (13 %). Interobserver variability ranged from 100 % to slight depending on the tendon and type of disease. Intense increased signal and caliber of the medial plantar nerve (MPN), indicative of neuritis, was seen in 6 of the 67 cases (9 %). Mildly increased T2 signal of the MPN was seen in 15 (22 %) and in 14 (70 %) of the control group.

CONCLUSIONS

Talocalcaneal coalitions may be associated with tarsal tunnel soft tissue abnormalities affecting, in decreasing order, the FHL, FDL, and PT tendons, as well as the MPN. This information should be provided to the referring physician in order to guide treatment and improve post-surgical outcome.

Magnetic Resonance Imaging of Sports Injuries Involving the Ankle

Understanding of ankle injuries has evolved for the past few decades, influenced by capability to visualize ligaments, tendons, and bone marrow on magnetic resonance imaging (MRI). Natural history of injury progression, complications, and healing has also been characterized using MRI. Stress injury is particularly common at the ankle in athletes and "weekend warriors" alike. This article will discuss manifestations of ankle injury on MRI as well as associated findings that should be addressed.

Tendon and ligament imaging

MRI and ultrasound are now widely used for the assessment of tendon and ligament abnormalities. Healthy tendons and ligaments contain high levels of collagen with a structured orientation, which gives rise to their characteristic normal imaging appearances as well as causing particular imaging artefacts. Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings. Novel imaging techniques are being developed that may improve the ability of MRI and ultrasound to assess tendon and ligament disease.

[Ultrasonography of the tendons: from image to pathology]

Radiology allows to define etiologies of tendon injuries and authorize a most suitable treatment. For that reason, the use of the sonography has been developed from several years and has four main purposes to define the type of injury and to orient the treatment: to confirm the real existence of the tendon tear, to need the exact location the same one, to determine the gravity of the lesion, and finally, to evaluate its acute or chronic character. In this paper, we will try to define the normal pattern of the tendon and describe the more frequent lesions of the shoulder or the ankle: complete or partial tear, tendinopathy, dislocation and enthesopathy.

Imaging of the Achilles tendon

The Achilles tendon is the most commonly injured tendon in the foot and ankle; injuries commonly are related to sports/athletic activities. Imaging modalities that are used most commonly in the diagnostic assessment of the Achilles tendon include conventional radiography, ultrasonography, and MRI. This article reviews the normal and pathologic imaging features of the Achilles tendon, and highlights the potential usefulness and limitations of various imaging techniques in the noninvasive assessment of the tendon and the potential impact of imaging findings on clinical patient care.

Pictorial review: MRI features of foot and ankle injuries in ballet dancers

Foot and ankle pain is common in ballet dancers. Although clinical examination often points to the underlying cause, imaging is often necessary to confirm the diagnosis and thus ensure appropriate future management. Factors predisposing to the increased incidence of injuries in this population include the classical position in which ballet dancers stand, which is on the tips of the toes in the en pointe position or on the balls of the feet in the demi-pointe position. Furthermore, the repetitious nature of ballet and the long hours spent rehearsing cause over-use injuries. The causes of foot and ankle pain can be thought of in four different groups: the impingement syndromes; tendon abnormalities; osseous pathology; and ligament abnormalities. These will be discussed and illustrated.