1. Ankle and foot
Saggital slice mri

2. Standard Ankle Series
AP Ankle
Medial Oblique Ankle
Lateral Ankle

3. AP Ankle Projection requires 5o of internal rotation and dorsiflexion
Without internal rotation, overlap of structures

4. Medial Oblique Ankle
Requires approximately 15-30° of internal rotation

5. Lateral Ankle Achilles tendon
Kager’s Triangle - the fat pad anterior to the Achilles

6. Accessory Views of the Ankle
Inversion and Eversion Stress views
Inversion stress view

7. Lateral collateral ligament sprain in a 13 y/o girl.

9. Sprain of lateral collateral ligaments in 31 y/o actress.

12. Sprain of lateral collateral ligaments in a 20 y/o woman.

14. Normal Variants of the Ankle

15. Talar Beak
an osseous projection of the talar neck

16. Kager’s Triangle
Calcaneal Apophysis
a fragmented and sclerotic appearance to the calcaneal apophysis
given the name Sever’s Disease

17. Tarsal Coalition
a fibrous or osseous union between two tarsal bones

18. Os Peroneum
located adjacent to the cuboid
Accessory bone

19. Os Tibiale Externum
located just medial to the navicular

20. Os Trigonum
located posterior to the ankle joint

21. Os Supranavicular
located superior to the navicular

22. Standard Foot Series
AP Foot
Medial Oblique Foot
Lateral Foot

23. AP Foot

24. Medial Oblique Foot
30o of internal rotation

25. Lateral Foot Projection

26. Accessory Views of the Foot

27. Tangential Calcaneus
45o cephalad tube tilt

28. Anatomic Regions of the Foot
Forefoot metatarsals and phalanges
Midfoot navicular, cuboid, and cuneiforms
Hindfoot calcaneus and talus

29. Metatarsal Growth Centers
epiphyseal growth centers:
distal aspect of the 2nd to 5th metatarsals
proximal aspect of the 1st metatarsal

30. 5th Metatarsal Styloid Process Secondary Ossification Center

31. Normal Variants of the Foot

32. Phalangeal Synostosis
aka sypmphalangism

33. Hallux Valgus
Denotes the valgus position of the 1st toe and the medial plateau-like protrusion of the 1st metatarsal head.
may be developmental or congenital.
Associated with sagging of the transverse and longitudinal arches with sideways splaying of the forefoot.
may have enlargement of the bursa medial to the 1st metatarsal head.

34. Hallux Rigidus a stiff painful 1st metatarsalphalangeal joint
may later result in degenerative joint disease

35. Morton’s Syndrome an abnormally short first metatarsal
AKA metatarsus atavicus
the second metatarsal experiences excess stress and has an increase in transverse diameter of its shaft and in the thickness of its cortical wall.
can be associated with a shot 1st cuneiform.
can be responsible for metatarsalgia.
this syndrome may be complicated by stress fractures of the 2nd and 3rd metatarsal shafts

36. Polydactyly
an increase in the number of fingers and toes

37. Bilateral Bipartite Sesamoid Bones
most commonly involves the sesamoids at the 1st MTP joint

38. Tripartite Medial Sesamoid of the 1st MTP

39. An area of lucency that may be visualized within the anterior calcaneus
due the the appearance of the normal trabecular pattern

40. Heel Spurs
Osteophyte formation at the insertion sites of the plantar aponeurosis and the Achilles tendon

41. Duplication of the 1st Digit of the Foot

42. Brachymetatarsia usually involves the 4th metatarsal bilateral
25 times more common in females

43. Foot Lines of Measurement

44. Heel Pad Thickness
should not exceed 25 mm in men or mm in women

45. Boehler’s Angle
the normal measurement is between 28 to 40 degrees

46. Review of Normal Foot and Ankle Variants

47. Normal Variant ?

48. Anomaly?

49. Normal Variant ?

50. Name of this Normal Appearance ?

51. Normal Variant ?

52. Normal Variant ?

53. Tarsal Coalition
a fibrous or osseous union between two tarsal bones

54. Abnormality

55. Normal Variant ?

56. Normal Variants?

57. Thank You