Ankle and Foot 47 - Department of Radiology - University of ...

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2234 VII Imaging of the Musculoskeletal System B A C D Figure 47-37. Accessory navicular syndrome in a 38-year-old. A, Anteroposterior radiograph shows a type 2 accessory navicular (white arrow in magnified gray dashed box). B, On the lateral radiograph, the accessory navicular can faintly be seen through the anterior calcaneus (open arrow in magnified white dashed box). Axial (C) and far-medial sagittal (D) T2-weighted fat-suppressed images reveal a line of fluid (white arrowhead) indicating an abnormal joint where there should be a solid fibrous union between the navicular (N) and accessory navicular (A). The far-medial sagittal image shows the posterior tibial tendon (T) inserting on the type 2 accessory navicular. of os peroneum syndrome is edema in and around the small ossicle, best shown with an edema-sensitive MRI sequence targeted to the lesion (Fig. 47-38). • Os Calcaneus Secondarius Os calcaneus secondarius is an occasionally seen normal variant that resides between the anterior process of the calcaneus (APC) and the lateral pole of the navicular (Fig. 47-39). It is discussed in more detail later. Imaging Protocol All imaging of the ankle and foot must begin with radiographs. Traumatic fractures are the most common cause of ankle and foot pain, and radiographs are the quickest and least expensive imaging modality for the detection and follow-up of these fractures. However, the question often arises as to which imaging modality should be obtained next if radiographs do not sufficiently delineate the fracture or do not demonstrate the cause of symptoms. Ch047-A05375.indd 2234 9/9/2008 5:34:07 PM
47 Ankle and Foot 2235 47 A B Figure 47-38. Os peroneum syndrome in a 58-yearold who developed chronic lateral foot pain after ballroom dancing. (Case courtesy of Edwin Rogers, MD.) Oblique (A) and lateral (B) radiographs reveal an os peroneum (white arrow) below the calcaneocuboid joint, a common normal variant. C, Far-lateral sagittal T1-weighted image shows the peroneus longus tendon (PB), wrapping around the lateral malleolus (LM), toward the base of the fifth metatarsal (5). Behind and below the PB is the peroneus longus tendon (PL). D, Sagittal T1-weighted image one slice medial to C. Here, the PL is passing under the calcaneus (Ca) and cuboid (Cu). Directly plantar to the calcaneocuboid joint is the os peroneum (black arrow), a sesamoid of the PL. (The os peroneum is difficult to see on this T1-weighted image because its edematous bone marrow is dark.) E, Corresponding inversion recovery image of slice at D demonstrates bone marrow edema throughout the os peroneum (arrow). Continued C D E Ch047-A05375.indd 2235 9/9/2008 5:34:10 PM
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