Ankle and Foot 47 - Department of Radiology - University of ...
Ankle and Foot 47 - Department of Radiology - University of ... Ankle and Foot 47 - Department of Radiology - University of ...
2214 VII Imaging of the Musculoskeletal System A B C D Figure 47-10. MRI of normal ankle tendons in the straight axial plane. Ach, Achilles tendon; AT, anterior tibial tendon; EDL, extensor digitorum longus tendon; EHL, extensor hallucis longus tendon; FDL, flexor digitorum longus tendon; FHL, flexor hallucis longus tendon. PB, peroneus brevis tendon; PL, peroneus longus tendon; PT, posterior tibial tendon; A&N (artery and nerve) points to the dotted circle surrounding the neurovascular bundle that includes the posterior tibial artery and nerve. A, Just above the syndesmosis. B, Through the tip of the medial malleolus. C, One slice distal to B there is loss of the dark signal from the EHL tendon. D, Image through the talonavicular joint demonstrates the PT tendon inserting on the navicular (N), and the FHL tendon passing under the sustentaculum tali (ST). At this level, the EDL is dividing into separate tendon slips. Ch047-A05375.indd 2214 9/9/2008 5:33:33 PM
47 Ankle and Foot 2215 47 A B C Figure 47-11. MRI of normal ankle tendons in the oblique coronal plane. FDL, flexor digitorum longus tendon; FHL, flexor hallucis longus tendon; PB, peroneus brevis tendon; PL, peroneus longus tendon; PT, posterior tibial tendon. A, Through the posterior facet of the subtalar joint. B, Through the middle facet of the subtalar joint. ST, sustentaculum tali. A&N (artery and nerve) points to the dotted circle surrounding the neurovascular bundle that includes the posterior tibial artery and nerve. C, Through the talonavicular joint. At this level, the PT tendon has divided into separate slips. The white line with the round end points to the portion of the PT that inserts onto the medial pole of the navicular (N). The white line with the square end points to the portion of the PT that passes under the navicular. This patient has an os peroneum, which is why the PL tendon appears enlarged and gray at this level (dark gray arrow). The lack of edematous signal along the course of the extensor hallucis longus on T2-weighted images should reassure the radiologist there is no pathologic process. Injury Tears of the anterior ankle tendons are rare, and if the patient indicates that the point of maximal tenderness is directly over the anterior tendons, it is prudent to search for other causes for pain, such as an unsuspected stress fracture (Fig. 47-12). Ganglion cysts can arise from any synovium-lined structure, including the anterior ankle tendons. Figure 47-13 shows a synovial cyst arising from and partially enveloping the anterior tibial tendon. • Posterior Tendons Normal Anatomy For anatomic purposes, the Achilles and plantaris tendons together make up the posterior group. The Achilles tendon is the largest tendon in the body, originating in the midcalf at the junction of the two heads of the gastrocnemius muscle and the soleus muscle, and inserts onto the back of the calcaneal tuberosity. Unlike the anterior, medial, Ch047-A05375.indd 2215 9/9/2008 5:33:35 PM
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2214 VII Imaging <strong>of</strong> the Musculoskeletal System<br />
A<br />
B<br />
C<br />
D<br />
Figure <strong>47</strong>-10. MRI <strong>of</strong> normal ankle tendons in the straight axial plane. Ach, Achilles tendon; AT, anterior tibial tendon; EDL, extensor digitorum<br />
longus tendon; EHL, extensor hallucis longus tendon; FDL, flexor digitorum longus tendon; FHL, flexor hallucis longus tendon. PB, peroneus brevis<br />
tendon; PL, peroneus longus tendon; PT, posterior tibial tendon; A&N (artery <strong>and</strong> nerve) points to the dotted circle surrounding the neurovascular<br />
bundle that includes the posterior tibial artery <strong>and</strong> nerve. A, Just above the syndesmosis. B, Through the tip <strong>of</strong> the medial malleolus. C, One slice<br />
distal to B there is loss <strong>of</strong> the dark signal from the EHL tendon. D, Image through the talonavicular joint demonstrates the PT tendon inserting on<br />
the navicular (N), <strong>and</strong> the FHL tendon passing under the sustentaculum tali (ST). At this level, the EDL is dividing into separate tendon slips.<br />
Ch0<strong>47</strong>-A05375.indd 2214<br />
9/9/2008 5:33:33 PM
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