foot radiological anatomy. shorouk zaki
TRANSCRIPT
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MRI OF THE FOOTPART I
Represented byRepresented by
Shorouk ZakiAssistant lecturer of radiology
Benha faculty of medicine
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MRI ANATOMY
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ANKLE• Formed of 4 aspects:
Posterior contains:
Tendons:Tendons: Achilles Tendon
Ligaments:Ligaments: No
Anterior contains:Anterior contains:
TendonsTendons:: Tibialis anterior
Extensor H. longus
Extensor digitorum longus
LigamentsLigaments:: No
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• Medial contains:
•• TendonsTendons:: Tibialis posterior
Flexor digitorum longus
Flexor H. longus
•• LigamentsLigaments:: Deltoid ligament•• LigamentsLigaments:: Deltoid ligament
• Lateral contains:
•• Tendons: Tendons: Peroneal tendons (longus and brevis)
•• Ligaments :Ligaments :
Tibiofibular syndesmotic complex
Lateral collateral ligament
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(Spring )
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Medial ligaments (deltoid or medial collateral)
1. Ant. Tibiotalar
2. Tibio navicular
3. Tibio spring
4. Tibio calcaneal
5. Post. Tibiotalar
T
6. Springs
N.B: TP & FDL tendons lie superficial to the deltoid ligament in axial &coronal planes [Landmark for the ligament]
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PT= tibialisposterior
FDL=Flexor dig. LongusPTTL=
posterior tibiotalarligament
Longus
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ATTL= anterior tibiotalar ligament
TSL= tibiospringligament
SL=spring ligament complex
PT= tibialis posterior
FDL=
Flexor dig. Longus
PTTL= posterior tibiotalar ligament
FR=flexor retinaculum
complex
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PT= tibialis posterior
FDL=
Flexor dig. Longus
PTTL= posterior tibiotalar ligament
TCL= Tibiocalceneal lig.
tibiotalar ligament
ATTL= anterior tibiotalar ligament
SL=spring ligament complex
TSL= tibiospringligament
FR=flexor retinaculum
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PB
PL
PL
PB
PL
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Lateral collateral ligamentATF= Anterior talofibular lig.
PTF= Posterior talofibular lig..
MF = Malleolar fossa
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ATbF= Anterior tibiofibular lig.
PTbF= posterior tibiofibular lig.
IT = inferior transverse lig.
Tibiofibular syndesmotic complex
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ATFL
ATFL
PTFL
PTFL
PTFL
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THE FOOT
1-Fore foot 2-Mid Foot 3-Hind foot
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BONESHuman foot consists of 28 bones which are:
A. 7 tarsal bones
1. calcaneus
2. talus
3. medial cuneiform
4. intermediate cuneiform
5. lateral cuneiform
6. cuboid
7. navicular7. navicular
B. 5 metatarsal bones (1st, 2nd, 3rd, 4th, 5th from great toe to little toe respectively)
C. 5 proximal phalanges (1st, 2nd, 3rd, 4th, 5th from great toe to little toe respectively)
D. 4 middle phalanges (2nd, 3rd, 4th, 5th from second toe to little toe respectively)
E. 5 distal phalanges (1st, 2nd, 3rd, 4th, 5th from great toe to little toe respectively)
F. 2 sesamoid bones below the 1st metacarpal head
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Fore foot
Hind foot
Mid foot
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JOINTS
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LAYERS OF THE PLANTAR SURFACE OF THE FOOT
• Plantar soft tissues of the foot are divided into three compartments by two intermuscular septa that arise from the plantar aponeurosis.
• The medial septum:
Extends from the plantar aponeurosis to the Extends from the plantar aponeurosis to the navicular bone, the medial cuneiform bone, and the lateral border of the plantar surface of the first metatarsal bone.
It forms the border between the medial and central or intermediate compartments.
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• The lateral septum extends from theplantar aponeurosis to the medial surface of the fifth metatarsal bone andseparates the lateral and central compartments.
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**Attach to transverse metatarsal ligaments of the toes
**
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It is normally a low signalintensity structure on all pulse sequences that should not measure more than 4 mm in
thickness at its thickest proximal attachment to the calcaneus.
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PLANTAR PLATE
• The plantar plate is a fibrocartilaginousanatomical structure (similar to menisci) that provides stability to the metatarsophalangealjoint, the integrity of the plantar plate is joint, the integrity of the plantar plate is essential for the safety of the proximal phalanges of the toes ( mainly second to fifth).
• It has its proximal insertion in the metatarsal head and its distal insertion in the base of the proximal phalanx
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MUSCLESA-Dorsal muscles : 2 muscle layers
Superficial layer:
Tibialis anterior, extensor hallucislongus, extensor digitorum longus.
Deep layer:Deep layer:
Extensor hallucis brevis, extensor digitorum brevis.
In forefoot:
long and short extensors run side byside in single layer
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B-Plantar Intrinsic muscles are of four layers:
1st “most superficial
”: 3 muscles
2nd: 5muscles and 2 tendons
MUSCLES
2nd: 5muscles and 2 tendons
3rd: 3 muscles
4th “most deep” 7 muscles and 2 tendons
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1st layer
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2nd layer
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2nd layer
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2nd layer
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3rd layer
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3rd layer
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4th layer
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4th layer
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1. Planter facia (aponeorosis): see before
2. Long plantar ligament: Originates calcanealtuberosity, inserts cuboid and bases 2nd-4th metatarsals Forms retinaculum for peroneuslongus tendon as it courses medially on plantar aspect of foot
LIGAMENTS
aspect of foot
3. Short plantar (plantar calcaneocuboid) ligament: Deep to long ligament, inserts more proximally on cuboid
4. Plantar calcaneocuboid (spring) ligament: Originates sustentaculum tali, inserts plantar aspect navicular
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5.Bifurcate ligament: Originates anterior process of calcaneus dorsally, inserts navicular and cuboid
6.Lisfranc ligament: Originates 1st cuneiform, inserts base 2nd metatarsal
7.Intermetatarsalligaments: Dorsal and plantarligaments between 2nd-5th metatarsal bases
8.Transverse metatarsal ligaments: Superficial and 8.Transverse metatarsal ligaments: Superficial and deep ligaments between metatarsal heads
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1. Tibial nerve divides into medial and lateral plantar branches at level of tarsal tunnelMedial plantar nerve
Between 1st and 2nd muscle layers, accompanies medial plantar arteryLateral plantar nerve: has deep and superficialdivisions
NERVES
divisions• Superficial lateral plantar nerve: Between Ist and 2nd muscle layers• Deep lateral plantar nerve: Between 3rd and 4th muscle layers; accompanies lateral plantar artery.
2. Deep peroneal nerve: Extends along dorsum of foot, between tibialis anterior and extensor hallucis longus
3. Sural nerve: Lateral, superficial branch of tibial nerve. Extends along lateral margin of foot
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Posterior tibial artery”•Divides into medial and lateral plantar arteries at level of tarsal tunnelPlantar arteries accompany medial and deep lateralplantar nervesPeroneal artery:•Accompanies superficial peroneal nerve down
Arteries
•Accompanies superficial peroneal nerve down anterolateral aspect ankleAnterior tibial artery:•continues into foot as dorsalis pedis artery, deep to extensor retinaculum•Divides into multiple branches in midfoot, formingarcade
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BURSAE
Extensor digitorum brevis: Between muscle and 2nd cuneiform and metatarsal bases
Extensor hallucis longus: Between tendon and 1st cuneiform and metatarsal basesand 1st cuneiform and metatarsal bases
Abductor digiti minimi: Between muscle andtuberosity of 5th metatarsal
Metatarsophalangeal joints: Dorsally; between metatarsal heads; and medial to 1st metatarsal head
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RETINACULAE
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MRI imaging of the foot
• Examinations are usually divided into :
1. Ankle and hind foot examination.
2. Mid foot examination.
3. Forefoot examination.
A dedicated examination technique and protocol is A dedicated examination technique and protocol is essential for each region
• If the region of suspected pathology is uncertain,
a large feld of view (FOV) short tau inversionrecovery (STIR) examination of the ankle and foot (200 mm – 270 mm) may be obtained, to identify a specifcregion of interest
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• Supine versus prone examinatonpositonA supine position is more comfortable for the patient, but the prone position has been advocated for cases with suspected Morton’s neuroma, as biomechanical Morton’s neuroma, as biomechanical action in the prone position aidsin visualising this condition.
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