Warm Weather Increases Chance of Foot and Ankle Injuries

Injuries to the foot and ankle tend to fill podiatry and physician waiting rooms as the warmer recreation season hits. It is important to diagnose and treat such injuries in order to avoid long-term complications, according to experts from the American College of Foot and Ankle Surgeons. From common ankle sprains to more serious conditions, medical imaging, particularly magnetic resonance imaging (MRI), can help physicians and podiatrists diagnose an injury and map out an appropriate recovery plan for their patients.

The inland northwest is nationally recognized as a hub for outdoor enthusiasts and athletic participation. From Hoopfest basketball players to Bloomsday runners to recreational softball players, area athletes are vulnerable to foot and ankle problems, which account for 27 percent of all sports injuries. Overuse and insufficient stretching can often cause such injuries. Imaging techniques such and general X-ray and computed tomography (CT) may be considered to visualize such injuries, but MRI tends to act as the most powerful tool in determining the extent of certain foot and ankle injuries.

MRI has become a study of choice for seeing musculoskeletal disease or injury in the foot and ankle due to its high soft tissue contrast resolution and its multiplanar capabilities. MRI is a quick and non-invasive tool for the diagnosis of injuries, which are often difficult to evaluate with alternative modalities. It is particularly useful for evaluating soft tissue structures such as tendons, ligaments, nerves and fascia and for detecting occult bony injuries. In some cases bone fractures, avascular necrosis, and arthritis can be evaluated through MRI.

Another painful foot condition to where MRI can be a useful evaluation tool is Planter Fasciitis. Plantar fasciitis is generally related to repetitive trauma and mechanical stress producing micro tears and inflammation of the fascia and soft tissues along the bottom of the foot. MRI is useful in distinguishing plantar fasciitis from other causes of heal pain and for excluding plantar fascia tears. Again, MRI can visualize inflammatory changes and measure thickening of the plantar fascia.

Tendon and ligament injury including lateral ankle sprains or Achilles tendon injury represent a large amount of sports-related traumatic lesions. The anterior talofibular ligament is the weakest and therefore the most frequent one to tear. MRI assessment is useful in the evaluation of athletes that may require surgical repair or in patients with a history of chronic ankle instability. Achilles tendinosis can also be detected on axial MRI. The images can assess the Achilles tendon stability and visualize thickening of the tendon on sagittal images. A preoperative MRI may also be useful for distinguishing partial from complete rupture and assessing the extent and site of an Achilles tear.

In addition, stress fractures and insufficiency fractures are frequent in the ankle and foot. Before a stress fracture takes place, a condition termed “stress reaction” occurs where edema, hyperemia and osteoclastic activity develops within the stressed area of the bone. An MRI image is able to visualize abnormal signs of the bone marrow, similar to a bone contusion. As the stress persists and a fracture develops, MRI will show an irregular line within the area of edema and hyperemia. MRI has been found to be more sensitive than conventional radiography (X-ray) and more specific than bone scintigraphy for detecting occult fractures, particularly in the elderly and osteoporotic patients.

In some cases, finding the source of foot pain from over use can be difficult to determine. MRI acts as one of several options for evaluating foot and ankle injury or underlying cause of pain. Additionally, if surgical management is considered, MR examination can confirm the diagnosis and determine the number and exact location of the neuromas. Inland Imaging has eight orthopedic or musculoskeletal radiologists specifically trained to read and assist in the area of foot and ankle injury.