Foot and Ankle Imaging in the Athlete

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Foot and ankle injuries are among the most common of all sports-related injuries. Many injuries are simplistic from a diagnostic standpoint, whereas others require a high level of suspicion and the use of appropriate diagnostic imaging modalities. Whether a professional athlete or a weekend warrior, all athletes want minimal disruption to their sporting activity and a quick return to competition. An accurate diagnosis aids in the development of an appropriate rehabilitation program and in return to activity. This article reviews the more common foot and ankle injuries seen in the podiatrist's office and the preferred imaging modalities used to evaluate them.

Section snippets

Sesamoiditis

Pain in the first metatarsophalangeal joint sesamoids is a commonly occurring clinical entity and represents up to 4% of overuse foot injuries [8]. The sesamoid complex normally transmits up to 50% of body weight and, during push-off, can transmit loads greater than 300%. These high stresses may lead to acute and chronic pathologies of the sesamoids [9]. Injuries involving the sesamoids may occur in a number of sports including running, basketball, gymnastics, high-impact aerobics, and dancing.

Turf toe

Turf toe is a traumatic injury of the first metatarsophalangeal joint that results in a ligamentous or capsular sprain of the joint. This injury most commonly occurs as a hyperextension of the joint, with hyperflexion and valgus strain as other mechanisms of injury. This injury is seen in sports such as football, soccer, and dance that have artificial playing surfaces, and the accompanying use of lighter footwear is thought to play a role in its occurrence [18]. The injury carries with it

Stress fractures

A stress fracture is a partial or complete bone fracture that results from repeated application of stress lower than that required to fracture the bone in a single loading [22]. The process begins with an increased rate of osseous remodeling, followed by resorption and rarefaction. Eventually, focal trabecular microfractures can progress to a linear stress fracture and a periosteal or endosteal response [23]. Stress fractures of the foot and ankle are common in sports in which there is

Interdigital neuromas

Interdigital neuromas are a common cause of forefoot pain in the athlete. Constrictive footwear found in sports such as ice hockey, cycling, and soccer may predispose to the development of interdigital neuroma symptoms. In these sports, the interface between the foot and playing surface is so important that the athlete may forgo comfort to obtain a sense that the foot and athletic surface are one.

The diagnosis is usually made by taking a thorough patient history and performing a physical

Midfoot sprain

Midfoot injuries are uncommon but can be devastating to the athlete, particularly when they are misdiagnosed. Such injuries can end a season or even a career, so careful examination, a high level of clinical suspicion, and appropriate diagnostic tests are crucial to obtain a correct diagnosis and to initiate an appropriate treatment plan. Anatomic restoration of displaced fracture/dislocation of the tarsometatarsal junction of the foot is essential because even minor disruptions of this joint

Ankle sprain

Ankle injuries are among the most common sports-related injuries and represent a significant source of persistent pain and disability for the athlete. Injury not only involves the osseous and ligamentous structures of the ankle but may also include tendinous or other osseous injuries. The Ottawa Ankle Rules were developed to aid the physician in determining whether radiographs are required in acute ankle injuries [43]. A number of studies have validated the use of the Ottawa Ankle Rules [44],

Summary

Foot and ankle injuries are among the most common of all sports-related injuries. Many injuries are simplistic from a diagnostic standpoint, whereas others require a high level of suspicion and the use of appropriate diagnostic imaging modalities. Whether a professional athlete or a weekend warrior, all athletes want minimal disruption to their sporting activity and a quick return to competition. An accurate diagnosis aids in the development of an appropriate rehabilitation program and in

References (53)

  • W.G. Fernandez et al.

    Epidemiology of lower extremity injuries among U.S. high school athletes

    Acad Emerg Med

    (2007)
  • I. Buist et al.

    The GRONORUN study: is a graded training program for novice runners effective in preventing running related injuries? Design of a randomized controlled trial

    BMC Musculoskelet Disord

    (2007)
  • J. Davis et al.

    Acute effects of walking on inflammatory and cardiovascular risk in sedentary post-menopausal women

    J Sports Sci

    (2007)
  • V. Ng et al.

    Low-intensity exercise improves quality of life in patients with Crohn's disease

    Clin J Sport Med

    (2007)
  • M.A. Tully et al.

    Randomised controlled trial of home-based walking programmes at and below current recommended levels of exercise in sedentary adults

    J Epidemiol Community Health

    (2007)
  • B.T. Dedmond et al.

    The hallucal sesamoid complex

    J Am Acad Orthop Surg

    (2006)
  • A.H. Bizarro

    On the traumatology of the sesamoid structures

    Ann Surg

    (1921)
  • S. Bronner et al.

    Management of a delayed-union sesamoid fracture in a dancer

    J Orthop Sports Phys Ther

    (2007)
  • R. Biedert et al.

    Stress fractures of the medial great toe sesamoids in athletes

    Foot Ankle Int

    (2003)
  • R. Biedert

    Which investigations are required in stress fracture of the great toe sesamoids?

    Arch Orthop Trauma Surg

    (1993)
  • J.C. Hillier et al.

    MRI features of foot and ankle injuries in ballet dancers

    Br J Radiol

    (2004)
  • G. Özkoç et al.

    Hallucal sesamoid osteonecrosis: an overlooked cause of forefoot pain

    J Am Podiatr Med Assoc

    (2005)
  • R.T. Hockenbury

    Forefoot problems in athletes

    Med Sci Sports Exerc

    (1999)
  • D.F. Murphy et al.

    Risk factors for lower extremity injury: a review of the literature

    Br J Sports Med

    (2003)
  • L.R. Allen et al.

    Turf toe: ligamentous injury of the first metatarsophalangeal joint

    Mil Med

    (2004)
  • D.P. Tewes et al.

    MRI findings of acute turf toe. A case report and review of anatomy

    Clin Orthop Relat Res

    (1994)
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