Pain with disruption of cartilaginous synchondrosis between os trigonum & lateral tubercle of posterior talar process
Anatomical variations:
1. normal tubercle
2.stedia’s process or enlarged tubercle
3.accessory bone or os trigonum
4.fused os trigonum via synchondrosis
with talus.
Fusion o os trigonum -- 8 to 11 yrs
Ossification -- 2nd decade
Pain syndrome -- 20 to 35 yrs
PROTOCOL:
sagittal view
T1 , FS PD FSE
MRI:
T1: Hyointense sclerosis,edema b/w
os trigonum & talus
T2:Hyperintense marrow edema and
edema posterior to talus
& superior to os trigonum
Differential diagnosis:
Fracture lateral tubercle
Posterior soft tissue impingement
FHL tenosynovitis
Dancer’s foot
FHL checkrein deformity
Accessory navicular:
Unattached accessory bone or synchondrosis within medial navicular
Types:
1. 4 to 6 mm
2. unossified zone of 1 to 3 mm
3.cornuate or enlarged navicular
tuberosity
Ossify at 9 to 11 yrs
Symptoms after 5 yrs
PROTOCOL:
direct axial
T1 & FS PD FSE or STIR
MRI:
T1:
1. small (4-6mm) marrow fat containing ossicle within TP tendon (seperated from navicle by 5-7 mm)
2. triangular or heart shaped ossicle with direct connection to medial navicular
3.cornuate extension of medial navicular with no synchondrosis
T2:
In types 1 & 2 – suppressed marrow fat signal
in type 3 - normal marrow fat characteristics
Differential diagnosis:
Navicular tuberosity fracture
TP tendon tear
Midfoot arthritis
Sesamoid dysfunction:
Bipartite, fracture, turf toe , osteochondritis, sesamoiditis
Altered signal & morphology of sesamoids
Mc – within the double tendons of flexor hallucis brevis , articulating with 1st metatarsal head
Bipartite- rounded edges
Fracture- discrete hypointense frcture line
Turf toe- capsular disruption
Dd:
stress fracture , synovitis
Compartment syndrome:
Compartments
MRI:
T1: intermediate signal in edematous muscle, loss of normal muscle striations
T2:hyperintensity of involved muscles
D/d:
DVT
Gastrocnemius-soleus muscle strain
Cellulitis
Tumour
Myositis ossificans
Gastro-soleus strain:
Diffuse hyperintensity of medial head of gastro & soleus
MRI:
T1: intermediate signal edema
laxity of intermuscular septum b/w
the 2 muscles
T2: hyperintense edematous muscle
fibers
GRADES:
1. no myofascial disruption
edema,swelling +
2. weakness
variable seperation of muscle
from tendon orfascia
3. complete myofascial
seper
2. Os trigonum syndrome
• Pain with disruption of cartilaginous
synchondrosis between os trigonum
& lateral tubercle of posterior talar
process
• Anatomical variations:
1. normal tubercle
2.stedia’s process or enlarged
tubercle
3.accessory bone or os trigonum
4.fused os trigonum via
synchondrosis
3. • Fusion o os trigonum -- 8 to 11 yrs
• Ossification -- 2nd decade
• Pain syndrome -- 20 to 35 yrs
• PROTOCOL:
sagittal view
T1 , FS PD FSE
8. Accessory navicular
• Unattached accessory bone or
synchondrosis within medial
navicular
• Types:
1. 4 to 6 mm
2. unossified zone of 1 to 3
mm
3.cornuate or enlarged
navicular
9. • Ossify at 9 to 11 yrs
• Symptoms after 5 yrs
• PROTOCOL:
direct axial
T1 & FS PD FSE or
STIR
10. • MRI:
T1:
1. small (4-6mm) marrow
fat containing ossicle within TP
tendon (seperated from navicle by 5-
7 mm)
2. triangular or heart
shaped ossicle with direct connection
to medial navicular
3.cornuate extension of
medial navicular with no
11. • T2:
In types 1 & 2 – suppressed
marrow fat signal
in type 3 - normal marrow
fat characteristics
17. Sesamoid dysfunction
• Bipartite, fracture, turf toe ,
osteochondritis, sesamoiditis
• Altered signal & morphology of
sesamoids
• Mc – within the double tendons of
flexor hallucis brevis , articulating
with 1st metatarsal head
24. Compartment syndrome
• Compartments
• MRI:
T1: intermediate signal in
edematous muscle, loss of normal
muscle striations
T2:hyperintensity of involved
muscles
29. Gastro-soleus strain
• Diffuse hyperintensity of medial head of
gastro & soleus
• MRI:
T1: intermediate signal edema
laxity of intermuscular septum
b/w
the 2 muscles
T2: hyperintense edematous muscle
fibers
30. • GRADES:
1. no myofascial disruption
edema,swelling +
2. weakness
variable seperation of
muscle
from tendon or fascia
3. complete myofascial
seperation
lack of muscle function
34. Plantaris rupture
• MRI:
T1: intermediate signal mass
b/w medial head of gastrocnemius &
soleus
T2: hyperintense hemorrhage
with hypointense hemosiderin rim
“comet sign”
53. Morton’s neuroma
• 3rd common digital branch of medial
plantar nerve
• 40 – 60 yrs, female
• MRI: T1: hypo to intermediate signal tear
drop shaped mass
T2: intermediate to yperintense
mass
T1 C+ : diffuse enhancement