MRI is useful for assessing soft tissues, vessels, and sometimes bones in the foot, which is a complex structure with over 26 bones, muscles, and ligaments. The document describes several cases where MRI provided valuable information: a case of suspected cuboid pathology where MRI found peroneus longus tendonitis; a non-healing foot ulcer where MRI discovered a foreign body; a case of plantar fasciitis where MRI is not usually needed but can detect fascia rupture; and a diabetic foot where MRI demonstrated osteomyelitis and septic arthritis. The document emphasizes that MRI is effective for evaluating diabetes-related foot infections and distinguishing neuropathic from infectious causes.

1. Dr Krishna Kiran MD DNB FRCR
Radiologist

2.  WHY MRI.. ?

3. • Foot is a complex piece of engineering..!
• It has 26 bones more than 100 muscles ,
ligaments and a network of blood vessels
and nerves.
• MRI is the ideal technique to assess soft
tissues , vessels and sometimes even in
bones..!

4. Anatomy in short

9. Case 1
32 year old complains of pain in
sole of foot , ? Cuboid pathology

11. Peroneus
longus
tendonitis

12. Case 2
Nonhealing ulcer on foot..
Operated 1 year back for same
complaint , patient says had healed
after surgery , now recurrence of ulcer.
Old records were not available.

15. Sinus with possible foreign body.
On repeat exploration was a thorn ..!

16.  MRI is a good
technique in detecting
foreign bodies.
 High index of suspicion
is essential

17. Case 3
Pain in heel since 1 month.

19. Plantar fasciitis

20. MRI in plantar fasciitis
 MRI is not
necessary to
diagnose plantar
fasciitis
 Only when
conservative
management fails
and fascia rupture
is suspected.

21. Case 4
Chronic diabetic 50 year old female
? Neuropathy of foot
? Osteomyelitis.

24. Indicate neuropathic
joint.

25. Case 5
66 year old male , known diabetic.
Severe pain , swelling and redness in ankle ,
hind foot region.

28. Osteomeylitis talus
talonavicular septic
arthritis.

29.  MRI is effective tool in diabetes related foot infections. It
demonstrates cellulitis , sinus tracts and abscesses.
 Location and joint morphology help in differentiation of neuropathic
versus osteomyelitis.
 It may not be possible on MRI to differentiate between the two.
MRI showing sinus
tracts with
osteomeylitis

30. Case 6
39 year old female
Evaluation for ankle pain

33. Talocalcaneal coalition

34.  Often plain films
overlook tarsal
coalition.
 MRI or CT may be
needed for evaluation
of tarsal coalition.
Plain film showing C sign in
talocalcaneal coalition

35. Case 7
38 year old lady complains of pain after
attending zumba fitness dance after a
week. Tenderness over 2nd
metatarsal

37. Normal Xray
Marrow edema
2nd
metatarsal
Follow up Xray
confirming stress
fracture.MRI is the modality of choice in
suspected stress fracture surpassing
bone scintigraphy

38. Case 8
Young male with ankle pain
and swelling

41. Osteochondral dissecans of
talus.

42. Staging of
OCD talus on
MRI

43. High resolution imaging for
articular cartilage to
assess and detect
unstable osteochondral
fragments.

44. What else can MRI do ..?
angiography

45. Keypoints …
 MRI is useful in investigation in foot pain.
 High resolution imaging preferably in
1.5Tesla is necessary to image foot.