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Normal anatomy and MR imaging pitfalls of the peroneus longus tendon. (A) Short-axis PD and sagittal FS T2-weighted (B) MR images demonstrate the normal fan-shaped distal divisions of the peroneus longus tendon (arrows), simulating a split tear. (C) Sagittal FS T2-weighted MR image shows an os peroneum embedded on the tendon fibers (arrow), not to be confused with a focal tear.
Source publication
Following a brief description of the normal anatomy and biomechanics of the midfoot, this article focuses on MR imaging features of common osseous, tendon, and ligament abnormalities that affect the midfoot. Discussion of the anatomy and pathology affecting the Chopart and Lisfranc joint complexes, both of which play important roles in linking the...
Similar publications
Lisfranc injuries are a disruption of one or more of the tarsometatarsal joints and have an estimated incidence of 1/55 000 people. However, the total number of Lisfranc injuries could be underreported, because almost 20% of these injuries are initially missed. Because of the relative infrequency of these injuries, the current literature is inconsi...
Background: The ankle joint is one of the most frequently injured joints in the body. Magnetic resonance imaging (MRI) is an emerging modality which is being used routinely for evaluation and diagnosis of pathologies of the ankle joint and foot as it can demonstrate pathologies before they become evident on other imaging modalities. Materials and M...
The anterolateral knee represents a complex anatomic area including osseous, fatty, tendinous and ligamentous structures. Disorders afflicting this anatomic area include acute trauma, which usually involves more than one structures, repetitive trauma, degeneration, inflammation and tumours and tumour-like lesions. A detailed understanding of the an...
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Citations
... The joint complex locks on heel eversion, stabilizing the midfoot during the push-off phase of gait cycle. 1,2 The spring ligament complex is a major ligamentous support described to have load-bearing capabilities. Davis et al 3 described that the ligament had two parts, namely superomedial and inferior calcaneonavicular. ...
Aims
The Chopart joint complex is a joint between the midfoot and hindfoot. The static and dynamic support system of the joint is critical for maintaining the medial longitudinal arch of the foot. Any dysfunction leads to progressive collapsing flatfoot deformity (PCFD). Often, the tibialis posterior is the primary cause; however, contrary views have also been expressed. The present investigation intends to explore the comprehensive anatomy of the support system of the Chopart joint complex to gain insight into the cause of PCFD.
Methods
The study was conducted on 40 adult embalmed cadaveric lower limbs. Chopart joint complexes were dissected, and the structures supporting the joint inferiorly were observed and noted.
Results
The articulating bones exhibit features like a cuboid shelf and navicular beak, which appear to offer inferior support to the joint. The expanse of the spring ligament complex is more medial than inferior, while the superomedial part is more extensive than the intermediate and inferoplantar parts. The spring ligament is reinforced by the tendons in the superomedial part (the main tendon of tibialis posterior), the inferomedial part (the plantar slip of tibialis posterior), and the master knot of Henry positioned just inferior to the gap between the inferomedial and inferoplantar bundles.
Conclusion
This study highlights that the medial aspect of the talonavicular articulation has more extensive reinforcement in the form of superomedial part of spring ligament and tibialis posterior tendon. The findings are expected to prompt further research in weightbearing settings on the pathogenesis of flatfoot.
Cite this article: Bone Jt Open 2024;5(4):335–342.
... Los ligamentos plantares largo y corto se observan bien en imágenes axiales y sagitales de la RM como haces de ligamentos estriados que se vuelven anchos y planos distalmente en forma de abanico. A lo largo de la cara plantar de la articulación calcaneocuboidea, el ligamento plantar corto se encuentra profundo y ligeramente medial al ligamento plantar largo 3,9,13 (Fig. 7). ...
... The Lisfranc joint complex is made up by the three cuneiform bones (C1 to C3) and the cuboid bone (Cu) proximally and the five metatarsal (M1 to M5) bases distally linked together by a ligamentous capsule structure [6]. ...
Lisfranc complex injuries are a spectrum of midfoot and tarsometatarsal (TMT) joint trauma, more frequent in men and in the third decade of life. Depending on the severity of the trauma can range from purely ligamentous injuries, in low-energy trauma, to bone fracture-dislocations in high-energy trauma. A quick and careful diagnosis is crucial to optimize management and treatment, reducing complications and improving functional outcomes in the middle and long-term. Up to 20% of Lisfranc fractures are unnoticed or diagnosed late, above all low-energy trauma, mistaken for simple midfoot sprains. Therefore serious complications such as post-traumatic osteoarthritis and foot deformities are not uncommon. Clinically presenting with evident swelling of the midfoot and pain, often associated with joint instability of the midfoot. Plantar region ecchymosis is highly peculiar. First level of examination is X-Ray performed in 3 projections. CT scan is useful to detect nondisplaced fractures and minimal bone sub-dislocation. MRI is the gold standard for ligament injuries. The major current controversies in literature concern the management and treatment. In stable lesions and in those without dislocation, conservative treatment with immobilization and no weight-bearing is indicated for a period of 6 weeks. Displaced injuries have worse outcomes and require surgical treatment with the two main objectives of anatomical reduction and stability of the first three cuneiform-metatarsal joints. Different surgical procedures have been proposed from closed reduction and percutaneous surgery with K-wire or external fixation (EF), to open reduction and internal fixation (ORIF) with transarticular screw (TAS), to primary arthrodesis (PA) with dorsal plate (DP), up to a combination of these last 2 techniques. There is no superiority of one technique over the other, but what determines the post-operative outcomes is rather the anatomical reduction. However, the severity of the injury and a quick diagnosis are the main determinant of the biomechanical and functional long-term outcomes.
... The bifurcate ligament is believed to be a major stabilizer of the Chopart joint line [8,9]. Interestingly, anatomical studies on the bifurcate ligament are rare and indicate a considerable variability. ...
... This considerable morphological variability of the bifurcate ligament casts a questionable light on its biomechanical relevance for the Chopart joint line. Especially, when taking the strong plantar ligaments, i.e. the plantar calcaneonavicular ligament (spring ligament) and the short and long plantar ligaments [8,9,13], as well as the unique bony anatomy of the Chopart joint line [9,14] into account. Previous biomechanical studies have either focused on the stability of the Chopart joint line [15] or the dorsal and plantar CC ligaments [16]. ...
Background
This study aims to analyze the ligaments of the dorso-lateral calcaneo-cuboid joint and to assess the biomechanical relevance of the bifurcate ligament.
Methods
16 specimens were analyzed for their ligamentous anatomy of the dorso-lateral calcaneo-cuboid joint and side-alternating assigned to two groups with varying ligamentous dissection order. The Chopart joint was stressed in plantar, medial, and lateral direction measuring the displacement by an 3D motion tracker for every dissection step.
Results
37.5% of specimens had all ligaments (lateral calcaneo-cuboid, dorsal calcaneo-cuboid, bifurcate calcaneo-cuboid, bifurcate calcaneo-navicular), 37.5% were lacking bifurcate´s calcaneo-cuboid-portion, and 25% presented without dorsal calcaneo-cuboid. Biomechanical testing revealed no significant displacement within the calcaneo-cuboid or talo-navicular joint for any stressed state except for axial compression with dissected dorsal talo-navicular joint capsule in Group 2.
Conclusion
Broad morphological variability and missing significant displacement regardless of its integrity, make the bifurcate ligament appear of limited biomechanical relevance.
... 4 They are important to appreciate as they may signal further extensive ligamentous injury to the plantar and medial supportive structures of the Chopart joint complex. 5,7 Diagnostic imaging can play an important role in clarifying diagnosis, extent of injury and guiding management and treatment of dorsal ligament injuries of the Chopart joint complex. 3 These ligaments can be efficiently assessed with ultrasound, however, are often not included in a routine sonographic assessment following an ankle sprain. ...
Ankle sprains are common. Midfoot ligaments, particularly the dorsal ligaments of the Chopart joint complex, can be injured in combination with other ankle and foot injuries via an ankle sprain, but are clinically difficult to detect. The prevalence of injury to dorsal midfoot ligaments may be underreported as they can be overlooked, underappreciated, and underdiagnosed. Symptoms can include chronic pain, long‐term functional limitations, and physical disability due to lack of timely management. Sonographic assessment of the ankle and foot following an ankle sprain should include assessment of the dorsal midfoot ligaments. This paper will provide a description of the sonographic anatomy, appearances, and assessment of the dorsal ligaments of the Chopart joint complex. Early diagnosis of injury can allow for appropriate management and treatment.
... MRI allows optimal visualization of the bone marrow within the ossicle and visualization of the synchondrosis. Accessory ossicles may also be associated with tendon pathology, which is also well assessed on MRI [74]. MRI allows clear demonstration of the findings often associated with posterior ankle impingement syndrome [75]. ...
Chronic foot pain is a frequent clinical complaint, which can significantly impact the quality of live in some individuals. These guidelines define best practices with regards to requisition of imaging studies based on specific clinical scenarios, which have been grouped into different variants. Each variant is accompanied by a brief description of the usefulness, advantages, and limitations of different imaging modalities. The present narrative is the result of an exhaustive assessment of the available literature and a thorough review process by a panel of experts on Musculoskeletal Imaging.
The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
... It represents an important link between the hindfoot and the midfoot. 45,46 The US examination of the BfL is best performed while keeping the plantar foot flat on the bench in slight inversion. The probe is placed with a horizontal orientation over the lateral aspect of the CCj. ...
Ligament injuries around the subtalar, talocalcaneonavicular, and calcaneocuboid joints are often underestimated on clinical and imaging findings during investigation of patients with ankle and foot injuries. Because a delayed diagnosis of midtarsal ligament tears may lead to chronic pain and functional disability, an in-depth knowledge of the complex regional anatomy and of the appropriate ultrasound scanning technique is a prerequisite for evaluating these structures and avoiding misdiagnoses. The objective of this article is twofold: to describe the relevant anatomy and biomechanics related to the ligaments that stabilize the subtalar, talocalcaneonavicular, and calcaneocuboid joints, and to illustrate reasoned landmark-based scanning techniques to provide a systematic examination of these ligaments and thus make ultrasound an effective tool for assessment of patients with suspected subtalar or midtarsal sprain.
... 4 They are important to appreciate as they may signal further extensive ligamentous injury to the plantar and medial supportive structures of the Chopart joint complex. 5,7 Diagnostic imaging can play an important role in clarifying diagnosis, extent of injury and guiding management and treatment of dorsal ligament injuries of the Chopart joint complex. 3 These ligaments can be efficiently assessed with ultrasound, however, are often not included in a routine sonographic assessment following an ankle sprain. ...
This presentation will predominantly bring together methods for scanning all regions of the ankle and midfoot to result in a thorough front-line approach to ligament injury in the acute setting.
While alternative diagnostic techniques exist, each offering varying degrees of accuracy, expense and time, it is posited that ultrasound is an accurate, cost-effective, and efficient modality for front-line assessment in acute and subacute ankle sprains.
Ultrasound examination is often confined to the lateral ligament complex due to operator inexperience or the ingrained perception that its use in other regions of the ankle is limited. However, if the scope of an ultrasound examination is not extended to include the midfoot, syndesmosis and medial ankle, more time-critical injuries may be missed leading to poor patient management and recovery.
The following demonstrations will be given in support of this posit:
1. Correct probe positioning to find important midfoot ligaments
2.Correct dynamic stress-ultrasound for detection of tibiofibular diastasis in the setting of AITFL ligament disruption (high ankle sprain)
3. Correct patient positioning to optimally visualise the components of the medial ankle deltoid ligament.
It will be seen that such ultrasound techniques can be used to obtain comparative views; allow for accurate appraisals of the tibiofibular syndesmosis, midfoot and deltoid ligaments (along with routine lateral ligament complex assessment). Dynamic positioning of the ankle or stress-ultrasound during assessment can assist with triage and ensure that best patient management is provided.
... It represents an important link between the hindfoot and the midfoot. 45,46 The US examination of the BfL is best performed while keeping the plantar foot flat on the bench in slight inversion. The probe is placed with a horizontal orientation over the lateral aspect of the CCj. ...
Objectives
In sonography of clinically relevant small structures of the ankle and foot, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intrasubject side‐to‐side variability must be minimal. The aim of this study was to assess the reliability of side‐to‐side sonographic evaluation of small structures of the ankle and foot.
Methods
Thirty healthy volunteers were prospectively studied. Small structures of the ankle and foot were evaluated bilaterally by 2 musculoskeletal radiologists in separate sessions. The deep peroneal nerve, superior extensor retinacula, calcaneofibular ligament, superior peroneal retinacula, tibialis posterior tendon, tibial nerve, Achilles tendon, plantaris tendon, plantar fascia, and sural nerve were considered. To assess intra‐ and interreader agreements, 30 (100%) examinations were repeated. A nonparametric statistic was used.
Results
Data were not normally distributed (P > .001). Intrareader agreement was k = 0.67 (95% confidence interval, 0.57–0.78) and interreader agreement was k = 0.73 (95% confidence interval, 0.68–0.77). The mean values and standard deviation for all the structures were 0.36 ± 1.85 mm. The overall coefficient of variation was 18.5%. The intraclass correlation coefficient was 0.93 (95% confidence interval, 0.92–0.94).
Conclusions
In ankle and foot sonography, the healthy contralateral side can be used as a reference during a real‐time musculoskeletal ultrasound evaluation of small structures.
... Recently, Thierfelder et al. [18] reviewed the anatomy for each ligament complex or tendon, followed by relevant facts on biomechanics and typical findings in case of injury and confirmed that magnetic resonance imaging (MRI) is invaluable regarding the correct assessment of (partial) ruptures, as well as for evaluating accompanying injuries. Tafur et al. [19] reported the MR imaging features of common osseous, tendon, and ligament abnormalities that affect the midfoot and also presented that MRI plays an important role in the early diagnosis of Lisfranc Ligament. The results of our study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries which extended those former studies. ...
Background:
The Lisfranc joint has complex structures, and articular surfaces overlap on conventional X-ray radiographs. Hence, there is no available auxiliary examination for diagnosing related injuries. At present, few studies on the imaging of Lisfranc ligaments have been reported, and related imaging data are rare. Therefore, no imaging reference can be used for related diagnosis and repair operations. This study aims to observe and describe the morphology and structure of Lisfranc ligaments using magnetic resonance imaging (MRI), in order to provide imaging reference for the diagnosis and repair of Lisfranc joint injuries.
Methods:
MRI scanning was performed on 60 sides of normal feet of 30 healthy adult volunteers. In the MRI scanning on the Lisfranc joint, sagittal scanning was focused on the area between the lateral margin and medial margin of the Lisfranc joint, while oblique coronal scanning was focused on the area parallel to the Lisfranc joint clearance. After acquisition of MRI images, data were burned into a CD, and the morphology and structure of the Lisfranc ligament on the MRI image were observed and described. Hence, the imaging parameters of the Lisfranc ligament were acquired, providing an imaging reference for the diagnosis and repair of Lisfranc joint injuries.
Results:
By observing the obtained images of the Lisfranc ligament through appropriate MRI scanning, it was found that the Lisfranc ligament originates at the site 12.63 ± 1.20 mm from the lateral side of the base of the medial cuneiform bone, with a length of 8.02 ± 1.5 mm, a width of 2.53 ± 0.61 mm, a height of 6.96 ± 1.01 mm, forms an included angle of 46.79 ± 3.47° with the long axis of the first metatarsal bone, and finally ends at the base of the second phalanx. Detailed imaging parameters of the Lisfranc joint and ligament were obtained from the present imaging experiment, providing an imaging reference for the diagnosis and repair of Lisfranc joint injuries.
Conclusions:
On the MRI images, the sagittal section can clearly display the corresponding situation of the Lisfranc joint bone and longitudinal arch of the foot, tolerably display the Lisfranc joint dorsal ligaments and metatarsal ligaments, and poorly display the Lisfranc ligament. The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. The oblique crosssection can clearly display the horizontal arch of the Lisfranc joint and more clearly display its surrounding ligaments and tendons, especially the entire Lisfranc ligament and its attachment points. This is an important section for the diagnosis of Lisfranc ligament injuries. This study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries. Further research with large sample size is still needed to confirm the conclusions.
