Ankle and Foot

  • George Y. El-Khoury
  • Jeremy J. Kaye


The tendon is a densely packed connective tissue structure consisting of type I collagen fibrils embedded in a matrix of proteoglycans. Tendons are relatively hypovascular but the predominant cell is the fibroblast, or tenocyte. Tenocytes are responsible for producing and maintaining a healthy matrix. Collagen fibrils are arranged in closely packed bundles to form fascicles. Tendons that move in a straight line, such as the Achilles tendon, are surrounded by loose areolar connective tissue called the “paratenon”. The paratenon is usually not visible on imaging studies unless it is surrounded by fluid on both sides. Tendons that bend sharply around corners, such as the long flexors of the foot, are subject to compressive forces and are enclosed by a tendon sheath. Tendons sheaths are lubricated by synovial fluid in order to reduce friction [1, 2].


Achilles Tendon Tendon Sheath Magnetic Resonance Arthrography Subtalar Joint Plantar Fascia 
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  1. 1.
    Teitz CC, Garrett WE Jr, Miniaci A, Mann RA (1997) Tendon problems in athletic individuals. J Bone Joint Surg 79-A(1):138–152Google Scholar
  2. 2.
    Lutter LD, Mizel MS, Pfeffer GB (1994) Tendon problems of the foot and ankle. In: Lutter LD, Mizel MS, Pfeffer GB (eds) Foot and ankle. American Academy of Orthopaedic Surgeons, Rosemont, Illinois, pp 269–282Google Scholar
  3. 3.
    O’Brien M (1992) Functional anatomy and physiology of tendons. Clin Sports Med 11(3):505–520PubMedGoogle Scholar
  4. 4.
    Leadbetter WB (1992) Cell-matrix response in tendon injury. Clin Sports Med 11(3):533–578PubMedGoogle Scholar
  5. 5.
    Schweitzer ME, van Leersum M, Ehrlich SS, Wapner K (1994) Fluid in normal and abnormal ankle joints: Amount and distribution as seen on MR images. AJR Am J Roentgenol 162:111–114PubMedGoogle Scholar
  6. 6.
    Campbell RSD, Grainger AJ (2001) Current concepts in imaging of tendinopathy. Clin Radiol 56:253–267CrossRefPubMedGoogle Scholar
  7. 7.
    Myerson MS, McGarvey W (1998) Disorders of the insertion of the Achilles tendon and Achilles tendinitis. J Bone Joint Surg 80-A(12):1814–1824Google Scholar
  8. 8.
    Karjalaninen PT, Soila K, Aronen HJ et al (2000) MR imaging of overuse injuries of the Achilles tendon. AJR Am J Roentgenol 175:251–260Google Scholar
  9. 9.
    Quirin SF, Murray WT, Clark RA, Cochran CF (1987) Achilles tendon: MR imaging at 1.5 T. Radiology 164:767–770Google Scholar
  10. 10.
    Karasick D, Schweitzer ME (1993) Tear of the posterior tibial tendon causing asymmetric flatfoot: radiologic findings. AJR Am J Roentgenol 161:1237–1240PubMedGoogle Scholar
  11. 11.
    Khoury NJ, El-Khoury GY, Saltzman CL, Brandser EA (1996) MR imaging of posterior tibial tendon dysfunction. AJR Am J Roentgenol 167:675–682PubMedGoogle Scholar
  12. 12.
    Schweitzer ME, Caccese R, Karasick D et al (1993) Posterior tibial tendon tears: utility of secondary signs for MR imaging diagnosis. Radiology 188:655–659PubMedGoogle Scholar
  13. 13.
    Rosenberg ZS, Beltran J, Cheung YY et al (1997) MR features of longitudinal tears of the peroneus brevis tendon. AJR Am J Roentgenol 168:141–147PubMedGoogle Scholar
  14. 14.
    Khoury N, El-Khoury GY, Saltzman CL, Kathol MH (1996) Peroneus longus and brevis tendon tears: MR imaging evaluation. Radiology 200:833–841PubMedGoogle Scholar
  15. 15.
    Ohashi K, Restrepo JM, El-Khoury GY, Berbaum KS (2007) Peroneal tendon subluxation and dislocation: detection on volume-rendered images — initial experience. Radiology 242(1):252–257CrossRefPubMedGoogle Scholar
  16. 16.
    Ostendorf B, Scherer A, Modder U, Schneider M (2004) Diagnostic value of magnetic resonance imaging of the forefeet in early rheumatoid arthritis when finding on imaging of the metacarpophalangeal joints of the hands remain normal. Arthritis Rheum 50:2094–2102CrossRefPubMedGoogle Scholar
  17. 17.
    El-Khoury GY, Kathol MH (1980) Neuropathic fractures in patients with diabetes mellitus. Radiology 134:313–316PubMedGoogle Scholar
  18. 18.
    Greaney RB, Gerber FH, Laughlin RL et al (1983) Distribution and natural history of stress fractures in U.S. Marine recruits. Radiology 146:339–346PubMedGoogle Scholar
  19. 19.
    Kiss ZS, Khan KM, Fuller PJ (1993) Stress fractures of the tarsal navicular bone: CT findings in 55 cases. AJR Am J Roentgenol 160:111–115PubMedGoogle Scholar
  20. 20.
    Myerson MS, Cerrato RA (2008) Current management of tarsometatarsal injuries in the athlete. J Bone Joint Surg 90-A(11):2522–2533Google Scholar
  21. 21.
    Zanetti M, Ledermann T, Holder J (1997) Efficacy of MR imaging in patients suspected of having Morton’s neuroma. AJR Am J Roentgenol 168:529–532PubMedGoogle Scholar
  22. 22.
    Grasel RP, Schweitzer ME, Kovalovich AM et al (1999) MR imaging of plantar fasciitis: Edema, tears, and occult marrow abnormalities correlated with outcome. AJR Am J Roentgenol 173:699–701PubMedGoogle Scholar
  23. 23.
    Theodorou DJ, Theodorou SJ, Kakitsubata Y et al (2000) Plantar fasciitis and fascial rupture: MR imaging findings in 26 patients supplemented with anatomic data in cadavers. Radio Graphics 20:S181–S197Google Scholar
  24. 24.
    Cardinal E, Chhem RK, Beauregard CG et al (1996) Plantar fasciitis: sonographic evaluation. Radiology 201:257–259PubMedGoogle Scholar
  25. 25.
    Newman JS, Newberg AH (2000) Congenital tarsal coalition: Multimodality evaluation with emphasis on CT and MR imaging. RadioGraphics 20:321–332PubMedGoogle Scholar
  26. 26.
    Kumar SJ, Guille JT, Lee MS, Couto JC (1992) Osseous and non-osseous coalition of the middle facet of the talocalcaneal joint. J Bone Joint Surg 74-A(4):529–535Google Scholar
  27. 27.
    Crim JR, Kjeldsberg KM (2004) Radiographic diagnosis of tarsal coalition. AJR 182:323–328PubMedGoogle Scholar
  28. 28.
    Erickson SJ, Quinn SF, Kneeland JB et al (1990) MR imaging of the tarsal tunnel and related spaces: Normal and abnormal findings with anatomic correlation. AJR Am J Roentgenol 155:323–328PubMedGoogle Scholar
  29. 29.
    Robinson P, White LM (2002) Soft-tissue and osseous impingement syndromes of the ankle: Role of imaging in diagnosis and management. RadioGraphics 22:1457–1471CrossRefPubMedGoogle Scholar
  30. 30.
    Cerezal L, Abascal F, Canga A et al (2003) MR Imaging of ankle impingement syndromes. AJR Am J Roentgenol 181:551–559PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • George Y. El-Khoury
    • 1
  • Jeremy J. Kaye
    • 2
  1. 1.Division of Diagnostic Radiology — Musculoskeletal, Department of RadiologyUniversity of IowaIowa CityUSA
  2. 2.Department of Radiology & Radiological SciencesVanderbilt University Medical CenterNashvilleUSA

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