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(3) Musculoskeletal Imaging > S3_L3 Anatomy & Radiologic Evaluation of the Ankle & Foot > Flashcards

S3_L3 Anatomy & Radiologic Evaluation of the Ankle & Foot Flashcards

1
Q

The most commonly injured weight-bearing joint in the body

A

ankle

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2
Q

The most commonly injured ligament in ligamental injuries of the ankle and foot

A

anterior talofibular ligament (part of lateral ligament complex)

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3
Q

Modified TF
A. Subtle fractures (hairline fractures) of the ankle and foot may mimic symptoms of ankle sprains.
B. It depends on the amount of tissue that is torn and amount of bone that is destroyed.

A

TT

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4
Q

TRUE OR FALSE: The true frequency of ankle sprains is unknown.

A

True

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5
Q

TRUE OR FALSE: The second toe is the center for push-off and the windlass maneuver.

A

False, correct answer: great toe (big toe)

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6
Q

Modified TF
A. Dorsiflexion and plantarflexion are motions of the talocrural joint.
B. Abduction and adduction are motions of the transverse tarsal joints (Chopart joint).

A

TT

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7
Q

Supination of the ankle and foot joint
A. Inversion, adduction, and dorsiflexion
B. Inversion, abduction, and plantarflexion
C. Eversion, adduction, and dorsiflexion
D. Eversion, abduction, and plantarflexion

A

A. Inversion, adduction, and dorsiflexion

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8
Q

Pronation of the ankle and foot joint
A. Inversion, adduction, and dorsiflexion
B. Inversion, abduction, and plantarflexion
C. Eversion, adduction, and dorsiflexion
D. Eversion, abduction, and plantarflexion

A

D. Eversion, abduction, and plantarflexion

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9
Q

Modified TF
A. Inversion and eversion are characterized by elevation of the medial and lateral borders of the foot.
B. These are motions of the subtalar joint.

A

TT

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10
Q

TRUE OR FALSE: Routine radiographic examination is indicated for trauma, such as fractures, ankle sprains, and contusions.

A

True

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11
Q

Modified TF
A. The magic angle effect causes an artifactual decrease in signal in tissues with ordered collagen (tendons, ligaments, fibrocartilage, hyaline cartilage).
B. This effect is seen as a false whitening, and the tissues “straighten out”.

A

FT

A. The magic angle effect causes an artifactual increase in signal in tissues with ordered collagen (tendons, ligaments, fibrocartilage, hyaline cartilage).

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12
Q

Modified TF
A. Talar tilt is determined by the angle made by the intersection of the lines drawn across the tibial plafond and the talar dome.
B. It shows the displacement of the talus and the contralateral ankle is used to establish a baseline.

A

TT

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13
Q

Modified TF
A. The normal values of the talar tilt are 5 – 15 degrees eversion and up to 10 degrees in inversion.
B. A difference of 5 degrees is considered significant.

A

FT

A. The normal values of the talar tilt are 5 – 15 degrees inversion and up to 10 degrees in eversion.

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14
Q

Modified TF
A. Radiographs should be the initial study for suspected bone and soft tissue abnormalities of the ankle and foot.
B. Stress tests are good for assessing the integrity of the ligaments without using advanced imaging.

A

TT

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15
Q

Modified TF
A. Radiographs are limited to identifying late changes in bone density and unable to assess soft tissues.
B. Ultrasound may be used to check for tendon disorders.

A

TT

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16
Q

Modified TF
A. MRI is used for analyzing patients with complex foot and ankle fractures, osteochondral lesions, and tarsal coalition
B. CT Scan is the established modality for detecting stress fractures and osteomyelitis of the foot and ankle, and tendon disorders.

A

FF

A. CT Scan is used for analyzing patients with complex foot and ankle fractures, osteochondral lesions, and tarsal coalition
B. MRI is the established modality for detecting stress fractures and osteomyelitis of the foot and ankle, and tendon disorders.

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17
Q

Modified TF
A. A CT exam of the ankle extends from the distal tibia to the inferior aspect of the calcaneus and from the posterior calcaneus to the metatarsal bases.
B. A CT exam of the foot extends from the distal fibula to the forefoot.

A

TF

B. A CT exam of the foot extends from the distal tibia to the forefoot.

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18
Q

Modified TF
A. Tarsal coalition is the abnormal connection that develops between 2 bones in the back of the foot (excess bony outgrowth) that limits 1 or 2 planes of movement of the foot.
B. It may consist of bone, fibrous tissue, or cartilage.

A

TT

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19
Q

The following are indications of CT Scan, except

A. Complex fractures and dislocations of the ankle and hindfoot
B. Osteochondral lesions
C. Tarsal Coalition
D. Pre-operative planning
E. None of the above

A

E. None of the above

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20
Q

Modified TF
A. The oblique axial view of the CT scan is the best view for the subtalar joint.
B. It can sssess the patency of the articular cartilage and calcified or intraarticular loose bodies in the joint spaces.

A

TT

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21
Q

Modified TF
A. CT Scans are not good with visualizing the muscles of the foot.
B. However, avulsion fractures at their points of tendinous attachments are seen clearly.

A

TT

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22
Q

Modified TF
A. Joint spaces are widened in cases of trauma.
B. Joint spaces are narrowed in cases of osteoarthritis.

A

TT

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23
Q

Modified TF
A. MRI of the ankle and hindfoot may be indicated to clarify and stage conditions diagnosed clinically and/or suggested by other imaging modalities.
B. These include fractures and stress fractures, primary and secondary bone and soft tissue tumor, and arthritides.

A

TT

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24
Q

Modified TF
A. The forefoot is the most visualized area on the MRI.
B. The forefoot is the area that needs the most imaging if pathologic conditions occur.

A

FF

A. The hindfoot is the most visualized area on the MRI.
B. The hindfoot is the area that needs the most imaging if pathologic conditions occur.

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25
Q

True about plantarflexion, except

A. It increases the magic angle effect
B. Accentuates the fat plane between the peroneal tendons
C. Allows better visualization of the calcaneofibular ligament
D. None

A

A. It increases the magic angle effect

Correct answer: decreases the magic angle effect

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26
Q

TRUE OR FALSE: In MRI, patients may either be positioned in supine with the ankle in neutral position or with the ankle in PF.

A

True

NOTE: Not routinely done d/t patient considerations

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27
Q

Modified TF
A. MRI can be used to check for tarsal coalition, which is the abnormal bridging of the tarsals that impedes normal ROM.
B. Tarsal coalition occurs most commonly at the calcaneonavicular joint and the middle facet of the talocalcaneal joint.

A

TT

NOTE: It may either be osseous, cartilaginous, or fibrous

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28
Q

Modified TF
A. Edema is expected to normally be present in joint fluid.
B. It is not expected to be seen within bone marrow, or within tendon sheaths, or cystic masses.

A

TT

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29
Q

Modified TF
A. Gout is common at the first metatarsophalangeal joint.
B. It is seen with inflammatory changes, as well as the presence of gouty tophi, fibrous periarticular nodules of low signal on MRI.

A

TT

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30
Q

Modified TF
A. In RA, early evidence on MRI includes synovitis and a fluffy bone marrow edema pattern.
B. The subtalar and metatarsophalangeal joints are most affected in RA of the ankle and foot.

A

TT

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31
Q

Modified TF
A. A possible MRI finding for RA is visualization of fibrous pannus.
B. Pannus formation is the hallmark for RA.

A

TT

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32
Q

Modified TF
A. Anterolateral impingement syndrome is characterized by hypertrophy and scarring of the synovium in the gutter (the anterolateral space between the tibia and fibula).
B. The anterior talofibular ligament is usually affected in this syndrome.

A

TT

NOTE: On MRI, T2 signals are low due to scarring.

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33
Q

Modified TF
A. Sinus tarsi syndrome is characterized by an injury that tears the interosseous ligaments which provide subtalar stability.
B. The sinus tarsi space is normally filled with fat, but replaced with granulation or scar tissue if damaged.

A

TT

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34
Q

Modified TF
A. Sinus tarsi syndrome has a low signal on T1.
B. It has a low signal on T2 if scar tissue is present, or a high signal if granulation tissue is present (newly been injured).

A

TT

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35
Q

Modified TF
A. The tibia connects to the medial malleolus.
B. The fibula connects to the lateral malleolus.

A

TT

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36
Q

Modified TF
A. The distal fibula & distal tibia are part of the ankle mortise.
B. The tibia plafond is the flat part of the distal tibia.

A

TT

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37
Q

Modified TF
A. The Chopart (Transverse Tarsal) Joint is found in between the midfoot and forefoot.
B. The Lisfranc (Tarsometatarsal) Joint is found in between the hindfoot and midfoot.

A

FF

A. The Chopart (Transverse Tarsal) Joint is found in between the hindfoot and midfoot.
B. The Lisfranc (Tarsometatarsal) Joint is found in between the midfoot and forefoot.

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38
Q

TRUE OR FALSE: The chopart and lisfranc joints are the sites where amputation takes place and the centers of movement of pronation and supination.

A

True

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39
Q
  1. 2nd most commonly injured ligament of the lateral ligament complex
  2. Deltoid Ligament

A. Medial Collateral Ligament
B. Anterior Talofibular Ligament
C. Calcaneofibular Ligament
D. Posterior Talofibular Ligament

A
  1. C
  2. A
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40
Q

3rd most commonly injured ligament of the lateral ligament complex

A. Medial Collateral Ligament
B. Anterior Talofibular Ligament
C. Calcaneofibular Ligament
D. Posterior Talofibular Ligament

A

D. Posterior Talofibular Ligament

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41
Q

One of the toughest ligaments of the body. The bony attachment will avulse first before this ligament is torn.
A. Medial Collateral Ligament
B. Anterior Talofibular Ligament
C. Calcaneofibular Ligament
D. Posterior Talofibular Ligament

A

A. Medial Collateral Ligament

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42
Q

TRUE OR FALSE: The Tarsal Sinus is important for proprioception of the ankle and foot.

A

True

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43
Q

Modified TF
A. The AP view of the ankle demonstrates the distal tibia and fibula, including the lateral and medial malleolus and the dome of the talus.
B. The patient lies supine and the central ray is directed vertically through the midpoint between the malleoli.

A

TT

44
Q

Modified TF
A. In a normal ankle, the fibular malleolus extends below the tibial malleolus.
B. The fibular malleolus is superimposed on top of the distal tibia in the AP view of the ankle.

A

TT

45
Q

True about the AP view of the ankle, except

A. Checks for shortening of the distal tibia and fibula
B. Checks for medial or lateral shift of the talus
C. Checks for the joint space between the distal tibiofibular joint
D. None

A

D. None

NOTE: Medial or lateral talar shift can indicate a ligamental problem or fracture of the talus

46
Q

Modified TF
A. In the AP oblique (Mortise view) of the ankle, the leg is internally rotated 15-20º until the intermalleolar plane is parallel with the image receptor.
B. The patient lies supine and the central ray is directed at a midpoint between the malleoli.

A

TT

NOTE: IR is done to place both malleoli in the same plane and avoid superimposition

47
Q

Modified TF
A. The AP oblique (Mortise view) of the ankle demonstrates the entire ankle mortise.
B. It is used to check the joint space between the tibia and fibula.

A

TT

48
Q

Modified TF
A. The mortise width is the space between the talar dome and ankle mortise.
B. The mortise width is normally 5–6 mm wide over the entire talar surface.

A

TF

B. The mortise width is normally 3-4 mm wide over the entire talar surface.

49
Q

TRUE OR FALSE: In the AP oblique (Mortise view), an additional 2mm in the mortise width is considered abnormal, indicating a disruption of the distal tibiofibular joint.

A

True

50
Q

TRUE OR FALSE: In the lateral view of the ankle, the patient is sidelying and the central ray is directed vertically through the medial malleolus.

A

True

51
Q

The lateral view of the ankle demonstrates the ff, except

A. Anterior and posterior aspects of the distal tibia
B. Lateral relationship of the tibiotalar and subtalar articulations
C. Talus
D. Calcaneus
E. None

A

E. None

52
Q

Modified TF
A. In the lateral view of the ankle, the subtalar joint, talus, and calcaneus are well-demonstrated.
B. The fibula is superimposed behind the tibia and talus in this view.

A

TT

NOTE: The posterior malleolus of the tibia is considered as the 3rd malleolus.

53
Q

TRUE OR FALSE: In a stable ankle, the mortise will remain relatively constant during the inversion and eversion maneuvers.

A

True

54
Q

Modified TF
A. Stress views have traditionally been used to assess the degree of joint stability.
B. However, recent studies questioned the value of radiographs as MRI offers the advantage of evaluating associated injuries and chronic instability.

A

TT

NOTE: In the absence of MRI, radiographs can be used. Stress radiographs are still used in some settings.

55
Q

TRUE OR FALSE: In the AP inversion and eversion stress views, the leg and ankle are placed in the true AP manner and the foot is turned medially for the inversion, and laterally for the eversion view.

A

True

56
Q

Modified TF
A. The ankle mortise widens as a result of ligamental disruption.
B. Ligamental disruption and the talar tilt can be seen in the AP inversion and eversion stress views.

A

TT

57
Q

Modified TF
A. A wide space between the medial border of the talus and the medial malleolus indicates disruption of the lateral collateral ligament.
B. A wide space between the lateral border of the talus and the lateral malleolus indicates disruption of the medial collateral ligament.

A

FF

A. A wide space between the medial border of the talus and the medial malleolus indicates disruption of the medial collateral ligament.
B. A wide space between the lateral border of the talus and the lateral malleolus indicates disruption of the lateral collateral ligament.

58
Q

Modified TF
A. For the anterior talar stress view, the leg and ankle are in a lateral position with the leg fixed manually in place.
B. Stress is applied to the posterior aspect of the heel, resulting in anterior transposition of the talus on the tibia.

A

TT

59
Q

Modified TF
A. In the anterior talar stress view, measurements are taken from the posterior aspect of the tibia to the posterior aspect of the talus.
B. Separation of up to 5mm is normal, and ≥ 10mm is pathologic, indicating
disruption of the ATFL ligament.

A

TT

60
Q

Modified TF
A. All the bones of the forefoot and midfoot are well-demonstrated on the AP view of the foot.
B. In this view, the central ray is directed toward the base of the second metatarsal.

A

TF

B. In this view, the central ray is directed toward the base of the third metatarsal.

61
Q

Modified TF
A. The AP view of the foot demonstrates the phalanges, metatarsals, cuneiforms, cuboid, and navicular.
B. This view can be used to check for sesamoid bones in the first and sometimes the second or third metatarsal heads.

A

TT

62
Q

Modified TF
A. The first intermetatarsal angle in the AP view of the foot is formed by the intersection of the lines bisecting the first and second metatarsal shafts.
B. Its normal value is < 9 degrees, and this angle is used as a baseline for assessing forefoot deformities (i.e., hallux valgus, hallux rigidus).

A

TT

63
Q

Modified TF
A. The normal values of the Calcaneal Inclination are 25–40º.
B. The normal values of the Bohler Angle are 20–30º.

A

FF

A. The normal values of the Calcaneal Inclination are 20-30º.
B. The normal values of the Bohler Angle are 25-40º.

64
Q

Modified TF
A. Normally, the plantar fascia is a thin, dark structure on the MRI extending anteriorly from the calcaneus.
B. If it is inflamed, it doubles in thickness, and presents as intermediate signals on T1, and high signals on T2.

A

TT

65
Q

Modified TF
A. Plantar fasciitis is the microtearing and inflammation of fascial and perifascial tissues.
B. If the plantar fascia is torn, the discontinuity will be evident on MRI.

A

TT

66
Q

Modified TF
A. Stress fractures are irregular lines of low signal on T1.
B. These have high signal on T2 weighted images owing to adjacent marrow edema.

A

TT

67
Q

Modified TF
A. Osteomyelitis is an infection of the bone that is a common complication of a patient with diabetes and pressure ulcers.
B. MRI confirms the diagnosis and extent of infection, with low signal on T1 and high signal on T2.

A

TT

68
Q

Modified TF
A. The Calcaneal Inclination, also known as calcaneal pitch, describes the angular position of the calcaneus.
B. Higher values indicate pes cavus, while lower values indicate pes planus.

A

TT

69
Q

Structures to see in the axial CT scan, except

A. Tibiofibular joint space
B. Medial and lateral malleoli
C. Calcaneus and talus of hindfoot
D. Sustentaculum tali of calcaneus
E. None

A

E. None

70
Q

Structures to see in the axial CT scan, except

A. Transverse tarsal joint space
B. Navicular and cuboid
C. 1st, 2nd, 3rd cuneiforms
D. None

A

D. None

71
Q

Structures to see in the sagittal CT scan, except

A. Anterior rim of tibia
B. Posterior rim of tibia
C. Talocrural joint space
D. Bodies of talus and calcaneus
E. None

A

E. None

72
Q

Structures to see in the sagittal CT scan, except

A. Subtalar joint space
B. Transverse tarsal joint space
C. Bodies of navicular and cuboid
D. Three cuneiform bones
E. None

A

E. None

73
Q

Structures to see in the sagittal CT scan, except

A. Tarsometatarsal joint space
B. Shafts of metatarsal
C. Sesamoid bones
D. None

A

D. None

74
Q

Structures to see in the coronal CT scan, except

A. Ankle mortise and subtalar joint
B. Talus and calcaneus
C. Talocalcaneal coalition, if present
D. Sustentaculum tali of calcaneus
E. None

A

E. None

75
Q

Structures to see in the axial MRI, except

A. Ankle tendons
B. Sinus tarsi
C. Tibiofibular ligament
D. Osseous structures (tibia, fibula, talus)
E. None

A

E. None

76
Q

Structures to see in the coronal MRI, except

A. Deltoid ligaments
B. Calcaneofibular ligament
C. Tarsal tunnel
D. None

A

D. None

77
Q

Structures to see in the coronal MRI, except

A. Talar dome
B. Subtalar joint
C. Plantar fascia in cross section
D. None

A

D. None

78
Q

Structures to see in the sagittal MRI, except

A. Achilles tendon
B. Tibiotalar joint
C. Subtalar joint
D. None

A

D. None

79
Q

Structures to see in the sagittal MRI, except

A. Transverse tarsal joint
B. Plantar fascia
C. Sinus tarsi
D. None

A

D. None

80
Q

Modified TF
A. The Bohler angle is the tuberosity or salient angle used to evaluate the angular relationship between the calcaneus and talus in the presence of trauma.
B. A lower than normal value indicates calcaneal fractures.

A

True

81
Q

Modified TF
A. The tarsal (Chopart) and tarsometatarsal (Lisfranc) joints dividing the midfoot and hindfoot are well-demonstrated on the lateral view of the foot.
B. The central ray is directed vertically through the base of the third metatarsal in this view.

A

TT

82
Q

Modified TF
A. The lateral view of the foot can be used to check for the presence of the tarsal sinus.
B. The Bohler angle and calcaneal inclination can be measured on this view.

A

TT

83
Q

The lateral view of the foot demonstrates the ff, except:

A. Calcaneus and talus
B. Subtalar joint
C. Talonavicular and calcaneocuboid articulations
D. None

A

D. None

84
Q

Modified TF
A. For the oblique view of the foot, the patient is sitting with lateral border of foot elevated (internally rotated) 55º from the image receptor.
B. The central ray is directed vertically through the base of the third metatarsal in this view.

A

FT

A. For the oblique view of the foot, the patient is sitting with lateral border of foot elevated (internally rotated) 45º from the image receptor.

85
Q

Modified TF
A. For the oblique view of the foot, the foot and leg are internally rotated 4 degrees.
B. This view is used to check for the shafts of the phalanges and metatarsals, and the joint spaces of the intermetatarsal and midtarsal joint articulations.

A

TT

86
Q

The oblique view of the foot demonstrates the ff, except:

A. phalanges and intermetatarsal
B. metatarsals and cuboid
C. navicular, anterior portions of the talus and calcaneus,
D. related midtarsal joints
E. second cuneiform

A

E. second cuneiform

Correct answer: Third cuneiform

87
Q

Modified TF
A. In a normal radiographic appearance of a 2-year-old toddler’s foot, the ossified calcaneus, talus, cuboid, and third cuneiform can be seen.
B. The navicular and first and second cuneiforms are barely seen as small oval densities.

A

TT

88
Q

Modified TF
A. On CT Scan, the four bursae of the ankle can be visualized when effused of thickened due to inflammation.
B. These bursae are the 2 subcutaneous bursae located under the medial and lateral malleolus and the subcutaneous and subtendinous calcaneal bursae that sandwiches the Achilles tendon.

A

TT

89
Q

Modified TF
A. The dome of the talus connects the distal tibia and fibula.
B. The navicular is important for noting the degree of flatfootedness.

A

TT

90
Q

Modified TF
A. The Distal Tibiofibular Syndesmotic Complex is composed of the interosseous membrane, anterior tibiofibular ligament, and posterior tibiofibular ligament.
B. In high ankle sprains, these ligaments are affected.

A

TT

91
Q

Modified TF
A. The commonly injured phalanges are the 1st and 5th.
B. The subtalar joint is the connection between the talus and calcaneus.

A

TT

92
Q

TRUE OR FALSE: Contusions are microfractures of trabecular bone and edema and hemorrhage within the marrow present as reticular or netlike areas of low signal on T1, but high signal on T2.

A

True

93
Q
  1. Osteonecrosis at the second metatarsal head
  2. Osteonecrosis at the talus as a sequelae of talar neck fractures with vascular compromise

A. Dias Disease
B. Freiburg’s Diease
C. Both
D. Neither

A
  1. B
  2. A
94
Q

CT Scan can be used to assess for the following
A. Osteochondral abnormalities
B. Tibial or talar spurs associated with anterior impingement syndrome
C. Tibiofibular syndesmotic joint, talocrural, and subtalar joint spaces
D. Transverse tarsal and tarsometatarsal joint divisions of the hindfoot, midfoot, and forefoot, as well as intertarsal and intermetatarsal articulations
E. All of the above

A

E. All of the above

95
Q

Modified TF
A. Osteonecrosis presents as areas of inhomogeneous signal intensity surrounded by a low signal band on MRI.
B. MRI can be used to assess for the change in girth of a tendon, with low signal on both T1 and T2 sequences.

A

TT

96
Q

The following conditions warrant an MRI except

A. Achilles, posterior tibial, and peroneal tendon disorders
B. ATFL, CFL, deltoid, spring, and syndesmotic ligament tears
C. Plantar fasciitis, fascial rupture, plantar fibromatosis
D. Sinus tarsi syndrome
E. None

A

E. None

97
Q

MRIs of the hindfoot and the ankle may be used to evaluate specific clinical scenarios such as
A. Tarsal tunnel syndrome
B. Patients with planned therapeutic arthroscopy and those with complications following ankle surgery
C. Acute ankle trauma
D. Ankle or subtalar instability
E. All of the above

A

E. All of the above

98
Q

MRIs of the hindfoot and the ankle may be used to evaluate specific clinical scenarios such as
A. LOM or painful ROM
B. Unexplained swelling, mass, or atrophy, or nerve entrapment
C. Ankle and hindfoot injuries in athletes and dancers
D. Prolonged, refractory, or unexplained ankle or heel pain
E. All of the above

A

E. All of the above

99
Q

TRUE OR FALSE: The tarsal tunnel is a common area for nerve entrapment in the ankle and foot

A

True

100
Q

TRUE OR FALSE: MRI may show hypertrophic bone mass impingement on adjacent structures, such as the tibialis posterior and the flexor hallucis longus in the tarsal tunnel.

A

True

101
Q

Modified TF
A. MR Arthrogram is the combination of MR and arthrogrpahy.
B. The joint is injected with contrast under fluroscopic guidance.

A

TT

102
Q

Modified TF
A. MR Arthrogram is used in cases when MRI is not sufficient enough to gather an adequate diagnosis.
B. In practice, an arthrogram is used most frequently to stage osteochondral lesions of the talus.

A

TT

103
Q

Modified TF
A. In MR arthrogram, communication between the flexor hallucis longus tendon and the ankle joint is present in 20% to 30% of individuals.
B. Thus, fluid seen here in the setting of an arthogram should not be misinterpreted as tenosynovitis.

A

TT

104
Q

Modified TF
A. In MR arthrogram, all three orthogonal planes are evaluated.
B. Distention of the tibiotibular joint capsule via injection of dilute gadolinium allows identification of all-intra-articular tissues in this procedure.

A

TT

105
Q

TRUE OR FALSE: MR arthrogram may facilitate the evaluation of:
* Lateral collateral ligaments
* Anterior talofibular ligament
* Calcaneofibular ligament
* Impingement syndromes
* Cartilage lesions
* Osteochondral lesions of the talus
* Loose bodies
* Synovial joint disorders

A

True

(3) Musculoskeletal Imaging (25 decks)

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