0:00

While we're talking about stress fractures,

0:02

let's look at some other common stress

0:04

fractures in the foot.

0:05

Here's a person who has heel pain with running,

0:08

and we can identify that characteristic Band

0:10

of sclerosis in the calcaneus that's perpendicular

0:13

to the normal trabecular pattern characteristic appearance

0:16

for a stress fracture.

0:18

Different patient with heel pain comes in

0:21

with eye symptoms and a discharge.

0:24

Here we see what looks like erosive features

0:27

along the inferior aspect of the calcaneus.

0:30

At the plantar fascia attachment site.

0:33

On MRI, we see a bone marrow edema pattern,

0:36

and this is a case of reactive arthritis.

0:40

So in patients with plantar fasciitis,

0:42

they have plantar heel pain upon walking,

0:44

particularly in the morning.

0:46

It's often related to chronic repetitious trauma

0:48

with some micro tears of the erotic complex.

0:50

At its origin, MRI appearance shows edema around the origin

0:55

if severe and longstanding, they can get stress

0:58

or revulsion fractures of the calcaneus.

1:01

Here's an MRI example of plantar fasciitis

1:03

where we see thickening of the plantar fascia, remodeling

1:06

of the epi neurosis

1:07

and associated bone marrow edema pattern

1:10

with a small evulsion.

1:11

More acute avulsions can occur in the calcaneus

1:14

as shown in this example here.

1:16

This is related to the attachment side

1:18

of the achilles tendon,

1:20

or you can get calcaneal insufficiency type fractures

1:23

in the setting of diabetes.

1:25

In terms of the calcaneal fracture anatomy,

1:28

once you identify a calcaneal fracture, you really go

1:31

to CT in order to further characterize it.

1:33

So radiography is more about the detection of

1:35

that calcaneus fracture,

1:37

whether it's an avulsion type lesion

1:39

or you're seeing an abnormal boar's angle.

1:42

So mechanism for calcan fractures are

1:44

typically a fall from a height.

1:46

Also look for concurrent spine injuries.

1:49

The primary fracture line separates the calcaneus into the

1:52

susac and the tuberosity fragments,

1:55

and a susac fragment typically is tethered

1:58

by the tail calcaneal ligament.

2:00

Couple of other interesting four foot injuries.

2:03

You can have a dislocation at the first

2:05

metatarsal phal joint.

2:07

Here we have intraarticular displacement of the sesamoids

2:10

and a type one where they're not widened

2:14

and the interrace space is normal,

2:16

or a type two where we have fracture of the sesamoids

2:19

and disruption of that interal ligament.

2:22

So in summary, the ankle is the most frequently injured

2:24

joint and ankle fractures are increasing in incidents.

2:27

As the population ages,

2:29

ankle fractures occur in a predictable pattern.

2:31

The classification systems provide a reproducible mode

2:34

of communication which allow for decision making with regard

2:37

to treatment.