0:01

So now let's consider a number of subtle uls

0:03

that can occur around the ankle and foot.

0:06

Here's a person with lateral ankle pain

0:08

after a twisting injury.

0:10

So with lateral ankle pain

0:11

after twisting injury, hard

0:13

to identify the abnormality here.

0:16

On a magnification part, we can see a little

0:19

displaced portion of bone off of the lateral malleolus.

0:23

That's at the attachment side of the perineal ret aum.

0:26

That represents a peroneal ret macular evulsion from the

0:29

fibula here on MRI, we can see that's

0:33

where the perineal tendons would be maintained

0:37

and these injuries have implications for being associated

0:39

with perineal tendon subluxation and dislocation.

0:44

Here's another person

0:46

after an inversion injury with lateral ankle pain.

0:50

Here is a AP of the foot

0:53

and we can see a little OSS osteo avulsion fragment here off

0:55

of the lateral aspect of the calcaneus.

0:58

If we go back to the frontal projection, we can see

1:01

that evulsion fracture off of the calcaneus

1:04

so lower than the ankle joint proper,

1:07

and it's associated with soft tissue swelling,

1:09

which represents an avulsion of the origin

1:11

of the extensor digitorum brevis muscle attachment.

1:15

Here's another example of pain in that region

1:18

and on the frontal projection, there's soft tissue edema

1:22

below the level of the malleolus

1:24

and a small fleck of bone that we see a vols off.

1:27

Another case of extensor digitorum brevis evulsion.

1:31

So here's a person whose status post foot inversion

1:33

and plantar flexion injury.

1:35

Here we have a lateral projection of the foot,

1:38

an oblique projection,

1:40

and if we look carefully, we see

1:43

that there is a fracture line through the anterior process

1:46

of the calcaneus, which you can see quite

1:48

well on both projections.

1:50

And so this is an anterior process fracture.

1:54

So here is another example of an avulsion fracture

1:56

that looks similar to an anterior process fracture,

2:00

but it represents a midtarsal sprain.

2:03

So the spring ligament has an attachment

2:05

to the navicular here and can a vols off.

2:08

And so this is another fracture

2:10

that may identify on an oblique projection.

2:13

Here we have a fracture coming off of the Taylor neck,

2:17

however, this is an avulsion type injury

2:20

and in this person, if we go back, we had a radiograph

2:24

before the injury that showed that there was a little

2:28

bony prominence there at the capsular attachment site,

2:31

which is now a vols acutely.

2:34

So these are some of the typical fractures

2:36

that can occur in midtarsal sprains.

2:38

So here on this lateral projection, we see an arrow pointing

2:41

to where you get evulsion

2:43

of the anterior process of the calcaneus.

2:45

You may also get a concomitant plantar flexion related

2:48

evulsion of the dorsal tail

2:50

and navicular joint shown with the arrowhead,

2:53

and potential for aversion related impaction fractures

2:57

about the calcaneal OID joint shown with the oval.