5 April 2023

Using MRI to diagnose foot and ankle injuries

5 April 2023

Using MRI to diagnose foot and ankle injuries

The foot and ankle are both complex and durable, yet vulnerable to a range of injuries which can occur either acutely or over time due to repetitive movements or strain.

The ankle is known as a hinged synovial joint and is formed where the talus, tibia and fibula bones meet. The ankle joint is vital to human mobility, as it adapts to the surface on which one walks. The joint is stabilised medially (toward the middle) by the deltoid ligament, and laterally by the anterior, posterior, talofibular and calcaneofibular ligaments.

Each ankle/foot joint is made up of 26 bones, 30 joints, and over 100 muscles, as well as many more ligaments and tendons working in synchrony to provide balance and support.

Five most common foot and ankle injuries

1. Plantar fasciitis

An injury that affects thousands of Australians every year, plantar fasciitis occurs when a band of tissue in the arch of the foot known as the fascia becomes inflamed. The condition results in sharp pain, generally felt around the heel. Many individuals find that pain is most severe when the foot has been rested, such as first thing in the morning, however when the fascia has been allowed to stretch, the pain may subside to some degree. 

2. Ankle sprain
A sprain occurs when one or more of the ankle’s supporting ligaments is either stretched or torn. The most common injury is an inversion strain (twisting the ankle inwards). High ankle sprains are another common injury and occur when the syndesmotic ligament, which stretches between the fibula and the tibia, is stretched or torn. Ankle sprains can be painful and reduce mobility, however less severe sprains can be treated by rest and periodic icing. If swelling and/or pain persists, it’s important to seek medical treatment. More severe sprains, if left untreated, can weaken the ankle and lead to repeated injuries.  

3. Stress fractures of the foot

Repetitive force to the foot can result in microscopic damage to the small bones in the foot, which over time can lead to stress fractures. Certain bones in the foot including the second, third and fifth metatarsals, navicular and sesamoid of the toe are particularly vulnerable. Stress fractures tend to occur when someone significantly increases their volume and type of exercise activity, such as introducing running on the road or a hard concrete surface multiple days per week. In these situations, the small bones don’t have an opportunity to heal before the damage is compounded over and again until stress fractures appear. 

4. Fractures of the ankle

The bones within the ankle are relatively sturdy and as such fractures tend to occur as a result of an acute traumatic injury, rather than from repetitive stress. A fracture of the ankle is a serious injury which is generally quite painful and often accompanied by swelling and bruising. If an ankle fracture is suspected, it’s important to seek medical attention quickly to determine the nature of the injury. 

5. Achilles tendonitis and tears

The Achilles tendon connects the bone of the heel to the muscles of the calf, called the gastrocnemius and soleus. It is the largest tendon in the body and is vulnerable to inflammation and injury. Inflammation of the Achilles tendon can occur as a result of repetitive strain and is known as Achilles tendonitis. Those suffering from Achilles tendonitis are more vulnerable to tendon rupturing or tearing, although this injury can also occur as a result of acute trauma, such as landing a jump hard or awkwardly on the heels. If a popping sound or sensation is noticed, accompanied by significant pain around the heel after landing hard on the feet, seek medical attention to determine the nature and extent of the injury.

Diagnosis and treatment

Accurate diagnosis of any persistent or troublesome injury to the foot or ankle is vital to ensuring it is treated correctly and can begin to heal quickly. The foot and ankle are among the hardest of all areas to image because of the complex three-dimensional anatomy. 

When it comes to diagnosing foot and ankle injuries, MRI is often recommended due to its ability to visualise soft tissue, bone marrow and fractures that are not evident on x-ray or other imaging modalities.

The longer an injury to a foot or ankle is ignored the more likely that further complications will develop which can lead to increased pain, further injury and even permanent damage. While minor injuries can usually be treated with frequent icing and rest, if pain or swelling persists, or the injury seems to keep coming back, the advice of a health professional should be sought.

Depending on the nature of the injury, some form of immobilisation such as a cast, splint or brace may be used in order to allow the injured bones or tissue to heal. There are a range of other treatment options which doctors may recommend, including prescription of non-steroidal anti-inflammatory drugs and corticosteroid injections, the use of custom orthotics, physical therapy and some newer regenerative therapies, as well as surgical options for more severe injuries. 

When to seek medical attention and MRI

If you’re suffering from acute or repetitive strain injuries, or unexplained pain in the foot or ankle that is not responding to treatment, talk to your doctor about scheduling an MRI scan to aid diagnosis. 

Find out more about MRI here.

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