Mri anatomy of ankle

1. By- Dr. Shrikant Nagare

2. ANKLE JOINT (TALOCRURAL JOINT):
 Tibia, fibula & talus form synovial joint.
 Supported by lateral & medial collateral ligaments.
DISTAL TIBIOFIBULAR JOINT:
 Fibrous joint.
 Supported by syndesmotic ligaments.
 Synovial recess from ankle joint extends into joint.
HINDFOOT :
 Talus & calcaneus.
 Posterior, middle & anterior subtalar joints between talus & calcaneus.

3. 3 sets bind ankle:
 Distal tibio-fibular syndesmotic complex.
 Lateral collateral ligament.
 Deltoid ligament.

4. ANTERIOR & POSTERIOR TIBIOFIBULAR
LIGAMENTS:
 Extends obliquely between anterior & posterior tibial &
fibular tubercles respectively.
 Distal anterior tibio-fibular ligament : Basset ligament.
INFERIOR TRANSVERSE LIGAMENT:
 Distal part of the posterior tibio-fibular ligament.
INTEROSSEOUS LIGAMENT:
 Distal thickening of syndesmotic membrane.

6. ANTERIOR TALO-FIBULAR LIGAMENT:
 Originates 1cm proximal to lateral malleolar tip, inserts
on talar neck.
 Weakest, first to tear.
CALCANEO-FIBULAR LIGAMENT:
 Originates from lateral malleolar tip, inserts on
calcaneal trochlear eminence.
POSTERIOR TALO-FIBULAR LIGAMENT:
 Extends from lateral malleolar fossa to lateral talar
tubercle.
 Strongest, rarely tears.

8.  Fan shaped, originates from medial malleolus,
inserts on talus & navicular.
 Deep: Posterior & Anterior Tibiotalar bands.
 Superficial: Tibio-calcaneal, Tibio-navicular &
Posterior Tibio-talar Bands

10.  PLANTAR CALCANEO-NAVICULAR LIGAMENT.
 Binds calcaneum to navicular.
 3 components: Superomedial, Medioplantar
oblique & Inferoplantar longitudinal.

12.  Focal thickening of deep fascia.
 Binds tendons down.
 SUPERIOR EXTENSOR RETINACULUM.
 INFERIOR EXTENSOR RETINACULUM.
 FLEXOR RETINACULUM.
 SUPERIOR PERONEAL RETINACULUM.
 INFERIOR PERONEAL RETINACULUM.

16. POSTERIOR (1)
MEDIAL (3) LATERAL (2)
ANTERIOR (4)

21.  Osseofibrous canal.
 Superficially – Flexor retinaculum.
 Deep – Medial surface of Talus & Calcaneum.
 Contents –
 3 medial tendons ( T.P. / FDL / FHL )
 Posterior Tibial vessels.
 Nerves.

22.  Lateral funnel shaped space between talus and
calcaneum.
 Contains Fat, NV structures and Talocalcaneal
(interosseous)& Cervical ligament.

24.  AXIAL, CORONAL & SAGGITAL PLANES.

25.  Axial plane is optimal for ankle tendons,
ligaments.
 Coronal useful for bones, cartilage, ankle and
sinus tarsi ligaments.
 Sagittal optimal for Achilles tendon, bones,
cartilage, sinus tarsi ligaments.

26.  The tendons show uniformly low signal intensity in all
spin echo pulse sequences except Achilles tendon and
tibialis posterior tendon occasionally show small foci of
intermediate signal intensity near their insertion on
long TR sequences.
 The ankle ligaments show low signal intensity with
exception of posterior talo-fibular ligament, which
often appears inhomogeneous.

27.  Magic angle artifact is often seen in ankle tendons.
 55 degree angle with the magnetic field.
 Because of the oblique course of ankle ligaments &
tendons.
 Specially in GRE sequences.
 Seen as areas of hyperintense signal .
 which may be confused for tears.
 Imaging with foot in plantar flexion decreases the angle
& hence the magic angle artifact.

28. 1 POSTERIOR
1. TENDOACHILLES
Inserts on calcaneum
Axial & Sagittal views

29.  Posterior to lateral malleolus
 Peroneus Brevis (anterior to P.L.
& inserts on the base of 5th m.t.)
 Peroneus Longus
( inserts on the undersurface of foot)
2 LATERAL TENDONS
F
T
AXIAL

30. 3 MEDIAL TENDONS
•Anterior to posterior
TIBIALIS POSTERIOR
FLEXOR DIGITORUM LONGUS
FLEXOR HALLUCIS LONGUS
.
•Just posterior to medial malleolus
T
F
AXIAL

31. 4 ANTERIOR TENDONS
•Medial to Lateral
Tibialis anterior
Extensor Hallucis Longus
Extensor Digitorium Longus
Divides into 4 tendons to 2nd to 4th toe
Peroneus Tertius
AXIAL

32. T.A.
T.A.
EHL
EDL
P.T.
P.L.
P.B.
T.P.
FDL
FHL

33. DELTOID LIGAMENT

34. Post.
Tibiotalar
(Deep)
Tibiocalcaneal
(Superficial)
MEDIAL COLLATERAL LIG.

35. Anterior
Posterior
TALOFIBULAR LIGAMENT
Talus

36. CALCANEOFIBULAR LIGAMENT
Peroneus
Calcaneofibular
Lig.
Difficult to Visualize
Oblique Coronal image
Or
Foot in greater plantar flexion

37. Anterior
Posterior
TIBIOFIBULAR LIGAMENT
AXIAL

38. Post. Tibiofibular
Ligament
Post. Talofibular
Ligament

39. T
C

40. PATHOLOGY
INJURY
INFECTIONS
TENOSYNOVITIS
 PLANTAR FASCITIS
TARSAL TUNNEL SYNDROME
-pain / paresthesias along the post. Tibial nerve
SINUS TARSI SYNDROME
-pain over lateral aspect of foot.

41. Partial T.A. Rupture

42. Torn Achilles tendon with fluid collected at the site
of the tear

44. Anterior Tibiofibular Lig.
Tear

45. DELTOID
TEAR

46. ANKLE KOCHS

47. Diffuse Soft Tissue Inflammation

48. Sinus Tarsi Syndrome
•Loss of normal fat
•Hyperintense signal
•Nonvisualisation of lig.
Most common cause-Trauma

49. EXCELLENT SOFT TISSUE DETAILS
While MRI can depict most of the ligaments & tendons , It is very often
difficult
To precisely point out individual bands/components of the ligaments
which is rarely
If ever required for diagnosis or management.
Hyperintense signal on T2 WI due either to edema or fluid strikingly
points out
Towards the pathology
GOOD BONY DETAILS
HIGH SENSITIVITY
To Summarise
•MINIMAL FLUID
•PARTIAL TEARS
•BONE MARROW EDEMA