The awareness of hindfoot malalignment on non-weight-bearing ankle MRI
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SCIENTIFIC ARTICLE
The awareness of hindfoot malalignment on non-weight-bearing ankle MRI Syed Ehtasham Junaid 1 & Anil Haldar 2 & Raul Colta 2 & Karan Malhotra 2 & Kar Ho Brian Lee 3 & Matthew Welck 2 & Asif Saifuddin 1 Received: 16 July 2020 / Revised: 6 November 2020 / Accepted: 15 November 2020 # ISS 2020
Abstract Objective Hindfoot malalignment is a relatively common clinical finding and several studies have suggested that hindfoot valgus can be identified on non-weight-bearing ankle MRI. The aim of this study was to determine the awareness of hindfoot malalignment on ankle MRI amongst consultant musculoskeletal radiologists. Materials and methods All MRI studies referred by Foot and Ankle Unit Consultants reported by one of 14 consultant musculoskeletal radiologists between March 2016 and August 2019 were retrieved from the Hospital Radiology Information System. These were reviewed independently by a radiology fellow and a consultant radiologist. Tibiocalcaneal angle (TCA) was measured, and extra-articular talocalcaneal (EA-TCI) and calcaneofibular impingement (EA-CFI) were recorded. Radiology reports were then analysed for mention of hindfoot malalignment and the presence of EA-TCI and EA-CFI. Results The study group comprised 129 patients, 46 males and 83 females with a mean age of 46.8 years (range 8–84 years). Based on review, hindfoot valgus was present in 78–80 cases (60.5–62%), EA-TCI in 30–36 cases (23.2–27.9%) and EA-CFI in 18–21 cases (14–16.3%). By comparison, MRI reports mentioned hindfoot valgus in 18 cases (2 incorrectly), EA-TCI in 8 cases (1 incorrectly) and EA-CFI in 10 cases (1 incorrectly). Conclusion Hindfoot valgus, EA-TCI and EA-CFI were present relatively commonly on review of ankle MRI studies in patients referred from a specialist Foot and Ankle Unit but were commonly under-reported highlighting a relative lack of awareness of hindfoot malalignment on ankle MRI amongst musculoskeletal radiologists, which could impact negatively on patient management. Keywords Ankle . MRI . Hindfoot valgus . Extra-articular impingement
Introduction Hindfoot valgus is a relatively common clinical finding of varying aetiology, which in the adult population is most commonly associated with or secondary to tibialis posterior tendon
* Syed Ehtasham Junaid [email protected] 1
Department of Imaging, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, England
2
Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, England
3
Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, 25 Waterloo Road, Yau Ma Tei, Kowloon, Hong Kong
dysfunction resulting in acquired adult flat foot deformity [1, 2]. Early recognition of this condition may prevent the development of fixed deformity and hindfoot osteoarthritis (OA) [3]. Imaging assessment is traditionally by weight-bearing radiography [4, 5], and more recently weight-bearing CT [6, 7], while ankle MRI is traditionally of value in assessing the status of relevant soft tissue structures including the tibialis posterior t
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