Lateral hind foot pain is a relatively common complaint in Trauma and Orthopedics, Rheumatology and Sports Clinics in the UK. The lateral hindfoot is frequently subjected to trauma and overuse injury. A history of trauma is elicited in some patients. The clinical examination and first line investigations, such as plain films, are not always diagnostic (except for the obvious fractures/dislocations). Our aim was to identify, on further evaluation, the more subtle, less obvious injuries in the lateral hind foot/midfoot area, improve the patients’ care and...

We studied the hind foot appearances on MRI of the ankle and foot in two large DGH Hospitals over one year period (Oct 2014-Oct 2016), in patients referred to our Departments (with- or without a trauma history), with lateral hind foot pain, where the plain films did not detect any diagnostic feature. Four dedicated MSK Radiologists reviewed the scans and agreed upon the findings.

1125 MRI scans of the foot and ankle were reviewed for the purpose of the study. The median age of the patients was 35(age range from 12 to 80). 685(n1=685) were female patients and 440 (n2=440) were male patients. A history of trauma was documented in 810(k=810) patients. MRI detectable findings include bone marrow oedema, osteochondral fractures, peroneus longus tendon tears and tendinosis, tears of the plantar fascia and injuries to the abductor digiti minimi. Many of these injuries are also overlooked in MRI reports,...

Lateral hind foot/midfoot pain is relatively common and can be a diagnostic challenge, in particular where plain films are negative and the cause of pain is not clinically obvious. Our preliminary results suggest the need of more extensive, early MRI use to detect more subtle, treatable injuries and avoid long-term disability (particularly important when weight bearing is affected). The use of limited, dedicated MR protocols may be helpful, but needs further evaluation.

1)Robinson P, White LM. Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management.RadioGraphics2002; 22(6):1457-1469. 2)Nazarenko A, Beltran LS, Bencardino JT. Imaging evaluation of traumatic ligamentous injuries of the ankle and foot.Radiol Clin North Am2013; 51:455–478. 3)Chan KW, Ding BC, Mroczek KJ. Acute and chronic lateral ankle instability in the athlete.Bull NYU Hosp Jt Dis2011; 69(1):17-26

Dr T. Jayawardhana is F1 Doctor in Surgery&Orthopaedics at Darent Valley Hospital NHS Trust Dartford Kent UK Dr A. Singaravelou is F1 Doctor in Surgery&Orthopaedics at Darent Valley Hospital NHS Trust Dartford Kent UK Mr. A. Tindall is Consultant in Trauma&Orthopaedics at at Greenwich&Lewisham Hospitals NHS Trust London UK Mr. M.Norris is Consultant in Trauma&Orthopaedics at Darent Valley Hospital NHS Trust Dartford Kent UK Dr L. Meacock is Consultant MSK Radiologist at Kings' College Hospital NHS Foundation Trust London UK Dr. M.S. Gulati is Consultant...