발목 관절의 MRI 체크리스트

1. Tibiotalar joint including talar dome (T1W for subchondral signal change and T2W) 

2. Subtalar joints : posterior, middle, anterior facets (T1 & T2) 

3. Midfoot : calcaneocuboid joint, talonavicular joint, Lisfranc ligament 

4. Interosseous membrane(high signal or thickening indicated injury : axial images)

5. Ligaments (at least axial and coronal proton density) 

1) Lateral Ligament

• AITF : "D" shaped fibula on axial plane 

• PITF : "D" shaped fibula on axial plane 

• ATF : "C" shaped/concave fibula on axial plane 

• PTF : "C" shaped/concave fibula on axial plane 

• CF : normally not as black as anterior talofibular ligament 

2) Medial Ligament (=Deltoid ligament) 

• Deep Deltoid : normally heterogenous, if loses hetergeneity this is bad 

• Spring ligament : travels under the talar head medial ankle

6. Tendons 

1) Posterior Tendons

• Achilles tendon : normally concave or flat anteriorly on axials. Normally <6mm thick

• FHL can have fluid around it as well, FDL 

• Tibialis posterior tendon

Allowed to have a small bit of fluid around it at the level of the medial malleolus, anymore and it is abnormal. 

If the fluid is circumferential or if it is > 3mm thick then it is abnormal. 

The normal tibialis posterior tendon should be only 2-3 times the size of the flexor digitorum tendon in the axial plane. 

2) Anterior Tendons : Tibialis Anterior tendon, Extensor digitorum longus tendon

7. Sinus tarsi : fat should remain preserve (FSE and T1 bright) 

8. Plantar fascia 

• Medial band is more commonly affected than lateral band 

• If thickness of the medial band is >5 mm or if high T2 signal (edema) this is abnormal 

9. Assess tarsal tunnel (look for masses such as ganglions or synovial cysts 

10. Check the base of the 5th metatarsal for a fracture on the axial PDs

* Tendon anatomy

1. FHL = FDL X 2 

2. TP = FDL X 2~3 

3. PTT = FDL X 3~4 

4. PB = FDL X 1.5