Ultrasound can be a useful tool in the diagnosis and evaluation of atrophy of the fat pad on the plantar foot, whether it is the forefoot or the heel. (a) Coronal proton-density-weighted (1,800/20) MR image shows a defect of the right plantar fascia representing a tear (black arrow). 6, American Journal of Roentgenology, Vol. The posterior tibial artery (PTA) and posterior tibial vein (PTV) lie closer to the flexor retinaculum than do the nerves. Note the anterior location of the posterior tibial (pt) and FDL (fdl) tendons. Associated diffuse bone marrow edema of the calcaneus demonstrates ill-defined low signal intensity. Musculoskeletal ultrasound is inexpensive, portable, reliable, quick and free of radiation. We also review pertinent MR imaging findings with emphasis on those findings that suggest a specific diagnosis. 42, No. The diagnosis of fibrous dysplasia was made at bone biopsy.Download as PowerPointOpen in Image Surgical bursectomy and resection of the superior prominence of the calcaneal tuberosity are rarely indicated. 197, No. Schwannoma in a 25-year-old man. (a) Radiograph shows a well-defined radiolucent lesion in the anterior third of the calcaneus, the region in which a unicameral bone cyst is typically seen. Heel fat pad syndrome with a thin heel fat pad with abnormal mobile fat and effusion between plantar fascia and heel fat pad. Stress fractures generally involve the posterosuperior or posterior calcaneus and have a vertical orientation. The underlying FDB muscle also demonstrates changes in signal intensity representing edema and hemorrhage (white arrows). When this fat pad isn’t able to cushion effectively, walking and moving can be very painful. (b) Sagittal T2-weighted (2,500/90) MR image obtained at same level shows a heterogeneous, predominantly low-signal-intensity lesion occupying the synovial sheath of the FHL tendon (arrowheads). Note the globular, heterogeneous pattern of increased signal intensity representing the xanthomatous deposit and the interspersed areas of low signal intensity representing residual normal collagen fibers. These disorders are classified on the basis of anatomic origin and predominant location of heel pain to foster a better understanding of this complaint. Associated diffuse bone marrow edema of the calcaneus demonstrates ill-defined low signal intensity. (c) On a sagittal STIR (2,421/20/160) MR image obtained at the same level as b, the lesion has inhomogeneous intermediate to high signal intensity. Athletes who perform repetitive forceful pushoffs with the forefoot (eg, ballet dancers) are predisposed to FHL tenosynovitis (,3,,21). The largest lesion (arrowheads) is heterogeneous and slightly hyperintense relative to adjacent muscle with small regions of low signal intensity. Musculoskeletal ultrasound is inexpensive, portable, reliable, quick and free of radiation. The associated lesion of the underlying FDB muscle has ill-defined high signal intensity (white arrows). (d) Follow-up radiograph obtained 3 weeks later shows a more evident band of new bone formation (arrowheads) corresponding to the abnormality seen at MR imaging.Download as PowerPointOpen in Image Figure 12c. 3, Journal of the American Academy of Orthopaedic Surgeons, Vol. Fibrous dysplasia of the calcaneus in a 53-year-old woman. Plantar fasciitis sufferers usually experience a sharper pain in a specific spot on the inner heel. The fat pad may be unstable from the underlying calcaneal tuberosity, with a concomitant bursitic reaction between the bone and the pad. Figure 12a. This lesion was also isointense relative to fat on T2-weighted and STIR images (not shown), strongly suggesting a diagnosis of calcaneus lipoma. 46, No. (b) Sagittal T1-weighted (450/25) MR image shows a lesion with low to intermediate signal intensity and hypointense, sclerotic borders. Diagnosis is essentially clinical, and further evaluation is not required. Fibrous dysplasia of the calcaneus in a 53-year-old woman. Patients often feel they are “walking on pebbles” or feel they are hitting the ground very hard with their bones. Associated diffuse bone marrow edema of the calcaneus demonstrates ill-defined low signal intensity. 5, The Journal of Foot and Ankle Surgery, Vol. Acute and subacute muscle tears are characterized by high-signal-intensity changes with a feathery appearance on both T1- and T2-weighted images representing muscle bleeding and edema. Figure 15b. The heel pain from heel fat pad syndrome is caused by a thin, damaged fat pad that covers the heel bone. In such cases, MR imaging demonstrates edematous changes in the fat pad, with ill-defined areas of decreased signal intensity on T1-weighted images that increase in signal intensity on T2-weighted images (,31). Heel fat pad syndrome is often caused by a decreased elasticity of the fat pad. 1, European Journal of Radiology, Vol. The associated lesion of the underlying FDB muscle has ill-defined high signal intensity (white arrows).Download as PowerPointOpen in Image

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