SLR - October 2018 - Frank L. Narcisi

Postoperative Foot and Ankle MR Imaging

Reference: Madoff SD, Kaye J, Newman JS. Postoperative Foot and Ankle MR Imaging. Magn Reson Imaging Clin N Am. 2017 Feb;25(1):195-209 http://dx.doi.org/10.1016/j.mric.2016.08.008.

Scientific Literature Review

Reviewed By: Frank L. Narcisi, DPM
Residency Program: Mercy Hospital and Medical Center, Chicago IL

Podiatric Relevance: This is a review article highlighting the MRI findings in foot and ankle surgery. There is a variety of pathology and surgical techniques covered, as well as an overview of the role of MRI in perioperative use. As we go through our training, preoperative pathology is studied in depth on MRI to assist in surgical or nonsurgical planning. The authors have broken down commonly injured tendons and ligaments into pre- and post-operative findings on MRI. Postoperative MRI is a potentially challenging study to interpret due to the nonanatomic nature of repairs, as well as additional foreign materials (metal plates and screws, suture, grafts for augmentation, etc.). This article is a great resource for the lesser studied postoperative changes seen in structures that vary in appearance based on time from surgery. Surgical complications are also noted, showing the usefulness of MRI postoperatively in certain instances. These findings can provide valuable information for guiding care postoperatively.

Methods: This article is part of a collection of 13 articles, with an in-depth look at the foot and ankle from a radiologist’s perspective. This article in particular is a collaboration of three musculoskeletal trained radiologists from New England Baptist Hospital (Tufts University School of Medicine, Boston, MA). They have put together and extensive review of the literature involving many types of podiatric surgery with associated MR findings.

Results:
This article is broken down into: 

  • MRI and Its Role in the Foot and Ankle
  • Tendon Repair and Reconstruction
  • Achilles Tendon
  • Posterior Tibialis Tendon
  • Ankle Lateral Collateral Ligaments
  • Ankle Medial Collateral Ligaments
  • Morton Neuroma-Interdigital Perineural Fibrosis
  • Coalition
  • Complications: Stress Injury or Fracture
  • Osteomyelitis
  • Multifocal Bone Marrow Edema

    Conclusions: Overall, the authors pooled together a great collection of literature, highlighting MRI in podiatric surgery. This article is a great reference for many common surgical findings seen on MRI, as well as changes during the postoperative course. Each section elaborates on the topic, going into normal and abnormal anatomy, basic surgical techniques and treatments, as well as findings during the postoperative course. In addition, there are many high-quality images available to help illustrate these findings as they change during the postoperative course. After going through this article, as well as the rest of the collection, I have found that this will be a wonderful reference to use not only as a guide, but to continue to improve my knowledge and understanding of MRI in the foot and ankle.

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