Sports Medicine: Just the Facts

•Other findings in cases of chronic Achilles tendon
injuries include reactive edema in the calcaneus and
fluid in the deep retrocalcaneal bursa.

• The sinus tarsus is an anatomic region between the
  posterior subtalar joint and the talocalcaneonavicular
  joint (Klein and Spreitzer, 1993). Fat and blood ves-
  sels are normally seen in the sinus tarsi in addition to
  five ligaments: the medial, intermediate, and lateral
  roots of the inferior extensor retinaculum; the cervi-
  cal ligament; and the ligament of the tarsal canal
  (Klein and Spreitzer, 1993). Patients with sinus tarsi
  syndrome may have a morphological abnormality in

the sinus tarsi, such as ligament tears or ganglion

cysts.

• The location of the peroneal tendons with respect to
  the fibular groove should be evaluated; insufficiency
  of the superior peroneal retinaculum can result in per-
  oneal tendon dislocation (Bencardino, Rosenberg, and
  Delfaut, 1999).
  •Plantar fasciitis is diagnosed with MR as diffuse fas-
  cial thickening, usually at the calcaneal insertion with
  intrafascial hyperintensity (Narvaez et al, 2000).
  Occasionally, reactive edema in the calcaneus and
  edema in the heel fat pad can also be identified.


• The presence of osseous spurs at the anterior margin
  of the tibial plafond should be looked for, as these
  may be associated with anterior impingement.


• Posterior ankle impingement, classically described in
  ballet dancers, can be seen on fat suppressed MR
  images as abnormal intraossoeus signal in the os
  trigonum or lateral talar tubercle (Bureau et al, 2000).

REFERENCES

Anderson MW, Kaplan PA, Dussault RG: Adductor insertion

avulsion syndrome (thigh splints): spectrum of MR imaging

features. Am J Roentgen2001;177:673–675.

Balen PF, Helms CA: Association of posterior tibial tendon injury

with spring ligament injury, sinus tarsi abnormality and plantar

fasciitis on MR imaging. Am J Roentgen2001;176:1137–1143.

Bencardino J, Rosenberg ZS, Delfaut E: MR imaging in sports

injuries of the foot and ankle. MRI Clinics of North America.

1999;7(1):131–149.

Berlet GC, Mascia A, Miniaci A: Treatment of unstable osteo-

chondritis dissecans lesions of the knee using autogenous

336 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE

FIG. 56-11 Coronal fast spin

echo (left) and sagittal inver-

sion recovery (right) images of

the ankle demonstrate an osteo-

chondral impaction injury

involving the medial aspect of

the talar dome (arrows).

Subchondral cystic change and

edema are seen in the talar

dome, as well as overlying

hyperintense, frayed articular

cartilage.

FIG. 56-12 Sagittal fast spin echo image demonstrating mod-
erate Achilles tendinosis with thickening and mild intrasubstance
hyperintensity in the Achilles tendon.