Plantar Fascia

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The plantar fascia is a fibrous aponeurosis attaching to the plantar anterior aspect of the calcaneus, coursing adjacent to the plantar margin of the flexor dig-itorum brevis muscle, and sending digital slips to each toe. Interconnecting transverse fasciculi are present between the digital slips. The superficial transverse metatarsal ligaments and the flexor digitorum brevis tendons also have attachments to the plantar fascia. A smaller lateral band of the plantar fascia is present, extending between the calcaneus and the base of the fifth metatarsal. Acute tear of the plantar fascia is occasionally seen in athletes (Fig. 51) [116]. In this population, surgical repair is typically performed. Chronic degeneration of the plantar fascia has been termed plantar fasciitis, despite a lack of inflammation [117]. This is manifested as thickening, heterogeneous appearance, and increased signal intensity at MRI (Fig. 52) [118]. Symptomatic relief has been reported from surgical release of the degenerated plantar fascia [119], which may be performed endoscopically, with improved recovery times compared with open release [120]. A biomechanical study has shown that increased stress is placed on the ligaments of the hindfoot after plantar fascia release [121]

MRI provides accurate evaluation of the articular cartilage, bones, ligaments, tendons, nerves, and vessels of the ankle. A thorough understanding of the anatomy and imaging manifestations of ankle injury is necessary for adequate evaluation. MRI is useful in treatment planning by evaluating the extent of injury and the presence of associated injuries.


[1] Gehrmann RM, Rajan S, Patel DV, et al. Athletes' ankle injuries: diagnosis and management. Am J Orthop 2005;34(11):551-61.

[2] LinklaterJ. Ligamentous, chondral, and osteochondral ankle injuries in athletes. Semin Mus-culoskelet Radiol 2004;8(1):81-98.

[3] Mintz DN, Tashjian GS, Connell DA, et al. Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy 2003;19(4): 353-9.

[4] De Smet AA, Fisher DR, Burnstein MI, et al. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. AJR Am J Roentgenol 1990;154(3):555-8.

[5] Hangody L, Kish G, Modis L, et al. Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int 2001;22(7): 552-8.

[6] Clanton TO, DeLeeJC. Osteochondritis dissecans. History, pathophysiology and current treatment concepts. Clin Orthop Relat Res 1982;167:50-64.

[7] Loredo R, Sanders TG. Imaging of osteochondral injuries. Clin Sports Med 2001;20(2): 249-78.

[8] Kumai T, Takakura Y, Higashiyama I, et al. Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 1999;81(9):1229-35.

[9] Nelson SC, Haycock DM. Arthroscopy-assisted retrograde drilling of osteochondral lesions of the talar dome. J Am Podiatr Med Assoc 2005;95(1):91-6.

[10] Takao M, Uchio Y, Kakimaru H, et al. Arthroscopic drilling with debridement of remaining cartilage for osteochondral lesions of the talar dome in unstable ankles. Am J Sports Med 2004;32(2):332-6.

[11] Wilder RP, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med 2004;23(1):55-81.

[12] Sullivan D, Warren RF, Pavlov H, etal. Stress fractures in 51 runners. Clin Orthop Relat Res 1984;187:188-92.

[13] Torg JS, Pavlov H, Cooley LH, et al. Stress fractures of the tarsal navicular. A retrospective review of twenty-one cases. J Bone Joint Surg Am 1982;64(5):700-12.

[14] Rossi F, Dragoni S. Talar body fatigue stress fractures: three cases observed in elite female gymnasts. Skeletal Radiol 2005;34(7):389-94.

[15] Kaye RA. Insufficiency stress fractures of the foot and ankle in postmenopausal women. Foot Ankle Int 1998;19(4):221-4.

[16] Ishibashi Y, Okamura Y, Otsuka H, et al. Comparison of scintigraphy and magnetic resonance imaging for stress injuries of bone. Clin J Sport Med 2002;12(2):79-84.

[17] Morrison WB, Carrino JA, Schweitzer ME, et al. Subtendinous bone marrow edema patterns on MR images of the ankle: association with symptoms and tendinopathy. AJR Am J Roentgenol 2001;176(5):1149-54.

[18] Bartonicek J. Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat 2003;25(5-6):379-86.

[19] Golano P, Mariani PP, Rodriguez-Niedenfuhr M, etal. Arthroscopic anatomy of the posterior ankle ligaments. Arthroscopy 2002;18(4):353-8.

[20] Norkus SA, Floyd RT. The anatomy and mechanisms of syndesmotic ankle sprains. J Athl Train 2001;36:68-73.

[21] Brown KW, Morrison WB, Schweitzer ME, et al. MRI findings associated with distal tibiofibular syndesmosis injury. AJR Am J Roentgenol 2004;182(1):131-6.

[22] Hopkinson WJ, St Pierre P, Ryan JB, et al. Syndesmosis sprains of the ankle. Foot Ankle 1990;10(6):325-30.

[23] Muhle C, Frank LR, Rand T, et al. Collateral ligaments of the ankle: high-resolution MR imaging with a local gradient coil and anatomic correlation in cadavers. Radiographics 1999;19(3):673-83.

[24] Kumai T, Takakura Y, Rufai A, et al. The functional anatomy of the human anterior talofibular ligament in relation to ankle sprains. J Anat 2002;200(5):457-65.

[25] Kreitner KF, Ferber A, Grebe P, etal. Injuries of the lateral collateral ligaments of the ankle: assessment with MR imaging. Eur Radiol 1999;9(3):519-24.

[26] Heilman AE, Braly WG, Bishop JO, et al. An anatomic study of subtalar instability. Foot Ankle 1990;10(4):224-8.

[27] BaumhauerJF, O'Brien T. Surgical considerations in the treatment of ankle instability. J Athl Train 2002;37(4):458-62.

[28] Javors JR, Violet JT. Correction of chronic lateral ligament instability of the ankle by use of the Brostrom procedure. A report of 15 cases. Clin Orthop Relat Res 1985;198: 201-7.

[29] Okuda R, Kinoshita M, Morikawa J, etal. Arthroscopic findings in chronic lateral ankle instability: do focal chondral lesions influence the results of ligament reconstruction? Am J Sports Med 2005;33(1):35-42.

[30] Kim SH, Ha KI. Arthroscopic treatment for impingement of the anterolateral soft tissues of the ankle. J Bone Joint Surg Br 2000;82(7):1019-21.

[31] Jacobson KE, Liu SH. Anterolateral impingement of the ankle. J Med Assoc Ga 1992;81(6):297-9.

[32] Bagnolesi P, Zampa V, Carafoli D, et al. Anterolateral fibrous impingement of the ankle. Report of 14cases. Radiol Med (Torino) 1998;95(4):293-7.

[33] Rubin DA, Tishkoff NW, Britton CA, et al. Anterolateral soft-tissue impingement in the ankle: diagnosis using MR imaging. AJR Am J Roentgenol 1997;169(3):829-35.

[34] Jordan LK 3rd, Helms CA, Cooperman AE, etal. Magnetic resonance imaging findings in anterolateral impingement of the ankle. Skeletal Radiol 2000;29(1):34-9.

[35] Milner CE, Soames RW. The medial collateral ligaments of the human ankle joint: anatomical variations. Foot Ankle Int 1998;19(5):289-92.

[36] Boss AP, Hintermann B. Anatomical study of the medial ankle ligament complex. Foot Ankle Int 2002;23(6):547-53.

[37] Davis WH, Sobel M, DiCarlo EF, etal. Gross, histological, and microvascularanatomyand biomechanical testing of the spring ligament complex. Foot Ankle Int 1996;17(2):95-102.

[38] Jehlicka D, BartonicekJ, Svatos F, etal. Fracture-dislocations of the ankle joint in adults. Part I: epidemiologic evaluation of patients during a 1-year period. Acta ChirOrthopTraumatol Cech 2002;69(4):243-7.

[39] Zeegers AV, van der Werken C. Rupture of the deltoid ligament in ankle fractures: should it be repaired? Injury 1989;20(1):39-41.

[40] Stromsoe K, Hoqevold HE, Skjeldal S, etal. The repairof a ruptured deltoid ligament is not necessary in ankle fractures. J Bone Joint Surg Br 1995;77(6):920-1.

[41] Maynou C, Lesage P, Mestdagh H, et al. Is surgical treatment of deltoid ligament rupture necessary in ankle fractures? Rev Chir Orthop Reparatrice Appar Mot 1997;83(7): 652-7.

[42] Hintermann B. Medial ankle instability. Foot Ankle Clin 2003;8(4):723-38.

[43] Paterson RS, Brown JN. The posteromedial impingement lesion of the ankle. A series of six cases. Am J Sports Med 2001;29(5):550-7.

[44] Taniguchi A, Tanaka Y, Takakura Y, etal. Anatomy of the spring ligament. J Bone Joint Surg Am 2003;85-A(11):2174-8.

[45] Deland JT, de Asla RJ, Sung IH, etal. Posterior tibial tendon insufficiency: which ligaments are involved? Foot Ankle Int 2005;26(6):427-35.

[46] Choi K, Lee S, Otis JC, et al. Anatomical reconstruction of the spring ligament using peroneus longus tendon graft. Foot Ankle Int 2003;24(5):430-6.

[47] Brodsky JW. Preliminary gait analysis results after posterior tibial tendon reconstruction: a prospective study. Foot Ankle Int 2004;25(2):96-100.

[48] Jahss MH, Kay BS. An anatomic study of the anterior superior process of the os calcis and its clinical application. Foot Ankle 1983;3(5):268-81.

[49] Robbins MI, Wilson MG, Sella EJ. MR imaging of anterosuperior calcaneal process fractures. AJR Am J Roentgenol 1999;172(2):475-9.

[50] Ruland WO, Schwering L, Hampe T, et al. Injuries of the bifurcate ligament. Unfallchirurg 1995;98(12):640-4.

[51] Anderson DJ, Fallat LM, Savoy-Moore T. Computer-assisted assessment of lateral column movement following plantar fascial release: a cadaveric study. J Foot Ankle Surg 2001;40(2):62-70.

[52] Bohne WH, Lee KT, Peterson MG. Action of the peroneus longus tendon on the first metatarsal against metatarsus primus varus force. Foot Ankle Int 1997;18(8):510-2.

[53] Scanlan RL, Gehl RS. Peroneal tendon injuries. Clin Podiatr Med Surg 2002;19(3): 419-31.

[54] SammarcoGJ. Peroneal tendon injuries. Orthop Clin North Am 1994;25(1):135-45.

[55] Petersen W, Bobka T, Stein V, et al. Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand 2000;71(2): 168-74.

[56] Sobel M, GeppertMJ, Hannafin JA, etal. Microvascularanatomyof the peroneal tendons. Foot Ankle 1992;13(8):469-72.

[57] Krause JO, Brodsky JW. Peroneus brevis tendon tears: pathophysiology, surgical reconstruction, and clinical results. Foot Ankle Int 1998;19(5):271-9.

[58] Rademaker J, Rosenberg ZS, Delfaut EM, et al. Tear of the peroneus longus tendon: MR imaging features in nine patients. Radiology 2000;214(3):700-4.

[59] Davis WH, Sobel M, DelandJ, etal. The superior peroneal retinaculum: an anatomic study. Foot Ankle Int 1994;15(5):271-5.

[60] Niemi WJ, SavidakisJJr, DeJesusJM. Peroneal subluxation: a comprehensive reviewofthe literature with case presentations. J Foot Ankle Surg 1997;36(2):141-5.

[61] Tan V, Lin SS, Okereke E. Superior peroneal retinaculoplasty: a surgical technique for peroneal subluxation. Clin Orthop Relat Res 2003;410:320-5.

[62] ZammitJ, Singh D. The peroneus quartus muscle. Anatomy and clinical relevance. J Bone Joint Surg Br 2003;85(8):1134-7.

[63] Bloome DM, Marymont JV, Varner KE. Variations on the insertion of the posterior tibialis tendon: a cadaveric study. Foot Ankle Int 2003;24(10):780-3.

[64] Kiter E, Gunal I, Karatosun V, et al. The relationship between the tibialis posterior tendon and the accessory navicular. Ann Anat 2000;182(1):65-8.

[65] Choi YS, Lee KT, Kang HS, et al. MR imaging findings of painful type II accessory navicular bone: correlation with surgical and pathologic studies. Korean J Radiol 2004;5(4): 274-9.

[66] ImhauserCW, Siegler S, Abidi NA, etal. The effect of posterior tibialis tendon dysfunction on the plantar pressure characteristics and the kinematics of the arch and the hindfoot. Clin Biomech (Bristol, Avon) 2004;19(2):161-9.

[67] Petersen W, HohmannG, PufeT, etal. Structure ofthe human tibialis posterior tendon. Arch Orthop Trauma Surg 2004;124(4):237-42.

[68] Valderrabano V, Hintermann B, Wischer T, et al. Recovery of the posterior tibial muscle after late reconstruction following tendon rupture. Foot Ankle Int 2004;25(2): 85-95.

[69] Bare AA, Haddad SL. Tenosynovitis of the posterior tibial tendon. Foot Ankle Clin 2001;6(1):37-66.

[70] Boruta PM, Beauperthuy GD. Partial tear of the flexor hallucis longus at the knot of Henry: presentation of three cases. Foot Ankle Int 1997;18(4):243-6.

[71] O'Sullivan E, Carare-Nnadi R, GreensladeJ, etal. Clinical significance of variations in the interconnections between flexor digitorum longus and flexor hallucis longus in the region of the knot of Henry. Clin Anat 2005;18(2):121-5.

[72] Lohman M, Kivisaari A, VehmasT, etal. MRI abnormalities of foot and ankle in asymptomatic, physically active individuals. Skeletal Radiol 2001;30(2):61-6.

[73] Hirose CB, McGarvey WC. Peripheral nerve entrapments. Foot Ankle Clin 2004;9(2): 255-69.

[74] Myerson MS, Berger BI. Nonunion of a fracture of the sustentaculum tali causing a tarsal tunnel syndrome: a case report. Foot Ankle Int 1995;16(11):740-2.

[75] Mezrow CK, Sanger JR, Matloub HS. Acute tarsal tunnel syndrome following partial avulsion of the flexor hallucis longus muscle: a case report. J Foot Ankle Surg 2002;41(4): 243-6.

[76] Ng WM, Chan KY. Tarsal tunnel syndrome caused by ganglion. Med J Malaysia 2004;59(Suppl F):69-71.

[77] Cheung YY, Rosenberg ZS, Colon E, et al. MR imaging of flexor digitorum accessorius longus. Skeletal Radiol 1999;28(3):130-7.

[78] Kim DH, Ryu S, Tiel RL, et al. Surgical management and results of 135 tibial nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery 2003;53(5): 1114-24 [discussion 1124-5].

[79] Maquirriain J. Posterior ankle impingement syndrome. J Am Acad Orthop Surg 2005;13(6):365-71.

[80] HedrickMR, McBryde AM. Posterior ankle impingement. Foot Ankle Int 1994;15(1):2-8.

[81] Peace KA, Hillier JC, Hulme A, et al. MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases. Clin Radiol 2004;59(11):1025-33.

[82] MoyerJ, Kosanovich R. Anterior tibial tendon injuries. Clin Podiatr Med Surg 2002;19(3): 433-40, vi-vii.

[83] Harvey L, Rockett MS. Mechanical comparison of two extensor tendon repairs of ankle tendons. J Foot Ankle Surg 2000;39(4):232-8.

[84] Mengiardi B, Pfirrmann CW, Vienne P, et al. Anterior tibial tendon abnormalities: MR imaging findings. Radiology 2005;235(3):977-84.

[85] Leung YF, Ip SP, Chung OM. A new method of functional tendon transfer for the dysfunction of extensor hallucis longus. Foot Ankle Int 2002;23(12):1124-5.

[86] RabM, EbmerJ, DellonAL. Innervation of the sinus tarsi and implications for treating anterolateral ankle pain. Ann Plast Surg 2001;47(5):500-4.

[87] Schwarzenbach B, Dora C, Lang A, et al. Blood vessels of the sinus tarsi and the sinus tarsi syndrome. Clin Anat 1997;10(3):173-82.

[88] Kjaersgaard-Andersen P, Wethelund JO, Helmig P, et al. The stabilizing effect of the liga-mentous structures in the sinus and canalis tarsi on movements in the hindfoot. An experimental study. Am J Sports Med 1988;16(5):512-6.

[89] Oloff LM, Schulhofer SD, Bocko AP. Subtalar joint arthroscopy for sinus tarsi syndrome: a review of 29 cases. J Foot Ankle Surg 2001;40(3):152-7.

[90] Light M, Pupp G. Ganglions in the sinus tarsi. J Foot Surg 1991;30(4):350-5.

[91] Akiyama K, Takakura Y, Tomita Y, et al. Neurohistology of the sinus tarsi and sinus tarsi syndrome. J Orthop Sci 1999;4(4):299-303.

[92] Dellon AL, Barrett SL. Sinus tarsi denervation: clinical results. J Am Podiatr Med Assoc 2005;95(2):108-13.

[93] Pisani G, Pisani PC, Parino E. Sinus tarsi syndrome and subtalar joint instability. Clin Podiatr Med Surg North Am 2005;22(1):63-77, vii.

[94] Rasmussen S, Hjorth Jensen C. Arthroscopic treatment of impingement of the ankle reduces pain and enhances function. ScandJ Med Sci Sports 2002;12(2):69-72.

[95] Tol JL, van Dijk CN. Etiology of the anterior ankle impingement syndrome: a descriptive anatomical study. Foot Ankle Int 2004;25(6):382-6.

[96] Robinson P, White LM. Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management. Radiographics 2002;22(6):1457-69 [discussion 1470-1].

[97] Nihal A, Rose DJ, Trepman E. Arthroscopic treatment of anterior ankle impingement syndrome in dancers. Foot Ankle Int 2005;26(11):908-12.

[98] Solan MC, Moorman CT 3rd, Miyamoto RG, et al. Ligamentous restraints of the second tarsometatarsal joint: a biomechanical evaluation. Foot Ankle Int 2001;22(8): 637-41.

[99] Kura H, Luo ZP, Kitaoka HB, et al. Mechanical behavior of the Lisfranc and dorsal cuneo-metatarsal ligaments: in vitro biomechanical study. J Orthop Trauma 2001;15(2): 107-10.

[100] de Palma L, Santucci A, Sabetta SP, et al. Anatomy of the Lisfranc joint complex. Foot Ankle Int 1997;18(6):356-64.

[101] Potter HG, Deland JT, Gusmer PB, et al. Magnetic resonance imaging of the Lisfranc ligament of the foot. Foot Ankle Int 1998;19(7):438-46.

[102] Lee CA, Birkedal JP, Dickerson EA, et al. Stabilization of Lisfranc joint injuries: a biomechanical study. Foot Ankle Int 2004;25(5):365-70.

[103] O'Brien M. The anatomy of the Achilles tendon. Foot Ankle Clin 2005;10(2):225-38.

[104] Morelli V, James E. Achilles tendonopathy and tendon rupture: conservative versus surgical management. Prim Care 2004;31(4):1039-54, x.

[105] Alfredson H. The chronic painful Achilles and patellar tendon: research on basic biology and treatment. ScandJ Med Sci Sports 2005;15(4):252-9.

[106] Stein V, Laprell H, Tinnemeyer S, etal. Quantitative assessment of intravascular volume of the human Achilles tendon. Acta Orthop Scand 2000;71(1):60-3.

[107] Knobloch K, Kraemer R, Lichtenberg A, et al. Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes. Am J Sports Med 2006;34(1):92-7.

[108] Pufe T, Petersen WJ, Mentlein R, et al. The role of vasculature and angiogenesis for the pathogenesis of degenerative tendons disease. Scand J Med Sci Sports 2005;15(4): 211-22.

[109] Haims AH, Schweitzer ME, Patel RS, et al. MR imaging of the Achilles tendon: overlap of findings in symptomatic and asymptomatic individuals. Skeletal Radiol 2000;29(11): 640-5.

[110] Calder JD, Saxby TS. Surgical treatment of insertional Achilles tendinosis. Foot Ankle Int 2003;24(2):119-21.

[111] Wapner KL, Pavlock GS, Hecht PJ, et al. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle 1993;14(8):443-9.

[112] Turco VJ, Spinella AJ. Achilles tendon ruptures-peroneus brevis transfer. Foot Ankle 1987;7(4):253-9.

[113] Sella EJ, Caminear DS, McLarney EA. Haglund's syndrome. J Foot Ankle Surg 1998;37(2):110-4 [discussion 173].

[114] BrunnerJ, Anderson J, O'MalleyM, etal. Physician and patient based outcomes following surgical resection of Haglund's deformity. Acta Orthop Belg 2005;71 (6):718-23.

[115] Schneider W, Niehus W, Knahr K. Haglund's syndrome: disappointing results following surgery-a clinical and radiographic analysis. Foot Ankle Int 2000;21 (1):26-30.

[116] La Porta GA, La Fata PC. Pathologic conditions of the plantar fascia. Clin PodiatrMed Surg North Am 2005;22(1):1-9, v.

[117] Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003;93(3):234-7.

[118] YuJS. Pathologic and post-operative conditions of the plantar fascia: review of MR imaging appearances. Skeletal Radiol 2000;29(9):491-501.

[119] JardeO, Diebold P, HavetE, etal. Degenerative lesions of the plantar fascia: surgical treatment by fasciectomy and excision of the heel spur. A report on 38 cases. Acta Orthop Belg 2003;69(3):267-74.

[120] Ogilvie-Harris DJ, LoboJ. Endoscopic plantar fascia release. Arthroscopy 2000;16(3): 290-8.

[121] Gefen A. Stress analysis of the standing foot following surgical plantar fascia release. J Biomech 2002;35(5):629-37.





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