Subtendinous bone marrow edema patterns on MR images of the ankle: association with symptoms and tendinopathy

Association between anterior talofibular ligament injury and ankle tendon, ligament, and joint conditions revealed by magnetic resonance imaging

Background

The lateral ankle ligament complex is the most frequently injured ligament secondary to strong ankle inversion movement during lateral ankle sprains (LAS). Among these injuries, anterior talofibular ligament (ATFL) injury is the most frequent condition (present in 66-85% of such injuries). The purpose of this research was to use magnetic resonance imaging (MRI) to determine the association between ankle tendon, ligament, and joint conditions and ATFL injuries.

Methods

A case-control MRI study was carried out to compare the presence of ankle muscle, tendon, ligament, and joint conditions in patients with injured ATFLs (case group; n=25) and non-injured ATFLs (control group; n=25).

Results

Achilles tendinopathy was present in 1/25 (4%) patients with injured ATFLs and 7/25 (28%) non-injured ATFL subjects (P=0.048). Injured calcaneofibular ligaments (CFLs) were present in 19/25 (76%) patients with injured ATFLs and 1/25 (4%) non-injured ATFL subjects (P<0.001). Finally, injured tibiotalar joints were present in 16/25 (64%) patients with injured ATFLs and 5/25 (20%) non-injured ATFL subjects (P=0.002). Other musculoskeletal structure injuries occurred at similar rates between patients with injured ATFLs and those with non-injured ATLFs (P≥0.05).

Conclusions

Patients with ATFL injuries showed a greater presence of CFL and tibiotalar joint injuries than subjects with non-injured ATFLs.

MRI of Cuboid Pulley Lesion

OBJECTIVE

The aim of this study was to describe cuboid pulley lesions and associated abnormalities on the basis of clinical findings and the results of MRI examinations of the ankle.

MATERIALS AND METHODS

A retrospective search was performed to identify patients who had a cuboid pulley lesion during a 10-year period. A cuboid pulley lesion was defined as bone marrow edema in the lateroplantar ridge of the cuboid that was shown to be wrapped by the peroneus longus tendon on MRI of the ankle. A total of 19 patients (11 men and eight women; mean age, 45.4 years) were included in the group of patients with a cuboid pulley lesion, and 38 age-and sex-matched patients without a cuboid pulley lesion were randomly selected as the control group. We reviewed medical records and assessed MRI findings that could be associated with a cuboid pulley lesion.

RESULTS

The mean (± SD) diameter of the cuboid pulley lesion was 8.9 ± 4.7 mm. Cuboid pulley lesions were associated with peroneal tenosynovitis (p < 0.001), Achilles enthesitis (p = 0.004), and a clinical diagnosis of inflammatory arthritis (p < 0.001). Eleven of the 19 patients in the group with cuboid pulley lesions had inflammatory arthritis (either rheumatoid arthritis [n = 7] or spondyloarthritis [n = 4]). The cuboid pulley lesions did not cause localized lateral foot pain and tenderness, except in one patient who had an accompanying stress fracture of the cuboid.

CONCLUSION

MRI of the ankle rarely but clearly shows cuboid pulley lesions, which themselves are not likely to cause localized pain, and cuboid pulley lesions show significant associations with peroneal tenosynovitis, Achilles enthesitis, and clinically diagnosed inflammatory arthritis.

[MRI diagnostics of bone marrow oedema and its significance for the forensic medical evaluation of the injuries to bones and articulations]

The objective of the present study was the analysis of the publications in the literature dealing with radiological methods employed for the diagnostics of injuries to and diseases of the bones and articulations as well as the role of bone marrow oedema in the development of these conditions in the specific context of the problems facing forensic medical expertise. The main results of the domestic and foreign authors concerning MRI-based investigations into the nature of injuries and other pathological changes in bones and articulations during different periods after their development are discussed with the major emphasis placed on diagnostics of bone marrow oedema. Magnetic resonance visualization of this diagnostic feature and the related manifestations of the above conditions in many cases provides an indisputable evidence of the damage whereas the discovery of its distribution to and localization in the bone structures makes it possible to elucidate the sources of this condition, such as a blow, torsional stress, stretching, etc., and its underlying mechanisms. The character and the mode of distribution of the signal from a bone marrow oedema under various conditions of visualization allow to carry out differential diagnostics of the damage prescription period of up to 1.5 months.

Ultrasonography assessment of heel entheses in patients with spondyloarthritis: a comparative study with magnetic resonance imaging and conventional radiography

The aim of the present study was to determine the agreement between ultrasonography (US), magnetic resonance imaging (MRI), and conventional radiography (CR) in the detection of findings indicative of enthesopathy in spondyloarthritis (SpA) patients. A cross-sectional study was performed in 40 SpA patients. Heel entheses (Achilles tendon and plantar fascia) were bilaterally examined by US, MRI, and CR. The three imaging modalities were carried out by three independent operators blinded to the other imaging modality data. Soft tissue abnormalities indicative of enthesopathy as thickening, structural changes, and bursitis were assessed by both US and MRI, and cortical bone abnormalities indicative of enthesopathy as erosions and enthesophytes were assessed by the three imaging modalities. The unweighted kappa values between US and MRI were 0.80, 0.66, 0.69, 0.70, and 0.70 for thickening, structural changes, bursitis, enthesophytes, and bone erosions, respectively. With respect to the detection of enthesophytes, the unweighted kappa values between CR and both US and MRI were 0.78 and 0.76, respectively. At last, for the recognition of bone erosions, the unweighted kappa values between CR and both US and MRI were 0.38 and 0.45, respectively. Using MRI as standard reference method, US was more sensitive with respect to CR revealing bone erosions. The present study provides evidence about the high overall agreement between US and MRI for all abnormal comparable findings at entheseal level and between US, MRI, and CR for the detection of enthesophytes in SpA patients.

Development and Reliability of a Preliminary Foot Osteoarthritis Magnetic Resonance Imaging Score

OBJECTIVE

Foot osteoarthritis (OA) is very common but underinvestigated musculoskeletal condition and there is little consensus as to common magnetic resonance imaging (MRI) features. The aim of this study was to develop a preliminary foot OA MRI score (FOAMRIS) and evaluate its reliability.

METHODS

This preliminary semiquantitative score included the hindfoot, midfoot, and metatarsophalangeal joints. Joints were scored for joint space narrowing (JSN; 0-3), osteophytes (0-3), joint effusion/synovitis, and bone cysts (present/absent). Erosions and bone marrow lesions (BML) were scored (0-3) and BML were evaluated adjacent to entheses and at sub-tendon sites (present/absent). Additionally, tenosynovitis (0-3) and midfoot ligament pathology (present/absent) were scored. Reliability was evaluated in 15 people with foot pain and MRI-detected OA using 3.0T MRI multi-sequence protocols, and assessed using ICC as an overall score and per anatomical site.

RESULTS

Intrareader agreement (ICC) was generally good to excellent across the foot in joint features (JSN 0.90, osteophytes 0.90, effusion/synovitis 0.46, cysts 0.87), bone features (BML 0.83, erosion 0.66, BML entheses 0.66, BML sub-tendon 0.60) and soft tissue features (tenosynovitis 0.83, ligaments 0.77). Interreader agreement was lower for joint features (JSN 0.43, osteophytes 0.27, effusion/synovitis 0.02, cysts 0.48), bone features (BML 0.68, erosion 0.00, BML entheses 0.34, BML sub-tendon 0.13), and soft tissue features (tenosynovitis 0.35, ligaments 0.33).

CONCLUSION

This preliminary FOAMRIS demonstrated good intrareader reliability and fair interreader reliability when assessing the total feature scores. Further development is required in cohorts with a range of pathologies and to assess the psychometric measurement properties.

Bone marrow edema patterns in the ankle and hindfoot: distinguishing MRI features

OBJECTIVE

Many disorders produce similar or overlapping patterns of bone marrow edema in the ankle. Bone marrow edema may present in a few hindfoot bones simultaneously or in a single bone. The purpose of this pictorial essay is to provide guidelines based on clinical history and specific MRI patterns and locations to accurately identify the cause of ankle bone marrow edema. We will first focus on bone marrow edema in general disease categories involving multiple bones, such as reactive processes, trauma, neuroarthropathy, and arthritides. A discussion of bone marrow edema in individual bones of the ankle and hindfoot including the tibia, fibula, talus, and calcaneus will follow. Helpful hints for arriving at the correct diagnosis will be provided in each section.

CONCLUSION

After review of this article, radiologists should be able to use their knowledge of clinical history and specific MRI patterns and locations to accurately distinguish between the various causes of bone marrow edema in the ankle and hindfoot.

Bone marrow lesions: a universal bone response to injury?

The ever increasing use of magnetic resonance imaging in clinical practice has led to the recognition of a new entity, bone marrow lesions (BMLs). These lesions are characterized by excessive water signals in the marrow space and have emerged as a central component of many different diseases affecting the musculoskeletal system. BMLs have in particular been associated with a wide variety of inflammatory and non-inflammatory rheumatologic conditions and are not only considered significant sources of pain, but also linked to the worsening of patient prognosis in many disease states. In this review, we summarize the current knowledge on BMLs with an emphasis on the clinical and histological features of this entity in inflammatory and non-inflammatory disease and provide a unifying hypothesis based on the appearance with various imaging technologies. We also try to pair this hypothesis with the apparent beneficial effects of various treatment regimens, mainly within the group of bone antiresorptive drugs (calcitonin, bisphosphonates) on symptoms associated with BMLs.

Pediatric cervical spine marrow T2 hyperintensity: a systematic analysis

OBJECTIVE

Hyperintense areas of vertebral bone marrow on fluid-sensitive sequences are at times seen on pediatric MRI of the cervical spine in children without suspicious clinical conditions to explain marrow pathology. Although these likely have no clinical significance they may be mistaken for pathology. The purpose of this study is to systematically evaluate the locations and patterns of marrow T2 hyperintensity in the pediatric cervical spine, with respect to age.

MATERIALS AND METHODS

At 1.5 T, the C2 through T3 vertebrae of 82 children aged 0-17 years without clinically suspicious marrow abnormality were retrospectively reviewed by two musculoskeletal radiologists, who were blinded to patients' age. The frequency, intensity, and location of the foci of marrow T2 hyperintensity were recorded for each vertebra on a 12-point scoring system and were correlated with the patients' age.

RESULTS

Foci of marrow hyperintensity were seen in 46/82 (56.1%) patients and in 241/734 (32.8%) vertebrae. Foci were most common in C4 (42% of patients), C5 (45.7%), and C6 (37.8%). The foci of T2 hyperintensity were more common inferiorly (188 foci) and adjacent to the anterior cortex (123). Analysis revealed no significant correlation between age and marrow score (Spearman = -0.147, P = 0.19), but did find a trend towards increased presence of marrow T2 hyperintensity in the ages of most rapid growth, 8-14 years (81.5% of patients).

CONCLUSION

Vertebral body marrow T2 hyperintensity was most common endosteally and in the mid-cervical spine with a slight peak in adolescence. We therefore believe that these pediatric cervical marrow changes may be related to rapid bone growth at the point of maximal kyphotic stress.

Age dependent T2 changes of bone marrow in pediatric wrist MRI

OBJECTIVE

Hyperintensity of the bone marrow on fluid-sensitive sequences can be seen on magnetic resonance imaging (MRI) during childhood, even in the absence of bone pathology. They can be related to hematopoietic marrow, normal and abnormal bone remodeling. We sought to investigate whether hyper intensity of the bone marrow on MRI of the wrist is age-dependent and to evaluate if this signal follows a consistent age-related pattern.

MATERIALS AND METHODS

Thirty-one wrist 1.5 T MR images of children (7-18 years) without suspected bone pathology were evaluated for foci of hyperintense bone marrow seen on fluid-sensitive coronal sequences using a scale of 1-3. Correlation of frequency, location and intensity of these foci with age was obtained. Results were analyzed for distribution in single bones and in the following regions: distal forearm, first/second carpal rows, and metacarpal bases.

RESULTS

A total of 448 bones were evaluated. Eighty-eight out of 448 (21 out of 31 wrists) showed hyperintense bone marrow seen on fluid-sensitive sequences. The distribution was: radius in 19, ulna in 19, first metacarpal base in 11, scaphoid in 9, lunate in 6, pisiform in 6, and fifth metacarpal base in 1. The involvement of the first and second carpal rows and the metacarpal bases was almost similar (13, 12, and 12 respectively). In the distal forearm, the intensity was similar to or higher than that in the wrist (2.2 vs. 2.0). Frequency decreased with age (100% at 7-9 and 25% at 16-18 years).

CONCLUSION

Foci of hyperintense bone marrow seen on fluid-sensitive sequences can be seen on MRI of the wrist during childhood even without apparent symptoms. It shows a consistent pattern with maturation: frequency and intensity decrease and there is distal-to-proximal resolution. This may be a normal finding that may represent normal bone remodeling or decreasing hematopoietic marrow and should not be confused with pathological bone marrow edema.

Founder's lecture of the ISS 2006: borderlands of normal and early pathological findings in MRI of the foot and ankle

The purpose of this article is to highlight the anatomical variants, technical pitfalls, and the prevalence of abnormal conditions in the asymptomatic population in magnetic resonance imaging of the foot and ankle. Special attention is drawn to the complex anatomy of the deltoid ligament (the superficial tibionavicular ligament, tibiospring ligament, the tibiocalcaneal ligament, and the deep anterior and posterior tibiotalar ligaments) and the posterior tibial tendon insertion including the magic angle artifact and the high prevalence of asymptomatic findings such as "hypertrophied" peroneal tubercle (abnormal only when larger than 5 mm), peroneus quartus (prevalence 17%), and cysts (vascular remnants) just inferior to the angle of Gissane.

Bone stress injury of the ankle in professional ballet dancers seen on MRI

Background

Ballet Dancers have been shown to have a relatively high incidence of stress fractures of the foot and ankle. It was our objective to examine MR imaging patterns of bone marrow edema (BME) in the ankles of high performance professional ballet dancers, to evaluate clinical relevance.

Methods

MR Imaging was performed on 12 ankles of 11 active professional ballet dancers (6 female, 5 male; mean age 24 years, range 19 to 32). Individuals were imaged on a 0.2 T or 1.5 T MRI units. Images were evaluated by two musculoskeletal radiologists and one orthopaedic surgeon in consensus for location and pattern of bone marrow edema. In order to control for recognized sources of bone marrow edema, images were also reviewed for presence of osseous, ligamentous, tendinous and cartilage injuries. Statistical analysis was performed to assess the strength of the correlation between bone marrow edema and ankle pain.

Results

Bone marrow edema was seen only in the talus, and was a common finding, observed in nine of the twelve ankles imaged (75%) and was associated with pain in all cases. On fluid-sensitive sequences, bone marrow edema was ill-defined and centered in the talar neck or body, although in three cases it extended to the talar dome. No apparent gender predilection was noted. No occult stress fracture could be diagnosed. A moderately strong correlation (phi = 0.77, p= 0.0054) was found between edema and pain in the study population.

Conclusion

Bone marrow edema seems to be a specific MRI finding in the talus of professional ballet dancers, likely related to biomechanical stress reactions, due to their frequently performed unique maneuvers. Clinically, this condition may indicate a sign of a bone stress injury of the ankle.

Bone marrow changes on STIR MR images of asymptomatic feet and ankles

The purpose of this study was to evaluate the prevalence, pattern and size of bone marrow changes on short-tau inversion recovery (STIR) magnetic resonance (MR) images of asymptomatic feet and ankles. In 78 asymptomatic volunteers (41 women, 37 men; median age 47 years; range 23-83 years) sagittal STIR MR images of hindfoot and midfoot were reviewed for various patterns of high signal changes in bone marrow. The size of these bone marrow changes was measured, and signal intensity was rated semi-quantitatively using a scale from 0 (=normal) to 10 (=fluid-like). Fifty percent (39/78) of all volunteers had at least one bone marrow change. Thirty-six percent (28/78) of all volunteers had edema-like changes, 26% (20/78) had necrosis-like changes, and 5% (4/78) had cyst-like changes. The long diameters of all changes varied between 4 mm and 16 mm (median 7.5 mm). The median signal intensity for all changes was 5.0 (range 1-10). Bone marrow changes on STIR MR images are commonly detected in asymptomatic feet and ankles. However, such changes tend to be small (<1 cm) or subtle.

Distal intersection tenosynovitis of the wrist: a lesser-known extensor tendinopathy with characteristic MR imaging features

OBJECTIVE

To present the MRI imaging findings of extensor tenosynovitis at the distal intersection or crossover between the second (extensor carpi radialis longus (ECRL) and brevis (ECRB)) and third (extensor pollicis longus (EPL)) extensor compartment tendons, and the anatomical details that may play a role in the pathogenesis of this condition.

DESIGN AND PATIENTS

The imaging studies and clinical records of five patients (three females and two males, with ages ranging between 22 and 78 years; mean age, 49 years) presenting with pain on the dorsal and radial aspect of the wrist were reviewed by two musculoskeletal radiologists in consensus. Three cases were identified serendipitously during routine clinical reading sessions; a follow-up computerized database search for additional cases reported in the prior two years yielded two additional cases. The overall number of cases screened was 1,031. The diagnosis of tendinopathy affecting the second and third compartment extensor tendons was made on the basis of MRI findings and clinical follow-up, or synovectomy.

RESULTS

All patients showed signs of tenosynovitis: in four patients both the tendons of the second and third extensor compartments were affected; the fifth patient showed signs of tenosynovitis of the EPL tendon, and tendinosis of the extensor carpi radialis tendons. Three patients showed tenosynovitis proximal and distal to the point of intersection; and in two of them, a discrete point of constriction was appreciated at the crossover site in relation to the extensor retinaculum. Two patients showed tenosynovitis limited to the segment distal to the point of decussation. Tendinosis tended to follow the presence of tenosynovitis. In one of the patients, subtendinous reactive marrow edema in Lister's tubercle was noted.

CONCLUSION

Distal intersection tenosynovitis may be related to the biomechanical pulley effect exerted by Lister's tubercle on the EPL tendon as it leaves the third compartment and crosses over the extensor carpi radialis tendons, as well as the constraining effect of the extensor retinaculum. These anatomical features determine the presence of characteristic MR imaging findings.

High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes?

BACKGROUND

High-signal T2-weighted bone marrow changes can be found in both bone marrow edema and hematopoietic marrow and are often seen on pediatric MR images of the feet and ankle.

OBJECTIVE

To evaluate whether high-signal T2 changes of the bone marrow seen on pediatric MRI of feet and ankles represent residual hematopoietic marrow.

MATERIALS AND METHODS

A total of 402 bones in 41 pediatric MRI studies of feet and ankles (34 children, 1-18 years) were reviewed by two observers who were blinded to the patients' ages. The studies were reviewed for the presence of high-signal changes of the bone marrow on sagittal fluid-sensitive images. The frequency and location of these foci were correlated with the patients' ages.

RESULTS

High-signal T2 changes of the bone marrow were seen in 45/402 bones (11%) and in 24/41 patients younger than 16 years (59%). The changes were most commonly located in the calcaneus (54%), followed by the talus (35%) and navicular bone (35%), invariably at the endosteal surface. In 16 ankles, such foci were seen in the feet but not in the distal tibia/fibula. Symmetric presence (two ankles) or absence (four ankles) of high-signal marrow were seen in six of seven patients with bilateral ankles.

CONCLUSION

High-signal T2 changes of the bone marrow in pediatric feet and ankle MRIs have a symmetric, fairly consistent pattern and disappear after the age of 15 years. We believe that these high-signal areas are normal and represent residual hematopoietic marrow.

A comparison of magnetic resonance imaging findings of the acromioclavicular joint in symptomatic versus asymptomatic patients

The purpose of this study was to compare acromioclavicular (AC) joint magnetic resonance imaging (MRI) findings in asymptomatic patients with those in symptomatic patients. The MRI scans of 25 patients with symptomatic AC joints were compared with 50 asymptomatic control subjects by use of the same grading scale. In the symptomatic group, AC joint arthritis grading was normal in 0%, mild in 20%, moderate in 52%, and severe in 28%. In the asymptomatic group, grading was normal in 18%, mild in 66%, moderate in 12%, and severe in 4%; there was a statistically higher grade of AC arthritis in the symptomatic group (P < .05). Of the symptomatic individuals, 80% demonstrated reactive bone edema in either the distal clavicle (6), the acromion (3), or both sides of the AC joint (11), whereas no individual in the asymptomatic group had this finding (P < .05). Reactive bone edema on MRI is a more reliable predictor of symptomatic AC pathology than degenerative changes seen on MRI and, when correlated with clinical examination, is reproducible.

Cuboid oedema due to peroneus longus tendinopathy: a report of four cases

OBJECTIVE

To highlight focal bone abnormality in the cuboid due to tendinopathy of the adjacent peroneus longus.

DESIGN

A retrospective review was carried out of the relevant clinical and imaging features.

PATIENTS

Two male and two female patients were studied, mean age 51.5 years (range 32-67 years), referred with foot pain and imaging showing an abnormal cuboid thought to represent either tumour or infection.

RESULTS

A long history of foot pain was usual with a maximum of 8 years. Radiographs were normal in two cases and showed erosion in two, one of which exhibited periosteal new bone formation affecting the cuboid. Bone scintigraphy was undertaken in two patients, both of whom showed increased uptake of isotope. MRI, performed in all patients, showed oedema in the cuboid adjacent to the peroneus longus tendon. The tendon and/or paratendinous tissues were abnormal in all cases, but no tendon discontinuity was identified. One patient possessed an os peroneum. Unequivocal evidence of bone erosion was seen using MRI in three patients, but with greater clarity in two cases using CT. Additional findings of tenosynovitis of tibialis posterior, oedema in the adjacent medial malleolus and synovitis of multiple joints in the foot were seen in one patient. Imaging diagnosis was made in all cases avoiding bone biopsy, but surgical exploration of the peroneal tendons was performed in two cases and biopsy of ankle synovium in one.

CONCLUSIONS

Oedema with erosion of the cuboid bone, simulating a bone lesion (cuboid "pseudotumour"), may be caused by adjacent tendinopathy of peroneus longus. It is vital to be aware of this entity to avoid unnecessary biopsy of the cuboid.

MRI findings of septic arthritis and associated osteomyelitis in adults

OBJECTIVE

The purpose of this study was to describe the soft-tissue, synovial, and osseous MRI findings of septic arthritis.

MATERIALS AND METHODS

At 1.5 T (T1-weighted, T2-weighted or STIR, and contrast-enhanced images), 50 consecutive cases of septic arthritis were evaluated by two observers for synovial enhancement, perisynovial edema, joint effusion, fluid outpouching, fluid enhancement, and synovial thickening. The marrow was assessed for abnormal signal on T1- and T2-weighted images or after contrast enhancement. We noted whether the marrow signal was diffuse or abnormal in bare areas. MRI findings were compared with microbiologic, clinical, and surgical data and diagnoses.

RESULTS

The frequency of MRI findings in septic joints was as follows: synovial enhancement (98%), perisynovial edema (84%), joint effusions (70%), fluid outpouching (53%), fluid enhancement (30%), and synovial thickening (22%). The marrow showed bare area changes (86%), abnormal T2 signal (84%), abnormal gadolinium enhancement (81%), and abnormal T1 signal (66%). Associated osteomyelitis more often showed T1 signal abnormalities and was diffuse.

CONCLUSION

Synovial enhancement, perisynovial edema, and joint effusion had the highest correlation with the clinical diagnosis of a septic joint. However, almost a third of patients with septic arthritis lacked an effusion. Abnormal marrow signal-particularly if it was diffuse and seen on T1-weighted images-had the highest association with concomitant osteomyelitis.

Imaging sports injuries of the foot and ankle

The complexity of foot and ankle anatomy and function is unique in the musculoskeletal system. Understanding the complex anatomy alone is a daunting task, not to mention transferring that understanding to the two-dimensional planes encountered on imaging studies. When evaluating sports injuries in the foot and ankle, the interpreting radiologist must take into account the type of activity, vector of stress, and inherent characteristics of the involved structures. A strong working relationship with the health care providers managing patient care, ideally orthopedists, is essential. But in this age of decreasing specialization and increasing availability of imaging resources, the interpreting radiologist must use all available tools for clinical investigation. When interpreting an ankle or foot MR imaging, one finding should trigger a search for the next finding along a logical pathway of injury evolution. Bone marrow edema patterns are guides to tendon and ligament failure. And a clinical syndrome without correlative imaging diagnosis should call attention to potential alternative diagnoses. As the number of MR imaging studies performed continues to increase and MR technology continues to improve, we expect further advancements in MR evaluation of foot and ankle injury. We hope to continue to work closely with our referring orthopedists in this arena to improve our diagnostic skills and our understanding of foot and ankle injury.

Magnetic resonance imaging of sports injuries of the ankle

Basic sports-related injuries of the ankle include ligament tear, tendon degeneration and tear, bone bruise, fracture, impingement, osteochondral defect, and plantar fasciitis. This article discusses the magnetic resonance imaging appearance of these injuries.