Imaging & Diagnostics

Ankle & Foot Diagnostic Imaging Arthritis & Trauma II| El Paso, TX.

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Lisfranc Fracture-Dislocation

  • M/C dislocation of the foot at tarsal-metatarsal articulation (Lisfranc joint). Direct impact or landing and plantar or dorsal flexing the foot. Lisfranc ligament holding 2nd MT base and 1st Cu is torn. Manifests with or w/o fracture-avulsion.
  • Imaging: 1st step: foot radiography in most cases sufficient to Dx. MSK US may help: show disrupted Cu1-Cu2. ligament and widened space > 2.5mm. MRI may help but not essential. Weight-bearing view aids Dx.
  • 2-types: homolateral (1st MTP joint i contact) and divergent (2-5 MT displaced laterally and 1st MT medially)
  • Management: operative fixation is crucial
  • N.B. Atraumatic Lisfranc dislocation is a frequent complication of a diabetic Charcot foot

Osteochondral Injury of the Talus (OCD)

  • Common. Non-traumatic found in superior-medial talar dome. Traumatic may affect supero-lateral dome.
  • Clinically: pain/effusion/locking. Imaging is crucial.
  • 1st step: radiography may reveal focal radiolucent concavity/halo, fragment.
  • MRI helpful esp. if OCD is cartilaginous and to demonstrate bone edema.
  • Management: non-operative: short-leg cast/immonbilization-4-6 wk. operative: arthrocsopic removal.
  • Complications: premature 2nd DJD

Metatarsal Injuries

  • Acute & Stress fractures are common: m/c 5th MT & 2nd, 3rd MT.
  • Jones Fx: extra-articular Fx of proximal metaphysis of the 5th MT. prone to non-union. Often fixed operatively.
  • Pseudo-Jones: intra-articular avulsion of 5th MT styloid/base by eccentric contraction of Peroneus brevis M. Managed conservatively: boot-cast immonbilization. Both Jones & Pseudo-Jones Dx by foot series radiography.
  • Stress Fx. Calcaneus, 2nd, 3rd, 5th MTs. Repeated loading (running) or “March foot” 2nd/3rd MT. Clinically: pain on activity, reduced by rest. Dx: x-rays often unrewarding earlier. MRI or MSK US may help. Managed: conservatively. Complications; progress into complete Fx
  • Turf toe: common athletic hyperextension of 1st MTP-sesamoid/plantar plate complex tearing. 1st MTP unstable/loose. Managed operatively.

Arthritis of the Foot & Ankle

  • DJD of the ankle: uncommon a sprimary OA. Typically develops as 2nd to trauma/AVN, RA, CPPD, Hemophilic arthropathy, Juvenile Idiopathic Arthritis etc. manifests as DJD: osteophytes, JSL, subcohnodral cysts all seen on x-rays
  • Infalmmatory Arthritis: RA may develop in the ankle or any synovial joint. Will typically  presents with symmetrical Hands/feet RA initially (2nd, 3rd MCP, wrists, MTPs in feet) typically with erosion, iniform JSL, juxta-articular osteopenia and delayed subluxations.
  • HLA-B27 spondyloarthropathies: commonly affect lower extremity: heel, ankle esp in Reactive (Reiter). Erosive-productive bone proliferation is a key Dx.
  • Gouty Arthritis: common in the lower extremity. Ankle, mid-foot foot esp 1st MTPs. Initial onset: acute gouty arthritis with ST effusion and no erosions/tophi. Chronic tophacious gout: peri-articular, intra-osseous punched-out erosions with over-hanging edges, no initial JSL/osteopenia, ST. tophi may be seen.
  • Miscellaneous arthropathy: PVNS. Not common. Affects 3-4th decades of life. The result of synovial proliferation with Machrophages and multi-nucleated Giant Cells filled with hemosiderin and fatty accumulation, may lead to inflammation, cartilage damage, extrinsic bone erosions. Dx: x-rays are insensity, MRI modality of choice. Synovial biopsy. Management: operative, can be difficult.

Neuropathic Osteoarthropathy

  • (Charcot joint) Common and on the rise d/t epidemic in type 2 DM. May present with pain initially (50% of cases) and painless destructive arthropathy as late manifestation. Early Dx: delayed. Imaging is crucial: x-rays: initially unrewarding, some SF effusion is seen. MRI helps with early Dx and extremity off-loading. Late Dx: irreversible dislocations, collapse, disability. Note: Lisfrance dislocation in Charcot joint
  • M/C mid-foot (TM joint) in 40% of cases, ankle 15%. Progression: Rocker-bottom foot, ulcerations, infections, increased morbidity and mortality.
  • Early Dx: by MRI is crucial. Suspect it in patients with type 2 DM especially if early non-traumatic foot/ankle pain reported.
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The information herein on "Ankle & Foot Diagnostic Imaging Arthritis & Trauma II| El Paso, TX." is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.

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Our information scope is limited to Chiropractic, musculoskeletal, acupuncture, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.

We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.

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Dr. Alex Jimenez DC, MSACP, RN*, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

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