Abstract:Thirty-nine patients with rheumatoid arthritis who had presented with tarsitis before, were investigated at the level of the rearfoot. The first 17 patients had CT with previous tenography when it was possible; the following 22 patients had MRI with gadolinium injection. Tendon involvement appeared in 52.9% of the cases on CT, and in 90% of the feet on MRI; therefore, in case of clinical or radiological signs of tarsitis, it appears that tendon involvement must be suspected. With the two procedures the tibiali… Show more
“…In the forefoot, nearly two thirds of tendon infections involved the flexor tendons because of the predominant plantar location of forefoot ulceration. Contrast enhancement of a tendon and the presence of peritendinous fluid signal on T2-weighted images are not specific for the presence of a tendon infection [3,6]; these findings can also be seen in patients with inflammatory conditions [23,24], pigmented villonodular synovitis [25], and degenerative disorders of the tendons [26] and in patients who have sustained trauma. However, circular enhancement of a tendon passing through an area of cellulitis from an infected pedal ulcer may be a specific sign of infection [27].…”
MR evidence of tendon infection is present in approximately half the patients who require surgery for pedal infection. Evidence of spread of the infection along tendons is seen infrequently on MR imaging. Detection of a tendon infection could influence surgical therapy.
“…In the forefoot, nearly two thirds of tendon infections involved the flexor tendons because of the predominant plantar location of forefoot ulceration. Contrast enhancement of a tendon and the presence of peritendinous fluid signal on T2-weighted images are not specific for the presence of a tendon infection [3,6]; these findings can also be seen in patients with inflammatory conditions [23,24], pigmented villonodular synovitis [25], and degenerative disorders of the tendons [26] and in patients who have sustained trauma. However, circular enhancement of a tendon passing through an area of cellulitis from an infected pedal ulcer may be a specific sign of infection [27].…”
MR evidence of tendon infection is present in approximately half the patients who require surgery for pedal infection. Evidence of spread of the infection along tendons is seen infrequently on MR imaging. Detection of a tendon infection could influence surgical therapy.
“…An abnormal thickening of the tendon sheath with enhancement after intravenous administration of gadolinium contrast medium may be seen. Associated signal alterations in the tendon indicate concomitant tendinosis [40]. Fig.…”
Section: Inflammatory and Infectious Lesionsmentioning
In the foot and ankle region, benign neoplasms and pseudotumoural soft tissue lesions are significantly more frequent than malignant tumours. The pseudotumoural lesions constitute a heterogeneous group, with highly varied aetiology and histopathology. This article reviews the imaging features of the most common pseudotumours of the soft tissues in the foot and ankle. Although the imaging characteristics of several of the lesions discussed are non-specific, combining them with lesion location and clinical features allows the radiologist to suggest a specific diagnosis in most cases.
“…Chronic inflammatory changes in the joints and local tendons are known to result in significant and irreversible structural changes such as flattening of the medial longitudinal arch, valgus deformity of the calcaneus, and tibialis posterior tendon dysfunction [2]. Although it has been argued that foot involvement in RA usually begins in the forefoot and later progresses to involve the midfoot and rearfoot [3,4], these claims were based on the typical progression of deformity and destruction as observed through radiological studies. Where soft tissues are concerned, however, it is not uncommon for ankle swelling to be the earliest symptom of RA [5], especially in atypical cases such as elderly-onset RA and male RA.…”
The aim of this study was to characterize the pathological conditions of symptomatic ankles in patients with rheumatoid arthritis (RA) using power Doppler sonography (PDS). We analyzed 17 consecutive ultrasonography (US) records of RA patients with symptomatic ankles who underwent B-mode ultrasonography (BUS) combined with PDS of their ankles in our department because of clinical need. Correlations between US findings and clinical and serological data were assessed. The diagnostic capabilities of BUS and PDS were also compared. Common US findings were talocrural synovitis (76%), subtalar synovitis (71%), and talonavicular synovitis (59%). Tenosynovitis around the ankle was detected in ten patients (59%), including several cases of tenosynovitis of tibialis posterior (41%) and tenosynovitis of peroneus longus and brevis (35%). Achilles tendon enthesitis was detected in six patients, and retrocalcaneal bursitis was detected in five. Compared with BUS, PDS offers demonstrably superior diagnostic capability for the detection of rheumatoid ankle diseases, especially subtalar joint synovitis and peroneal tenosynovitis. Rheumatoid factor (RF) levels were significantly higher in patients with tenosynovitis than in patients without tenosynovitis. PDS is an excellent modality for diagnosing both intra- and extracapsular synovitis in rheumatoid ankles. Using PDS, we found positive association between ankle tenosynovitis and RF levels in RA patients.
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