Evaluation of the relations between foot - ANKLE pathologies and anatomic variations with magnetic resonance imaging

Foot-ankle pathologies cause serious negativities in walking, daily life and sportive activities of patients. Therefore, it is important to know the common pathologies in the foot and ankle and anatomical variations that may be associated with them. Magnetic resonance imaging is one of the most useful non-invasive diagnostic tools used in the evaluation of the foot and ankle. In our study, we retrospectively analyzed 849 ankles of 738 patients who underwent magnetic resonance imaging due to ankle symptoms in our hospital between 2016 and 2020 years. Peroneal tendinopathies, anterior talofibular ligament (ATFL) injuries, talus osteochondral lesions (TOL), flexor hallucis longus (FHL) and achilles tendinitis, retrocalcaneal bursitis and Haglund deformities were examined from ankle pathologies. Among the anatomical variations, retromalleolar fibular groove (RMFO) shape, os peroneum, os trigonum, accessory peroneus quartus muscle, flexor digitorum accessory longus (FDAL) muscle, low-lying peroneus brevis and FHL muscles were evaluated. The distance of the peroneus brevis (PB) and FHL musculotendinous junctions (MTJ) from the reference points we determined was measured. Area calculations of TOL were performed. In the statistical evaluation, chi-square analysis was used for the proportional data of the cases, and independent sample t-test was used for the quantitative data measurements. Cut-off value for PB and FHL musculotendinous junction distances were determined by receiver operating characteristic (ROC) analysis. Of the 738 patients included in the study, 274 (37.10%) were male and 464 (62.90%) were female. It was determined that 427 (50.3%) of 849 ankles of the patients were right side and 422 (49.7%) were left side. It has been shown that RMFO shape variations and low-lying PB muscle can cause peroneal tendon pathologies. The cut-off point value of the PB MTJ, which may be associated with a vertikal tear of the PB tendon, was calculated as 4.40 mm distal from fibular tip. Os peroneum bone variation was determined to be a risk factor for PL tendinopathies. It was shown that there is a significant correlation between ATFL and peroneal tendon pathologies. It was determined that TOL observed in peroneal tendon and ATFL pathologies were more frequently localized on the lateral side of the talar dome. Os trigonum bone variation was determined to be a risk factor for FHL tendinopathies, TOL and retrocalcaneal bursitis pathologies. It has been shown that there is a significant correlation between FHL tendinopathies and achilles pathologies, retrocalcaneal bursitis, Haglund deformity. It has been determined that the low-lying FHL muscle may be a predisposing factor for FHL tendinopathies. The cut-off point value of the FHL MTJ, which may be associated with FHL tendinopathies, was calculated as 4.15 distal from highest point of calcaneus posterior facet. It has been determined that achilles tendinitis, paratendinitis and tendinosis, retrocalcaneal bursitis and Haglund deformities can be seen in isolation as well as concomitantly. As a result; to be able to evaluated of foot-ankle pathologies and anatomical variations with using magnetic resonance imaging, as well as to know the concomitantly correlation between these pathologies and anatomical variations will guide physicians in diagnosis and treatment.