Presentation
Twisted ankle.
Patient Data
No fracture or traumatic malalignment identified.
No ankle joint effusion.
No osteochondral lesion of the talar dome or distal tibial plafond. Microtrabecular injury to the plantar aspect of the talar head. Mild marrow edema within the anterior calcaneal process.
Syndesmotic and the medial and lateral collateral ligaments are intact.
Edema to the spring ligament complex with partial tear of the medioplantar oblique component. Dorsal talonavicular and bifurcate ligament edema without rupture.
Mild edema within the sinus tarsi with sprain of the interosseous talocalcaneal ligament.
Case Discussion
Midtarsal sprains are less common than collateral ligament injuries of the ankle and are often overlooked both clinically and radiologically. On the initial x-ray, there is a very good clue with a ROI indicated by the radiographer indicating symptoms in the midtarsal region rather than at the ankle joint. Midtarsal injuries can often be occult on plain radiographs. On MRI, plantar talar head marrow edema (+/- microtrabecular injury) is a really good clue that the midtarsal ligaments may be injured.
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