The Adult Ankle and Foot

Measurements of osteoarticular relationships and their related soft tissue structures using multiple imaging modalities, play an important role in the diagnosis and management of traumatic and non-traumatic adult ankle and foot disorders. As in the paediatric foot, familiarity with anatomical landmarks/lines related to the adult standard radiographic projections is a necessary prerequisite before their clinical application. It is important to remember that the normal painless adult foot can have a wide range of bony relationships and measured values can indeed be in the abnormal range. Contralateral assessment and comparisons are very important in this respect (Steel et al. 1980). In this chapter the large number of lines, angles and measurements are presented by grouping them under the heading of the standard radiographic view that allows their evaluation to be made. Weight-bearing films are essential as there are significant measurement differences from non-weight-bearing radiographic measurements. More detailed coverage of the main angles then follows. In particular special attention is given to the difficulties in evaluating the distal tibiofibular syndesmosis and the current roles that CT, MRI and US play in its evaluation in trauma and post-operative scenarios. Attention to the important soft tissue structures is then included emphasizing the role of US and MRI in evaluating the dimensions and morphological features of ligaments and tendons.