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Partial Care should be taken to differentiate physiologic fluid ac- tears buy generic sinemet 300 mg online treatment kidney disease, especially when acute purchase 125 mg sinemet with visa medications held before dialysis, often depict edema and he- cumulation within the tendon sheath and tenosynovitis morrhage within Kager’s fat pad. Complete Achilles ten- from fluid within the common peroneal sheath secondary to a tear of the calcaneofibular ligament. Care should al- don rupture manifests as discontinuity with fraying and so be taken as well to differentiate between tendinosis retraction of the torn edges of the tendon. US is comparable to MR imaging for assessing Longitudinal intrasubstance tears of the peroneus bre- Achilles tendon injuries. In addition, US demonstrates vis tendon have a distinct appearance on axial MR im- neovascularization in painful Achilles tendons. The tendon assumes a C-shaped or boomerang con- while strongly associated with pain, is not predictable of figuration that partially envelops the peroneus longus an unfavorable outcome. Ultrasound may miss Achilles tendon lesions at frequently seen at the level of the peroneal tubercle or the muscle- tendon junction, while MR imaging at this cuboid tunnel. The imaging diagnosis of a tear of the per- site is associated with muscle edema, retraction of mus- oneus longus tendon at this location is clinically impor- cle fibers and hematoma. On An abnormal position of an os peroneum on conven- most follow-up MR imaging studies, intratendinous sig- tional radiographs may be a clue for possible tear of the nal intensity will decrease as the tendon heals. Hypertrophy of the peroneal tu- the tendon may remain thickened, simulating chronic bercle has also been implicated as a cause for tear of the tendinosis, even after normal signal intensity has been re- peroneus longus tendon at the midfoot. Imaging of the Foot and Ankle 43 Ligaments the ligament will allow the talar head to collapse result- ing in an acquired flat foot deformity. There is a high as- Lateral Collateral Ligaments sociation between rupture of the spring ligament and dys- function of the posterior tibial tendon. Ankle sprains are the most common musculoskeletal The spring ligament is composed of the inferior longi- cause for hospital emergency rooms and private practice tudinal calcaneonavicular and superomedial calcaneonav- visits. The anterior tibiofibular lig- oblique) of the spring ligament has been demonstrated. The posterior tibiofibular ligament, also visible on icular in the lower layer of the spring ligament complex, axial images at the tip of the fibula, is rarely torn. Early investigations have indicated that the calcane- Each of the three components can be visualized on MR ofibular ligament runs obliquely from the fibular tip pos- images. Therefore, oblique images have been considered to be superior in the Impingement Syndromes assessment of the ligament. In our experience, however, this plane is not clearly superior to coronal images in de- The role of impingement syndromes in producing chron- lineating the calcaneofibular ligament. This may be ex- ic ankle pain has been better appreciated in recent years. This is discussed more fully under the category of Among the four most common impingement syn- osseous injuries. Intra-articular synovial hypertrophy The tibiofibular syndesmosis is an important stabilizer of and fibrosis may occur in the lateral gutter secondary to the distal tibiofibular joint. It consists of the anteroinfe- capsular or ligamentous tears associated with inversion rior tibiofibular ligament, the posteroinferior tibiofibular injuries. This condition is optimally assessed with MR ligament, the transverse tibiofibular ligament, and the in- arthrography, although positive experience with this ap- terosseous tibiofibular ligament. Disruption or irregularities of the ligaments, ankle, excluding Morton’s neuroma, is tarsal tunnel syn- degenerative changes at the distal tibiofibular joint, and drome. The tarsal tunnel is a fibro-osseous space formed proximal extension of fluid into the lateral gutter (greater by the talar surface, the sustentaculum tali, and the cal- than 1 cm) aid in making the diagnosis. It is traversed by the posterior tibial, flexor dig- Medial Collateral Ligament itorum longus, and flexor hallucis longus tendons, the tibial nerve and its branches and accompanying vessels. The medial collateral ligament plays an important role in In about 50% of cases, tarsal tunnel syndrome is idio- medial ankle instability. Marked inter-individual differ- pathic, whereas in the other 50% a specific cause is iden- ences are found for the main components (tibionavicular, tified, such as space occupying lesions including gan- tibiospring, tibiocalcaneal, deep posterior and anterior glion, varicosities, lipoma, accessory muscles, and nerve- tibiotalar and superficial posterior tibiotalar bands).