Konventionelle Bildgebung Fuß und Sprunggelenk – akut und chronisch

Zusammenfassung

Grundlage für Diagnose und Behandlung akuter und chronischer Beschwerden an Fuß und Sprunggelenk sind, neben einer ausführlichen klinischen Untersuchung, konventionelle Röntgenbilder. Basis der Diagnostik sind standardisierte Röntgenaufnahmen, wobei empfohlen wird, bei der Wahl der Projektion zwischen akuten und chronischen Beschwerden zu differenzieren. Bei akuten Symptomen an Fuß und Sprunggelenk empfehlen wir standardmäßig eine „5er-Serie“ mit Röntgen des Fußes dorsoplantar, schräg und lateral sowie des Sprunggelenks anterior–posterior und lateral ohne Belastung. Bei chronischen Beschwerden hingegen empfiehlt sich eine „4er-Serie“ unter Belastung mit Röntgen des Fußes dorsoplantar und lateral sowie des Sprunggelenks anterior–posterior sowie einer Saltzman-Aufnahme. Wichtig ist es, bei chronischen Symptomen die Aufnahmen im Stehen und unter Belastung durchzuführen, während bei Patienten nach frischem Trauma oder unmittelbar nach einem operativen Eingriff Röntgenaufnahmen ohne Belastung durchgeführt werden sollten. Nach primär konventioneller Bildgebung kann bei Bedarf die Diagnostik im Anschluss zielgerichtet erweitert werden.

Abstract

The basis for diagnosis and treatment of acute and chronic complaints of the foot and ankle are conventional X-ray images, in addition to a detailed clinical examination. Standardized radiographs should always represent the beginning of the diagnostic process. It is recommended to differentiate between acute and chronic complaints when selecting the X-ray projection. For acute symptoms of the foot and ankle, we suggest a standard “five-series” with X-rays of the foot dorsoplantar, oblique, and lateral, and of the ankle anterior–posterior and lateral without loading. In the case of chronic symptoms, we recommend a “four-series” under stress with X-rays of the foot dorso-plantar and lateral as well as of the ankle joint anterior–posterior and a Saltzman image. It is important to perform the radiographs with the patient standing and under weight bearing in cases of chronic symptoms, whereas radiographs should be performed without weight bearing in patients after fresh trauma, or immediately after a surgical procedure. After primary conventional X-ray imaging, diagnostics can subsequently be expanded in a targeted manner if necessary.

Schlüsselwörter

konventionelle Röntgenaufnahmen von Fuß und Sprunggelenk - Saltzman-Aufnahme - radiologische Beurteilung der Rückfußausrichtung

Key words

radiographs of the foot and ankle - Saltzman view - radiographic assessment of hindfoot alignment

Publication History

Article published online:
15 July 2021

• Literatur

• 1 Barg A. Natives Röntgen vom Rückfuß und Saltzman-Aufnahme. Fuss Sprungg 2015; 13: 58-77
• 2 Linklater JM, Read JW, Hayter CL. Imaging of the Foot and Ankle. In: Coughlin MJ, Saltzman CL, Anderson RB. eds. Mannʼs Surgery of the Foot and Ankle. 9th ed. Philadelphia, PA: Elsevier Saunders; 2014: 61-120
• 3 Rammelt S, Amlang M, Zwipp H. Standardröntgendiagnostik an Fuß und Sprunggelenk. Fuss Sprungg 2010; 7: 80-91
• 4 Saltzman CL, el-Khoury GY. The hindfoot alignment view. Foot Ankle Int 1995; 16: 572-576
• 5 Steiger M, Bohndorf K. CT-Diagnostik von Sprunggelenk- und Fußwurzelfrakturen. Fuss Sprungg 2010; 8: 92-98
• 6 Barg A, Bailey T, Richter M. et al. Weightbearing Computed Tomography of the Foot and Ankle: Emerging Technology Topical Review. Foot Ankle Int 2018; 39: 376-386 DOI: 10.1177/1071100717740330.
• 7 Ananthakrisnan D, Ching R, Tencer A. et al. Subluxation of the talocalcaneal joint in adults who have symptomatic flatfoot. J Bone Joint Surg Am 1999; 81: 1147-1154
• 8 El-Khoury GY, Alliman KJ, Lundberg HJ. et al. Cartilage thickness in cadaveric ankles: measurement with double-contrast multi-detector row CT arthrography versus MR imaging. Radiology 2004; 233: 768-773 DOI: 10.1148/radiol.2333031921.
• 9 Hsu AR, Gross CE, Lee S. Intraoperative O-arm computed tomography evaluation of syndesmotic reduction: case report. Foot Ankle Int 2013; 34: 753-759 DOI: 10.1177/1071100712468872.
• 10 Stürznickel J, Rolvien T, Delsmann A. et al. Clinical Phenotype and Relevance of LRP5 and LRP6 Variants in Patients With Early-Onset Osteoporosis (EOOP). J Bone Miner Res 2021; 36: 271-282 DOI: 10.1002/jbmr.4197.
• 11 Chhabra A, Soldatos T, Chalian M. et al. Current concepts review: 3 T magnetic resonance imaging of the ankle and foot. Foot Ankle Int 2012; 33: 164-171 DOI: 10.3113/fai.2012.0164.
• 12 Juras V, Zbýň Š, Mlynarik V. et al. The compositional difference between ankle and knee cartilage demonstrated by T2 mapping at 7 Tesla MR. Eur J Radiol 2016; 85: 771-777 DOI: 10.1016/j.ejrad.2016.01.021.
• 13 Cerezal L, Llopis E, Canga A. et al. MR arthrography of the ankle: indications and technique. Radiol Clin North Am 2008; 46: 973-994 DOI: 10.1016/j.rcl.2008.09.002.
• 14 Groshar D, Gorenberg M, Ben-Haim S. et al. Lower extremity scintigraphy: the foot and ankle. Semin Nucl Med 1998; 28: 62-77
• 15 Pagenstert GI, Barg A, Leumann AG. et al. SPECT-CT imaging in degenerative joint disease of the foot and ankle. J Bone Joint Surg Br 2009; 91: 1191-1196 DOI: 10.1302/0301-620x.91b9.22570.
• 16 Arbab D, Abbara M, Rath B. et al. Bildgebende Diagnostik der Peronealsehnen. Fuss Sprungg 2015; 13: 113-122
• 17 Barg A, Schneider SW, Pagenstert G. et al. Thrombembolische Komplikationen nach Sprunggelenkprothesenimplantation. Orthopäde 2013; 42: 948-956 DOI: 10.1007/s00132-013-2173-2.
• 18 Schuh R, Trnka HJ. Metatarsalgia: distal metatarsal osteotomies. Foot Ankle Clin 2011; 16: 583-595 DOI: 10.1016/j.fcl.2011.08.009.
• 19 Zadek I. The significance of the accessory tarsal scaphoid. J Bone Joint Surg 1926; 8: 618-626
• 20 Brian PL, Mahraj RP. Imaging of the calcaneus. Foot Ankle Clin 2005; 10: 443-461 DOI: 10.1016/j.fcl.2005.04.002.
• 21 Sanders R. Intra-articular fractures of the calcaneus: present state of the art. J Orthop Trauma 1992; 6: 252-265
• 22 Clare MP, Sanders RW. Calcaneal fractures. Fuss Sprungg 2007; 5: 58-73
• 23 Rammelt S, Schneiders W, Zwipp H. Gelenkerhaltende Korrektur fehlverheilter Kalkaneusfraktur. Unfallchirurg 2014; 117: 776-784 DOI: 10.1007/s00113-014-2602-7.
• 24 Camathias C, Valderrabano V, Pagenstert G. et al. Die Fraktur des Processus lateralis tali (Snowboarderʼs Foot). Fuss Sprungg 2006; 4: 184-193
• 25 Herrera-Pérez M, Andarcia-Bañuelos C, Barg A. et al. Comparison of cannulated screws versus compression staples for subtalar arthrodesis fixation. Foot Ankle Int 2015; 36: 203-210 DOI: 10.1177/1071100714552485.
• 26 Barg A, Tochigi Y, Amendola A. et al. Subtalar instability: diagnosis and treatment. Foot Ankle Int 2012; 33: 151-160 DOI: 10.3113/fai.2012.0151.
• 27 Linklater J, Hayter CL, Vu D. et al. Anatomy of the subtalar joint and imaging of talo-calcaneal coalition. Skeletal Radiol 2009; 38: 437-449 DOI: 10.1007/s00256-008-0615-4.
• 28 Benirschke SK, Sangeorzan BJ. Extensive intraarticular fractures of the foot. Surgical management of calcaneal fractures. Clin Orthop Relat Res 1993; (292) 128-134
• 29 Higgins TF, Baumgaertner MR. Diagnosis and treatment of fractures of the talus: a comprehensive review of the literature. Foot Ankle Int 1999; 20: 595-605
• 30 Canale ST, Kelly jr. FB. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am 1978; 60: 143-156
• 31 Suter T, Barg A, Knupp M. et al. Surgical technique: talar neck osteotomy to lengthen the medial column after a malunited talar neck fracture. Clin Orthop Relat Res 2013; 471: 1356-1364 DOI: 10.1007/s11999-012-2649-0.
• 32 Shereff MJ, DiGiovanni L, Bejjani FJ. et al. A comparison of nonweight-bearing and weight-bearing radiographs of the foot. Foot Ankle 1990; 10: 306-311
• 33 Tochigi Y, Suh JS, Amendola A. et al. Ankle alignment on lateral radiographs. Part 1: sensitivity of measures to perturbations of ankle positioning. Foot Ankle Int 2006; 27: 82-87
• 34 Tochigi Y, Suh JS, Amendola A. et al. Ankle alignment on lateral radiographs. Part 2: reliability and validity of measures. Foot Ankle Int 2006; 27: 88-92
• 35 Ebraheim NA, Mekhail AO, Haman SP. External rotation-lateral view of the ankle in the assessment of the posterior malleolus. Foot Ankle Int 1999; 20: 379-383
• 36 van Dijk CN, Wessel RN, Tol JL. et al. Oblique radiograph for the detection of bone spurs in anterior ankle impingement. Skelet Radiol 2002; 31: 214-221 DOI: 10.1007/s00256-002-0477-0.
• 37 van Dijk CN. Anterior and posterior ankle impingement. Foot Ankle Clin 2006; 11: 663-683 DOI: 10.1016/j.fcl.2006.06.003.
• 38 Barg A, Wimmer MD, Wiewiorski M. et al. Endoprothetischer Ersatz des oberen Sprunggelenks – Indikationen, Prothesendesigns, Ergebnisse. Dtsch Arztebl 2015; 111: 1-21
• 39 Barg A, Amendola RL, Henninger HB. et al. Influence of ankle position and radiographic projection angle on measurement of supramalleolar alignment on the anteroposterior and hindfoot alignment views. Foot Ankle Int 2015; 36: 1352-1361 DOI: 10.1177/1071100715591091.
• 40 Broden B. Roentgen examination of the subtaloid joint in fractures of the calcaneus. Acta Radiol 1949; 31: 85-91
• 41 Sijbrandij ES, van Gils AP, van Hellemondt FJ. et al. Assessing the subtalar joint: the Broden view revisited. Foot Ankle Int 2001; 22: 329-334
• 42 Krähenbühl N, Lenz AL, Lisonbee RJ. et al. Morphologic analysis of the subtalar joint using statistical shape modeling. J Orthop Res 2020; 38: 2625-2633 DOI: 10.1002/jor.24831.
• 43 Colin F, Horn Lang T, Zwicky L. et al. Subtalar joint configuration on weightbearing CT scan. Foot Ankle Int 2014; 35: 1057-1062 DOI: 10.1177/1071100714540890.
• 44 Harris RI, Beath T. Etiology of peroneal spastic flat foot. J Bone Joint Surg Br 1948; 30 B: 624-634
• 45 Kulik jr. SA, Clanton TO. Tarsal coalition. Foot Ankle Int 1996; 17: 286-296
• 46 Stoskopf CA, Hernandez RJ, Kelikian A. et al. Evaluation of tarsal coalition by computed tomography. J Pediatric Orthopedics 1984; 4: 365-369
• 47 Vallier HA, Nork SE, Barei DP. et al. Talar neck fractures: results and outcomes. J Bone Joint Surg Am 2004; 86: 1616-1624
• 48 Thomas JL, Boyce BM. Radiographic analysis of the Canale view for displaced talar neck fractures. J Foot Ankle Surg 2012; 51: 187-190 DOI: 10.1053/j.jfas.2011.10.037.
• 49 Juliano PJ, Dabbah M, Harris TG. Talar neck fractures. Foot Ankle Clin 2004; 9: 723-736 DOI: 10.1016/j.fcl.2004.07.001.
• 50 Inman VT. The Joints of the Ankle. Baltimore (MD): Williams & Wilkins; 1976
• 51 Barg A, Harris MD, Henninger HB. et al. Medial distal tibial angle: comparison between weightbearing mortise view and hindfoot alignment view. Foot Ankle Int 2012; 33: 655-661 DOI: 10.3113/fai.2012.0655.
• 52 Stufkens SA, Barg A, Bolliger L. et al. Measurement of the medial distal tibial angle. Foot Ankle Int 2011; 32: 288-293 DOI: 10.3113/fai.2011.0288.
• 53 Barg A, Wiewiorski M, Paul J. et al. Supramalleolare Osteotomie bei asymmetrischer Arthrose des oberen Sprunggelenks. Kurzfristige klinische und radiologische Ergebnisse. Orthopäde 2017; 46: 761-775
• 54 Chao EY, Neluheni EV, Hsu RW. et al. Biomechanics of malalignment. Orthop Clin North Am 1994; 25: 379-386
• 55 Knupp M, Ledermann H, Magerkurth O. et al. The surgical tibiotalar angle: a radiologic study. Foot Ankle Int 2005; 26: 713-716
• 56 Krähenbühl N, Akkaya M, Deforth M. et al. Extraarticular supramalleolar osteotomy in asymmetric varus ankle osteoarthritis. Foot Ankle Int 2019; 40: 936-947 DOI: 10.1177/1071100719845928.
• 57 Krähenbühl N, Susdorf R, Barg A. et al. Supramalleolar osteotomy in post-traumatic valgus ankle osteoarthritis. Int Orthop 2020; 44: 535-543 DOI: 10.1007/s00264-019-04476-x.
• 58 Paley D, Herzenberg JE, Tetsworth K. et al. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 1994; 25: 425-465
• 59 Wang B, Saltzman CL, Chalayon O. et al. Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis?. Clin Orthop Relat Res 2015; 473: 318-325 DOI: 10.1007/s11999-014-3960-8.
• 60 Magerkurth O, Knupp M, Ledermann H. et al. Evaluation of hindfoot dimensions: a radiological study. Foot Ankle Int 2006; 27: 612-616
• 61 Hintermann B, Knupp M, Barg A. Gelenkerhaltende Therapieoptionen bei peritalarer Instabilität. Fuss Sprungg 2013; 11: 196-206
• 62 Cox JS, Hewes TF. “Normal” talar tilt angle. Clin Orthop Relat Res 1979; (140) 37-41