Advanced Imaging of the Foot and Ankle

RADIOLOGY CORNERclinical utility, diagnostic accuracy, and limitations.Relevant findings were synthesized to provide a practical, evidence-based overview. AnAtomy o f tendons A n d LigAmentsThe anatomy of the tendons and ligaments is generally best evaluated with US or MRI.MRI offers limited advantage if expertise in musculoskeletal (MSK) US is available.The dynamic nature of US is particularly useful in the assessment of tendon or ligament rupture.US can also be used to guide injections.The flexor tendons, located on the medial side of the ankle, are often remembered using the mnemonic "Tom, Dick, and very nervous Harry."Running from medial to lateral, "Tom" represents the tibialis posterior tendon; "Dick" is the flexor digitorum longus tendon; "and very nervous" are the posterior tibial artery, vein, and nerve; and "Harry" corresponds to the flexor hallucis longus tendon.The tendons pass through the tarsal tunnel deep to the flexor retinaculum.The peroneal tendons are located on the posterolateral introduction Accurate imaging plays a pivotal role in diagnosing foot and ankle pathology, yet inappropriate or suboptimal imaging requests 1 are commonly encountered in clinical practice.This often leads to diagnostic delays, increased healthcare costs, and patient frustration. 2The complexity of foot and ankle anatomy, combined with a wide spectrum of possible pathologies, requires a clear understanding of the strengths and limitations of various imaging modalities.Unfortunately, this knowledge gap persists among many referring clinicians.This concise review aims to address that gap by offering a practical, accessible guide to advanced imaging techniques including ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), dual-energy CT (DECT), singlephoton emission computed tomography (SPECT), and positron emission tomography (PET).By fostering interdisciplinary awareness among radiologists, orthopedic surgeons, and other healthcare providers, this review promotes more accurate and efficient investigation strategies.Selecting the most appropriate imaging modality early in the diagnostic process reduces unnecessary studies, minimizes radiation exposure, and accelerates diagnosis and treatment.Ultimately, informed imaging decisions enhance diagnostic accuracy and improve patient outcomes. methodoLogyThis article is a narrative review focusing on advanced imaging modalities used in the evaluation of foot and ankle pathology.Key advanced modalities-including US, MRI, CT, DECT, and nuclear medicine techniques-were selected based on their clinical relevance and frequency of use.A targeted literature search was conducted using databases such as PubMed and Google Scholar, focusing on studies and reviews published within the last 5-10 years.The aim was to identify current evidence supporting each modality's indications, 1,3,