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Imaging the ankle

Nuffield Orthopaedic Centre and Oxford Radcliffe Hospital, Oxford OX3 7LD, UK

• Plain films are useful as an initial screen test for diffuse ankle and foot pain.
  
• MRI is the most suitable technique for global assessment of bone and soft tissues for persistent pain following injury.
  
• Ultrasound should be reserved for specific focal soft-tissue conditions and when dynamic information is required.
  
• Ultrasound is an excellent technique for guiding injections.
  

This article covers all of the common and important conditions of the ankle and foot that may present to the radiologist for imaging, with the exception of acute bony trauma. For a variety of clinical scenarios, the possible imaging strategies are explored and examples of the various pathologies are described and illustrated. Plain films are usually requested but many cases also require MRI or ultrasound. In general, MRI is best for diffuse symptoms and ultrasound for focal soft-tissue problems, particularly if dynamic imaging or guided injection is required.