Introduction Musculoskeletal injuries and disorders of the ankle are a common cause of disability and pain, with an estimated prevalence of ankle pain in the general adult population of 9 to 15%.
Musculoskeletal injuries and disorders of the ankle are a common cause of disability and pain, with an estimated prevalence of ankle pain in the general adult population of 9 to 15%. Patients with ankle-related symptoms often present to a wide range of specialties, including primary care, orthopedic, and emergency medicine providers. Following history and physical examination, imaging is commonly employed to assist in the diagnosis and management of ankle symptomatology.
In 2000, the American College of Radiology (ACR) published Appropriateness Criteria for imaging acute and chronic ankle symptoms, recommending ankle radiographs as the initial imaging exam for both acute and chronic ankle symptoms [3, 4]. These guidelines rate ankle MRI as a “usually not appropriate” initial test and reserve MRI for patients requiring further evaluation following radiographs. Similarly, the Ottawa ankle rules and the more recent 2018 Choosing Wisely recommendations from the Pediatric Orthopedic Society of North America suggest radiography as the initial best test when imaging is indicated.
We will cover common practices on reading ankle radiographs. The ankle is a hinge joint and is formed by the tibia , fibula and talus . The distal end of the tibia (medial malleolus), distal end of the fibular (lateral malleolus) and tibial plafond make up the ankle joint.
They collectively form a rectangular socket called the ankle mortise into which fits the talar dome distally. Reinforcement of the ankle joint is provided in multiple areas. The syndesmosis is a strong fibrous complex between the distal tibia and fibula.
Medial (deltoid) and lateral ligaments (posterior talofibular, anterior talofibular and calcaneofibular ligaments) arise from the medial and lateral malleolus. AP view of the ankle depicting location of major ankle ligaments. A standard series of radiographs of the ankle will usually have three views – AP, mortise, and lateral.
If you are experiencing symptoms that may be related to how to read ankle radiographs, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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