Foot

Common indications
Evaluation of bony and soft tissue abnormalities (tumour,
infection)
Diagnosis of bone trauma not seen with conventional
radiography
Bony tumours
Mortons neuroma
Tarsal coalitions
Diabetic foot
Equipment
Extremity coil/head coil/flexible surface coils/small coil configured
as a multi-coil array
Foam immobilization pads and straps
Earplugs/headphones
Patient positioning
Due to the non-orthogonal axis of the feet, true coronal and sagittal imaging can
be difficult to obtain without oblique scan prescription. With the feet dorsiflexed,
true sagittal imaging is possible, but due to the curvature of the tarsal bones,
coronal imaging is sometimes difficult. It is probably advisable to examine the
patient as for an ankle if the tarsal bones are the ROI, and reserve specific
imaging of the foot if the toes and metatarsals are under investigation. The
patient is usually positioned as for an ankle in the extremity or head coil. When
using these coils, ensure that the toes do not protrude beyond the coil anteriorly.
This may happen if the patient has large feet and, under these circumstances, a
surface coil is required to provide adequate coverage. The forefoot can be
examined effectively and comfortably using a flexible surface coil or a two-coil
array with the patient prone and the foot plantar flexed. Immobilization of the
foot and the coil using crossed straps and sponges is essential in both cases. If
the prone position is used, raise the foot and coil so that the long axis of the foot
is at the level of the horizontal alignment light. If the feet are flat down on the
surface coil, raise the coil and foot so that the vertical alignment light lies
through the middle of the foot in the vertical axis. This enhances patient comfort
and ensures that every part of the foot is at isocentre, which simplifies
subsequent imaging as no offsets are needed. The patient is made as
comfortable as possible and immobilized with pads and straps if necessary.
Suggested protocol
Scan plane alignment
These protocols refer to the following anatomical planes. The axial plane

is perpendicular to the long axis of the foot, showing the metatarsals in

cross section. A coronal plane is analogous to the AP X-ray view, with the
metatarsals adjacent to each other.
Note: These planes may not coincide with terminology used in other
texts and, depending on patient positioning, may not correspond to your
scanners orthogonal plane labelling.
Axial SE/FSE/incoherent (spoiled) GRE T1
Acts as a localizer if three-plane localization is unavailable so that the
curvature of the tarsals and metatarsals can be evaluated. Medium slices/
gap are prescribed on either side of the horizontal alignment light.
I 20mm to S 20mm
Axial SE/FSE T1
Thin slices/gaps are prescribed to include from the end of the toes to the
tarsal bones, with good resolution to provide a clear anatomical display
of the anatomy of the foot (Figure 14.28). SE sequences are preferred for
Figure 14.28 Sagittal FSE
PD-weighted image showing slice
prescription boundaries and
orientation for axial imaging
of the foot.
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evaluating tendon damage, but short ETL FSE sequences can be used to
achieve higher spatial resolution in an acceptable scan time.
Axial FSE PD/T2 +/ tissue suppression
Slice prescription as for axial T1.
These sequences demonstrate joint effusions, mass lesions and collections. The
addition of fat suppression enables visualization of subtle trabecular damage in
stress fractures of the metatarsal bones.
In soft tissue imaging (i.e. Mortons neuroma), T2W images are used
(TE>65ms).
Sagittal SE/FSE T1/PD (Figure 14.29)
Thin slices/gaps are prescribed from the lateral to the medial aspects

of the foot and should include the sole of the foot to the distal tibia
(Figure 14.30).
Sagittal FSE PD T2/STIR/coherent GRE T2/T2* + tissue suppression
(Figure 14.31)
Slice prescription as for sagittal T1.
For demonstration of fluid collections, infection, and metatarsal or tarsal
fractures.
Figure 14.29 Sagittal FSE
PD-weighted image of the foot.
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Figure 14.30 Coronal FSE
PD-weighted localizer of the foot
showing slice prescription boundaries and orientation for sagittal
imaging of the foot.
Figure 14.31 Sagittal FSE
PD-weighted image of the foot with
tissue suppression.
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In soft tissue imaging (i.e. Mortons neuroma), T2W images are used
(TE>65ms).
Additional sequences
Coronal SE T1 or FSE PD/T2 + tissue suppression
This scan plane is used in preference to the sagittal where the axial images
show significant pathology extending between the metatarsal bones
(Figure 14.32).
Sagittal 3D coherent GRE PD/T2*
Acquired as an isotropic data set, this sequence may be useful to assess
anatomy and pathology in any plane. Sagittal slices should include the
whole of the foot from the sole to the distal tibia.
3D FSE with variable refocusing flip angle
Provides high resolution and good SNR in a shorter acquisition time than

conventional 3D FSE.
Figure 14.32 Sagittal FSE
T2-weighted image of the foot
showing slice prescription boundaries and orientation for coronal
imaging of the foot.
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