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Foot injuries in athletes are often subtle but can lead to a substantial loss of function. For many of those injuries, the treatment options are controversial. Although foot injuries count for significant time loss in sports participation, their severity is easily underestimated. Typical sports-related injuries of the foot include high-energy trauma, Lisfranc ligament ruptures, metatarsal fractures, fractures at the base of the fifth metatarsal bone, stress fractures of the navicular bone, and plantar plate injuries of the first metatarsophalangeal joint.

The horse is the most prominent veterinary athlete, competing in many different disciplines. Musculoskeletal injuries account for the majority of injuries encountered in athletic horses and are the main cause of wastage in the equine industry. Most musculoskeletal lesions in horses resemble those occurring in human athletes. Diagnostic imaging encompasses the same modalities as used in human medicine with the exception that due to the size of the animal, the tomographic modalities are mainly limited to the head and the lower limb area. Similar to man, radiography and ultrasonography are the first choice for imaging of orthopedic problems. Currently, computed tomography (CT) is mainly used for examination of head injuries and magnetic resonance imaging (MRI) for lower limb problems. Generally, veterinary imaging techniques make use of techniques also used in human imaging. Nuclear medicine modalities are used to pinpoint undefined orthopedic problems and to evaluate the clinical importance of radiographic findings. The advantage of scintigraphy is that all areas of the body can be screened.

In sports medicine, foot disorders present a significant clinical challenge due to the complex anatomy and function of the foot. Injuries are complex involving soft tissue as well as bony structures. Bone scintigraphy is a sensitive technique, which provides essential functional information which correlates better with clinical symptoms and treatment response than anatomical abnormalities. It is a useful tool to detect conditions affecting the bony structures of the foot in an early phase, but can also be helpful in the initial evaluation of soft tissue injuries. MRI though remains better in delineating most soft tissue injuries. The emergence of SPECT-CT has increased the accuracy of bone scintigraphy. This is particularly true for the recently developed hybrid systems, which are capable of acquiring high-resolution multislice CT images. Bone SPECT-CT has shown to have incremental value in orthopedic conditions and sports injuries. However, one should be aware of the fact that available evidence concerning the clinical value of bone SPECT-CT in sports injuries in the foot is scarce; especially the specificity of the technique needs to be further elucidated.

About 40–50 % of the general population will develop a foot disorder at some stage in their lives. Of these injuries, 90 % will concern the forefoot. This comprehensive chapter on injuries of the foot aims to discuss the most common foot injuries in either recreational or elite athletes. Although technological advances in nuclear medicine and radiology enable physicians to obtain a precise diagnosis and monitor the rehabilitation process, a sound understanding of the pathophysiology of these common foot injuries remains the basis for a successful diagnosis and treatment.

This chapter describes the endoscopic access to the posterior tibial tendon. The indications, technique, and results are described. Patients tend to show a quick recovery, early mobilization, none or mild postoperative pain, and good wound healing.

Periosteal new bone formation is seen after the irritation of periosteum. Typical finding of Caffey’s disease is the extensive new bone of mandible. In rapid growing disease such as malignancy and osteomyelitis, there is Codman’s triangle. In benign disease including fracture and even normal growth, single layer of periosteal new bone is formed.

The Medial Longitudinal Arch (MLA) is the largest arch of the foot and is regarded as the most important foot arch in clinical foot assessments due to its influence on lower limb function, foot stability and foot pain. Each foot is classified as either high arched, low arched or normally arched depending on the structure of the MLA. There are currently a number of techniques that are used to classify the foot in a static state based on measurements of the MLA. These static measurements are then used to predict the behaviour of the foot arch in a dynamic state. However, it is easy to identify limitations with these techniques as the shape of the MLA in a static state cannot predict the behaviour of the MLA during dynamic activities. Therefore, the aim of this chapter is to introduce a high accuracy 3D modelling system that has been developed to map the shape of the MLA during gait using high definition video camcorders. The objectives of the study were hence: (1) to determine whether changes can be detected along the MLA for different weight bearings during gait, (2) to test the accuracy and reliability of the developed imaging system for creating dynamic 3D models of the foot arch and (3) to determine the quality and suitability of the 3D model. The results of the study show that changes can be detected along the MLA during gait with a level of accuracy of less than 0.4 mm when a 3D model of the foot is generated in PhotoModeler Scanner.

Recalling the expression “all is not gold that glitters,” increased uptake is not necessarily pathological. Indeed, normal bone scintigraphs are often altered or modified by physiological or anatomical factors, imitating pathology (Howarth et al. 1996). For example, the tuberosity of the humerus and proximal tibia, to which the deltoid and quadriceps muscles are attached, respectively, may accumulate tracer intensely due to constant physical stress. Tracer uptake is normally increased in growing bones, either locally in the physes (Figs. 4.13 and 4.15) or generally in the entire skeleton, and also in anatomical variants. Modest tracer uptake may be observed in secondary ossification centers that have recently been fused (Fig. 4.31a).

In 2004, skeletal scintigraphy was the most frequently performed nuclear medical in vivo examination in Europe and can thus also be considered the most frequently performed procedure worldwide. The quantification of bone metabolism was also among the first applications of tracers in biology. The Letter to Nature published in 1935 by George de Hevesy, which earned him the Nobel Prize in 1943, described the use of radioactive strontium to investigate bone metabolism in rats.

Pes calcaneovalgus, called also flatfoot or pes planus or planovalgus, is less frequent in congenital form than that which appears in adults. This constitutional type of flatfoot in the majority of cases is not pathologic. All infants have flat feet for a year or two after they begin to stand. Later on, this regress spontaneously till the age 8–10. Only a few cases need more aggressive treatment than wearing sole inlay. There are, however, cases where the deformation of the feet is so expressed that an operative correction is necessary (Figs. 20.1 and 20.2).

During the Summer Olympics in 2004 the most frequent musculoskeletal injuries consisted of muscle strains, mainly of biceps femoris, gastrocnemius, adductors and rectus femoris, stress fractures (located mainly in the tibia, navicular bone and metatarsals) and knee injuries including isolated meniscal tears, ACL ruptures followed by more complex ligamentous injuries. Subtle muscle strains could be depicted by ultrasound whereas MRI was more accurate in identifying the extent of a more severe injury. The most common injuries at the ankle joint were lateral ligamentous injuries often combined with impingement, tendinosis of the Achilles tendon and plantar fasciitis, or tears, and stress fractures of the navicular bone and metatarsals. At the shoulder, rotator cuff tears and/or instability lesions were most frequent. Lower back complaints were frequent and stress injuries of the pars interarticularis were not uncommon.

Osteonecrosis is a common condition that is believed to develop after an ischemic event in the bone and bone marrow and is likely due to intravascular coagulopathy. It may be secondary to many other known causes, such as trauma, sickle cell disease, and steroid intake. It may also be primary, or idiopathic, with no apparent cause such as Legg-Calve-Perthes disease in the pediatric age group and spontaneous osteonecrosis of the femoral head and knee in adults. Bone scintigraphy is more sensitive than standard radiographs. MRI is an excellent complementary modality. Generally, early on, bone scanning shows decreased activity with a subsequent progressive increase in uptake, which starts at the periphery. SPECT is more sensitive than planar imaging, and pinhole imaging is particularly useful in children and small bones. Osteonecrosis may affect one bone or can be multifocal. The osteochondroses are a group of conditions mostly affecting children and adolescents that are characterized by the alteration of endochondral ossification; some forms feature osteonecrosis, such as Freiberg’s disease (affecting the second metatarsal head), Kohler’s disease (affecting the navicular bone and occasionally the patella), and Osgood-Schlatter disease (affecting the tibial tuberosity).

The flat foot (pes planus) can be defined as decrease, collapse or inversion of the medial longitudinal arch of the foot. This deformity is sufficient in itself to establish the diagnosis of flat foot, whatever the associated deformities of the forefoot or hindfoot.

The initial radiologic evaluation of the painful wrist should consist of a minimum of posteroanterior, lateral, and oblique projections. If the pain is localized to the anatomic snuff box, a posteroanterior view in ulnar deviation is added to this routine. Many patients without obvious fracture or dislocation have chronically painful wrists. The evaluation of these patients is considerably more difficult than those with acute trauma. A “wrist instability series,” which consists of a minimum of the routine films, as well as posteroanterior films with radial and ulnar deviation, is sometimes necessary. Gilula and Weeks also advocate lateral views in flexion and extension and a “carpal-loading,” anteroposterior view of the wrist with a clenched fist [4]. This carpal instability series may bring out subtle, abnormal relationships between the carpal bones, particularly rotary subluxation of the navicular bone.