HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ledermann, H. P. Articles by Raikin, S. M. Search for Related Content PubMed PubMed Citation Articles by Ledermann, H. P. Articles by Raikin, S. M. Social Bookmarking                      What's this?

Tendon Involvement in Pedal Infection: MR Analysis of Frequency, Distribution, and Spread of Infection

¹ Radiologisches Institut, Universitätsspital Basel, Petersgraben 4, 4031 Basel, Switzerland.
² Department of Radiology, Thomas Jefferson University Hospital, 111 S. 11th St., No. 3390, Gibbon, Philadelphia, PA 19107.
³ Department of Othopedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut St., Philadelphia, PA 19107.

OBJECTIVE. The objective of our study was to evaluate the frequency, distribution, and extent of tendon involvement in patients with pedal infections.

MATERIALS AND METHODS. Contrast-enhanced MR imaging examinations of 159 infected feet performed at 1.5 T were reviewed by two musculoskeletal radiologists for the presence and location of tendon infection (peritendinous enhancement contiguous to an adjacent ulcer or cellulitis) and for the spread of infection along tendons, which was defined as peritendinous contrast enhancement extending more than 2 cm beyond surrounding cellulitis. The study group was composed of 156 consecutive patients, 82.7% of whom had diabetes; all patients underwent subsequent surgical treatment. Results of MR evaluations were compared with the patients' charts and surgical reports.

RESULTS. Of the 129 MR examinations showing an infection in the forefoot, MR evidence of tendon involvement in the infection was observed in 56 MR examinations (43%). The sum of involved tendons per ray was as follows: first ray (flexor tendon, n = 19; extensor tendon, n = 13), second (flexor tendon, n = 12; extensor tendon, n = 7), third (flexor tendon, n = 5; extensor tendon, n = 4), fourth (flexor tendon, n = 5; extensor tendon, n = 1), and fifth (flexor tendon, n = 11; extensor tendon, n = 6). Of the 32 MR examinations showing infection in the hindfoot, 14 examinations (44%) showed evidence of tendon involvement, most frequently of the distal Achilles tendon (n = 7). MR evidence of the spread of infection along a tendon was seen in 12 examinations, always with proximal spread of infection; and infection led to the development of an abscess in the central plantar compartment in three patients. Intraoperative evidence of a tendon infection was documented in 11 patients. The surgical procedure was altered because of the tendon infection in six patients.

CONCLUSION. MR evidence of tendon infection is present in approximately half the patients who require surgery for pedal infection. Evidence of spread of the infection along tendons is seen infrequently on MR imaging. Detection of a tendon infection could influence surgical therapy.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				P L Tan and J Teh MRI of the diabetic foot: differentiation of infection from neuropathic change Br. J. Radiol., November 1, 2007; 80(959): 939 - 948. [Abstract] [Full Text] [PDF]

				J. L. Bloem, T. J. Mosher, M. R. Schmid, M. Zanetti, H. P. Ledermann, W. B. Morrison, and M. E. Schweitzer Dynamic Gadolinium-enhanced MR Imaging in Bone Marrow Disorders [letter] * Dr Mosher responds: * Drs Schmid and Zanetti respond: * Dr Ledermann and colleagues respond: Radiology, April 1, 2003; 227(1): 303 - 305. [Full Text] [PDF]