Painful Heel: MR Imaging Findings1
José A. Narváez, MD,
Javier Narváez, MD ,
Raúl Ortega, MD ,
Carlos Aguilera, MD ,
Ana Sánchez, MD and
Eduard Andía, MD
1 From the Department of CT and MRI-Institut de Diagnòstic per la Imatge (J.A.N., R.O., C.A., A.S., E.A.) and the Department of Rheumatology (J.N.), Hospital Duran Reymals, Ciutat Sanitària y Universitària de Bellvitge, Autovía de Castelldefels km 2'7, L'Hospitalet de Llobregat, 08907 Barcelona, Spain. Recipient of a Certificate of Merit award for a scientific exhibit at the 1998 RSNA scientific assembly. Received February 25, 1999; revision requested April 7 and received May 24; accepted May 24. Address reprint requests to J.A.N. (e-mail: cvalls@csub.scs.es).
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Figure 1a. Major anatomic structures of the heel. (a) Diagram shows the location of the retrocalcaneal and retroachilleal bursae, Achilles tendon, and plantar fascia and their relationship to the calcaneus. (b) Diagram shows the normal anatomy of the tarsal tunnel. The posterior tibial and FDL tendons and the posterior tibial nerve course under the flexor retinaculum. The posterior tibial vascular bundle and FHL tendon (not shown) run adjacent to the posterior tibial nerve. Distal to the flexor retinaculum, the abductor hallucis muscle overlies the terminal branches of the posterior tibial nerve.
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Figure 1b. Major anatomic structures of the heel. (a) Diagram shows the location of the retrocalcaneal and retroachilleal bursae, Achilles tendon, and plantar fascia and their relationship to the calcaneus. (b) Diagram shows the normal anatomy of the tarsal tunnel. The posterior tibial and FDL tendons and the posterior tibial nerve course under the flexor retinaculum. The posterior tibial vascular bundle and FHL tendon (not shown) run adjacent to the posterior tibial nerve. Distal to the flexor retinaculum, the abductor hallucis muscle overlies the terminal branches of the posterior tibial nerve.
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Figure 2a. Normal plantar fascia. (a) Sagittal T1-weighted (repetition time msec/echo time msec = 450/25) MR image shows the plantar fascia (arrows) as a low-signal-intensity structure extending anteriorly from the medial tuberosity of the calcaneus. Note the course of the FHL tendon (fhl) under the sustentaculum tali (ST). Insertion of the Achilles tendon (a) on the posterior aspect of the calcaneus is also seen. (b) Coronal T1-weighted (450/25) MR image demonstrates the three components of the plantar fascia. The central component is the structure referred to as the plantar fascia (white arrow), and its fibers adhere to the underlying FDB muscle (fd). The medial (black arrows) and lateral (arrowheads) components represent the investing fascia of the abductor hallucis (ah) and abductor digiti minimi (adm) muscles, respectively. Note the quadratus plantae muscle (qp) adjacent to the medial aspect of the calcaneus (C).
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Figure 2b. Normal plantar fascia. (a) Sagittal T1-weighted (repetition time msec/echo time msec = 450/25) MR image shows the plantar fascia (arrows) as a low-signal-intensity structure extending anteriorly from the medial tuberosity of the calcaneus. Note the course of the FHL tendon (fhl) under the sustentaculum tali (ST). Insertion of the Achilles tendon (a) on the posterior aspect of the calcaneus is also seen. (b) Coronal T1-weighted (450/25) MR image demonstrates the three components of the plantar fascia. The central component is the structure referred to as the plantar fascia (white arrow), and its fibers adhere to the underlying FDB muscle (fd). The medial (black arrows) and lateral (arrowheads) components represent the investing fascia of the abductor hallucis (ah) and abductor digiti minimi (adm) muscles, respectively. Note the quadratus plantae muscle (qp) adjacent to the medial aspect of the calcaneus (C).
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Figure 3a. Plantar fasciitis in a 60-year-old woman. Sagittal T1-weighted (590/25) (a) and STIR (2,416/20; inversion time msec = 160) (b) MR images show marked thickening of the proximal plantar fascia (large arrows) with increased intrasubstance signal intensity (small arrows). Note also the perifascial edema, which has low signal intensity in a and high signal intensity in b (arrowheads).
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Figure 3b. Plantar fasciitis in a 60-year-old woman. Sagittal T1-weighted (590/25) (a) and STIR (2,416/20; inversion time msec = 160) (b) MR images show marked thickening of the proximal plantar fascia (large arrows) with increased intrasubstance signal intensity (small arrows). Note also the perifascial edema, which has low signal intensity in a and high signal intensity in b (arrowheads).
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Figure 4a. Plantar fascia rupture in a 22-year-old professional basketball player. (a) Coronal proton-density-weighted (1,800/20) MR image shows a defect of the right plantar fascia representing a tear (black arrow). The underlying FDB muscle also demonstrates changes in signal intensity representing edema and hemorrhage (white arrows). (b) Corresponding coronal T2-weighted (1,800/90) MR image depicts the aponeurotic defect (black arrow). The associated lesion of the underlying FDB muscle has ill-defined high signal intensity (white arrows).
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Figure 4b. Plantar fascia rupture in a 22-year-old professional basketball player. (a) Coronal proton-density-weighted (1,800/20) MR image shows a defect of the right plantar fascia representing a tear (black arrow). The underlying FDB muscle also demonstrates changes in signal intensity representing edema and hemorrhage (white arrows). (b) Corresponding coronal T2-weighted (1,800/90) MR image depicts the aponeurotic defect (black arrow). The associated lesion of the underlying FDB muscle has ill-defined high signal intensity (white arrows).
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Figure 5a. Plantar fibromatosis in a 60-year-old man. (a) Coronal proton-density-weighted (1,800/20) MR image demonstrates three nodules arising from the plantar fascia. The largest lesion (arrowheads) is heterogeneous and slightly hyperintense relative to adjacent muscle with small regions of low signal intensity. The other two nodules have homogeneous low signal intensity (arrows). (b) On a corresponding T2-weighted (1,800/90) MR image, the two small lesions remain hypointense (arrows), whereas the largest lesion (arrowheads) shows decreased signal intensity but remains slightly hyperintense relative to adjacent muscle.
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Figure 5b. Plantar fibromatosis in a 60-year-old man. (a) Coronal proton-density-weighted (1,800/20) MR image demonstrates three nodules arising from the plantar fascia. The largest lesion (arrowheads) is heterogeneous and slightly hyperintense relative to adjacent muscle with small regions of low signal intensity. The other two nodules have homogeneous low signal intensity (arrows). (b) On a corresponding T2-weighted (1,800/90) MR image, the two small lesions remain hypointense (arrows), whereas the largest lesion (arrowheads) shows decreased signal intensity but remains slightly hyperintense relative to adjacent muscle.
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Figure 6a. Xanthomas of the plantar fascia and Achilles tendon in a 56-year-old woman. (a) Sagittal T1-weighted (450/25) MR image demonstrates fusiform thickening of the plantar fascia (arrows) and Achilles tendon (arrowheads) with a speckled pattern of increased signal intensity. (b) Coronal T1-weighted (450/25) MR image shows fusiform enlargement of the plantar fascia (arrows). Note the globular, heterogeneous pattern of increased signal intensity representing the xanthomatous deposit and the interspersed areas of low signal intensity representing residual normal collagen fibers. (c) On a corresponding T2-weighted (1,800/90) MR image, the increased signal intensity of the aponeurotic xanthoma is less evident (arrows).
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Figure 6b. Xanthomas of the plantar fascia and Achilles tendon in a 56-year-old woman. (a) Sagittal T1-weighted (450/25) MR image demonstrates fusiform thickening of the plantar fascia (arrows) and Achilles tendon (arrowheads) with a speckled pattern of increased signal intensity. (b) Coronal T1-weighted (450/25) MR image shows fusiform enlargement of the plantar fascia (arrows). Note the globular, heterogeneous pattern of increased signal intensity representing the xanthomatous deposit and the interspersed areas of low signal intensity representing residual normal collagen fibers. (c) On a corresponding T2-weighted (1,800/90) MR image, the increased signal intensity of the aponeurotic xanthoma is less evident (arrows).
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Figure 6c. Xanthomas of the plantar fascia and Achilles tendon in a 56-year-old woman. (a) Sagittal T1-weighted (450/25) MR image demonstrates fusiform thickening of the plantar fascia (arrows) and Achilles tendon (arrowheads) with a speckled pattern of increased signal intensity. (b) Coronal T1-weighted (450/25) MR image shows fusiform enlargement of the plantar fascia (arrows). Note the globular, heterogeneous pattern of increased signal intensity representing the xanthomatous deposit and the interspersed areas of low signal intensity representing residual normal collagen fibers. (c) On a corresponding T2-weighted (1,800/90) MR image, the increased signal intensity of the aponeurotic xanthoma is less evident (arrows).
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Figure 7a. Achilles tendinitis in a 34-year-old long-distance runner. Sagittal T1-weighted (590/25) (a) and STIR (2,416/20/160) (b) MR images demonstrate diffuse thickening of the Achilles tendon throughout its length (arrows) with minimal intratendinous foci of increased signal intensity.
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Figure 7b. Achilles tendinitis in a 34-year-old long-distance runner. Sagittal T1-weighted (590/25) (a) and STIR (2,416/20/160) (b) MR images demonstrate diffuse thickening of the Achilles tendon throughout its length (arrows) with minimal intratendinous foci of increased signal intensity.
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Figure 8a. FHL tenosynovitis in an 18-year-old girl. (a) Sagittal STIR (2,416/20/160) MR image shows fluid distending the synovial sheath of the FHL tendon (arrows). (b) Axial T2-weighted (2,500/90) MR image demonstrates hyperintense synovial fluid within the sheath of the FHL tendon (flh, arrows). Because the sheath of this tendon communicates with the ankle joint in 20% of patients, the diagnosis of tenosynovitis requires a disproportionate amount of fluid within the sheath. Note the adjacent course of the FDL tendon (fdl) and the small, physiologic amount of synovial fluid within its sheath.
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Figure 8b. FHL tenosynovitis in an 18-year-old girl. (a) Sagittal STIR (2,416/20/160) MR image shows fluid distending the synovial sheath of the FHL tendon (arrows). (b) Axial T2-weighted (2,500/90) MR image demonstrates hyperintense synovial fluid within the sheath of the FHL tendon (flh, arrows). Because the sheath of this tendon communicates with the ankle joint in 20% of patients, the diagnosis of tenosynovitis requires a disproportionate amount of fluid within the sheath. Note the adjacent course of the FDL tendon (fdl) and the small, physiologic amount of synovial fluid within its sheath.
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Figure 9a. Stress fracture in a 65-year-old man who presented with heel pain after completing a 2-week program of vigorous aerobic exercise. (a) Radiograph shows only a faint sclerotic band in the posterior region of the calcaneus (arrowheads). (b) Sagittal T1-weighted (450/25) MR image shows a low-signal-intensity band in the posterior region of the calcaneus (arrowheads) representing the fracture line. Associated diffuse bone marrow edema of the calcaneus demonstrates ill-defined low signal intensity. (c) Axial T2-weighted (2,500/90) MR image clearly depicts the irregular hypointense fracture line parallel to the posterior cortical margin (arrowheads). The associated diffuse bone marrow edema of the calcaneus has high signal intensity (cf b). (d) Follow-up radiograph obtained 3 weeks later shows a more evident band of new bone formation (arrowheads) corresponding to the abnormality seen at MR imaging.
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Figure 9b. Stress fracture in a 65-year-old man who presented with heel pain after completing a 2-week program of vigorous aerobic exercise. (a) Radiograph shows only a faint sclerotic band in the posterior region of the calcaneus (arrowheads). (b) Sagittal T1-weighted (450/25) MR image shows a low-signal-intensity band in the posterior region of the calcaneus (arrowheads) representing the fracture line. Associated diffuse bone marrow edema of the calcaneus demonstrates ill-defined low signal intensity. (c) Axial T2-weighted (2,500/90) MR image clearly depicts the irregular hypointense fracture line parallel to the posterior cortical margin (arrowheads). The associated diffuse bone marrow edema of the calcaneus has high signal intensity (cf b). (d) Follow-up radiograph obtained 3 weeks later shows a more evident band of new bone formation (arrowheads) corresponding to the abnormality seen at MR imaging.
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Figure 9c. Stress fracture in a 65-year-old man who presented with heel pain after completing a 2-week program of vigorous aerobic exercise. (a) Radiograph shows only a faint sclerotic band in the posterior region of the calcaneus (arrowheads). (b) Sagittal T1-weighted (450/25) MR image shows a low-signal-intensity band in the posterior region of the calcaneus (arrowheads) representing the fracture line. Associated diffuse bone marrow edema of the calcaneus demonstrates ill-defined low signal intensity. (c) Axial T2-weighted (2,500/90) MR image clearly depicts the irregular hypointense fracture line parallel to the posterior cortical margin (arrowheads). The associated diffuse bone marrow edema of the calcaneus has high signal intensity (cf b). (d) Follow-up radiograph obtained 3 weeks later shows a more evident band of new bone formation (arrowheads) corresponding to the abnormality seen at MR imaging.
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Figure 9d. Stress fracture in a 65-year-old man who presented with heel pain after completing a 2-week program of vigorous aerobic exercise. (a) Radiograph shows only a faint sclerotic band in the posterior region of the calcaneus (arrowheads). (b) Sagittal T1-weighted (450/25) MR image shows a low-signal-intensity band in the posterior region of the calcaneus (arrowheads) representing the fracture line. Associated diffuse bone marrow edema of the calcaneus demonstrates ill-defined low signal intensity. (c) Axial T2-weighted (2,500/90) MR image clearly depicts the irregular hypointense fracture line parallel to the posterior cortical margin (arrowheads). The associated diffuse bone marrow edema of the calcaneus has high signal intensity (cf b). (d) Follow-up radiograph obtained 3 weeks later shows a more evident band of new bone formation (arrowheads) corresponding to the abnormality seen at MR imaging.
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Figure 10a. Osteomyelitis in a 67-year-old diabetic woman. Axial proton-density-weighted (2,500/20) (a) and STIR (2,421/21/160) (b) MR images reveal diffuse alteration in bone marrow signal intensity in the calcaneus corresponding to osteomyelitis. Arrows indicate soft-tissue extension of the infectious process.
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Figure 10b. Osteomyelitis in a 67-year-old diabetic woman. Axial proton-density-weighted (2,500/20) (a) and STIR (2,421/21/160) (b) MR images reveal diffuse alteration in bone marrow signal intensity in the calcaneus corresponding to osteomyelitis. Arrows indicate soft-tissue extension of the infectious process.
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Figure 11a. Lipoma of the calcaneus in a 43-year-old woman. (a) Radiograph shows a well-defined radiolucent lesion in the anterior third of the calcaneus, the region in which a unicameral bone cyst is typically seen. (b) Sagittal T1-weighted (450/25) MR image reveals a focal lesion that is isointense relative to fat with thin, low-signal-intensity margins. This lesion was also isointense relative to fat on T2-weighted and STIR images (not shown), strongly suggesting a diagnosis of calcaneus lipoma.
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Figure 11b. Lipoma of the calcaneus in a 43-year-old woman. (a) Radiograph shows a well-defined radiolucent lesion in the anterior third of the calcaneus, the region in which a unicameral bone cyst is typically seen. (b) Sagittal T1-weighted (450/25) MR image reveals a focal lesion that is isointense relative to fat with thin, low-signal-intensity margins. This lesion was also isointense relative to fat on T2-weighted and STIR images (not shown), strongly suggesting a diagnosis of calcaneus lipoma.
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Figure 12a. Fibrous dysplasia of the calcaneus in a 53-year-old woman. (a) Radiograph shows a radiolucent lesion with sclerotic margins and thick intralesional septations occupying most of the calcaneus. (b) Sagittal T1-weighted (450/25) MR image shows a lesion with low to intermediate signal intensity and hypointense, sclerotic borders. (c) On a sagittal STIR (2,421/20/160) MR image obtained at the same level as b, the lesion has inhomogeneous intermediate to high signal intensity. (d) On an axial proton-density-weighted (2,500/20) MR image, the lesion has intermediate signal intensity. (e) On a corresponding axial T2-weighted (2,500/90) MR image, the signal intensity of the lesion has decreased. The relative hypointensity of the lesion on both T1- and T2-weighted images suggested fibrotic lesional tissue. The diagnosis of fibrous dysplasia was made at bone biopsy.
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Figure 12b. Fibrous dysplasia of the calcaneus in a 53-year-old woman. (a) Radiograph shows a radiolucent lesion with sclerotic margins and thick intralesional septations occupying most of the calcaneus. (b) Sagittal T1-weighted (450/25) MR image shows a lesion with low to intermediate signal intensity and hypointense, sclerotic borders. (c) On a sagittal STIR (2,421/20/160) MR image obtained at the same level as b, the lesion has inhomogeneous intermediate to high signal intensity. (d) On an axial proton-density-weighted (2,500/20) MR image, the lesion has intermediate signal intensity. (e) On a corresponding axial T2-weighted (2,500/90) MR image, the signal intensity of the lesion has decreased. The relative hypointensity of the lesion on both T1- and T2-weighted images suggested fibrotic lesional tissue. The diagnosis of fibrous dysplasia was made at bone biopsy.
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Figure 12c. Fibrous dysplasia of the calcaneus in a 53-year-old woman. (a) Radiograph shows a radiolucent lesion with sclerotic margins and thick intralesional septations occupying most of the calcaneus. (b) Sagittal T1-weighted (450/25) MR image shows a lesion with low to intermediate signal intensity and hypointense, sclerotic borders. (c) On a sagittal STIR (2,421/20/160) MR image obtained at the same level as b, the lesion has inhomogeneous intermediate to high signal intensity. (d) On an axial proton-density-weighted (2,500/20) MR image, the lesion has intermediate signal intensity. (e) On a corresponding axial T2-weighted (2,500/90) MR image, the signal intensity of the lesion has decreased. The relative hypointensity of the lesion on both T1- and T2-weighted images suggested fibrotic lesional tissue. The diagnosis of fibrous dysplasia was made at bone biopsy.
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Figure 12d. Fibrous dysplasia of the calcaneus in a 53-year-old woman. (a) Radiograph shows a radiolucent lesion with sclerotic margins and thick intralesional septations occupying most of the calcaneus. (b) Sagittal T1-weighted (450/25) MR image shows a lesion with low to intermediate signal intensity and hypointense, sclerotic borders. (c) On a sagittal STIR (2,421/20/160) MR image obtained at the same level as b, the lesion has inhomogeneous intermediate to high signal intensity. (d) On an axial proton-density-weighted (2,500/20) MR image, the lesion has intermediate signal intensity. (e) On a corresponding axial T2-weighted (2,500/90) MR image, the signal intensity of the lesion has decreased. The relative hypointensity of the lesion on both T1- and T2-weighted images suggested fibrotic lesional tissue. The diagnosis of fibrous dysplasia was made at bone biopsy.
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Figure 12e. Fibrous dysplasia of the calcaneus in a 53-year-old woman. (a) Radiograph shows a radiolucent lesion with sclerotic margins and thick intralesional septations occupying most of the calcaneus. (b) Sagittal T1-weighted (450/25) MR image shows a lesion with low to intermediate signal intensity and hypointense, sclerotic borders. (c) On a sagittal STIR (2,421/20/160) MR image obtained at the same level as b, the lesion has inhomogeneous intermediate to high signal intensity. (d) On an axial proton-density-weighted (2,500/20) MR image, the lesion has intermediate signal intensity. (e) On a corresponding axial T2-weighted (2,500/90) MR image, the signal intensity of the lesion has decreased. The relative hypointensity of the lesion on both T1- and T2-weighted images suggested fibrotic lesional tissue. The diagnosis of fibrous dysplasia was made at bone biopsy.
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Figure 13. Retrocalcaneal bursitis in a 25-year-old woman. Sagittal STIR (2,421/20/160) MR image shows marked distention of the retrocalcaneal bursa by high-signal-intensity fluid (arrowheads), a finding that represents bursitis. Note also the mild thickening of the Achilles tendon with increased intratendinous signal intensity, a finding that represents tendinitis.
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Figure 14a. Normal tarsal tunnel. (a) Oblique axial T1-weighted (500/25) MR image through the midportion of the tarsal tunnel demonstrates that the medial aspect of the talus (T) and calcaneus (C) form the floor of the tarsal tunnel and the flexor retinaculum (fr) forms the roof. The posterior tibial (PT) and FDL (fdl) tendons are seen in the anterior portion of the tarsal tunnel. The medial plantar nerve (MN) is adjacent to the FHL tendon (fhl), whereas the lateral plantar nerve (LN) lies posteriorly. The posterior tibial artery (PTA) and posterior tibial vein (PTV) lie closer to the flexor retinaculum than do the nerves. (b) Oblique axial T1-weighted (500/25) MR image through the inferior portion of the tarsal tunnel shows the medial aspect of the talus (T) and calcaneus (C) forming the floor of the tarsal tunnel, whereas at this level the roof is formed by the abductor hallucis muscle (ab). The transverse interfascicular septum (tis) forms separate upper and lower chambers for the medial and lateral neurovascular bundles, respectively. The medial plantar nerve (mn) lies close to the FHL tendon (fhl), and the medial plantar vascular bundle (mvb) is more superficially located. The lateral plantar nerve (ln) and lateral vascular bundle (lvb) lie between the abductor hallucis and quadratus plantae (qp) muscles. Note the anterior location of the posterior tibial (pt) and FDL (fdl) tendons.
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Figure 14b. Normal tarsal tunnel. (a) Oblique axial T1-weighted (500/25) MR image through the midportion of the tarsal tunnel demonstrates that the medial aspect of the talus (T) and calcaneus (C) form the floor of the tarsal tunnel and the flexor retinaculum (fr) forms the roof. The posterior tibial (PT) and FDL (fdl) tendons are seen in the anterior portion of the tarsal tunnel. The medial plantar nerve (MN) is adjacent to the FHL tendon (fhl), whereas the lateral plantar nerve (LN) lies posteriorly. The posterior tibial artery (PTA) and posterior tibial vein (PTV) lie closer to the flexor retinaculum than do the nerves. (b) Oblique axial T1-weighted (500/25) MR image through the inferior portion of the tarsal tunnel shows the medial aspect of the talus (T) and calcaneus (C) forming the floor of the tarsal tunnel, whereas at this level the roof is formed by the abductor hallucis muscle (ab). The transverse interfascicular septum (tis) forms separate upper and lower chambers for the medial and lateral neurovascular bundles, respectively. The medial plantar nerve (mn) lies close to the FHL tendon (fhl), and the medial plantar vascular bundle (mvb) is more superficially located. The lateral plantar nerve (ln) and lateral vascular bundle (lvb) lie between the abductor hallucis and quadratus plantae (qp) muscles. Note the anterior location of the posterior tibial (pt) and FDL (fdl) tendons.
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Figure 15a. Pigmented villonodular synovitis with involvement of the tarsal tunnel in a 50-year-old man. (a) Sagittal T1-weighted (450/25) MR image shows the relationship of the mass (arrowheads) to the FHL tendon. (b) Sagittal T2-weighted (2,500/90) MR image obtained at same level shows a heterogeneous, predominantly low-signal-intensity lesion occupying the synovial sheath of the FHL tendon (arrowheads).
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Figure 15b. Pigmented villonodular synovitis with involvement of the tarsal tunnel in a 50-year-old man. (a) Sagittal T1-weighted (450/25) MR image shows the relationship of the mass (arrowheads) to the FHL tendon. (b) Sagittal T2-weighted (2,500/90) MR image obtained at same level shows a heterogeneous, predominantly low-signal-intensity lesion occupying the synovial sheath of the FHL tendon (arrowheads).
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Figure 16. Tarsal tunnel syndrome secondary to venous insufficiency in a 68-year-old woman. Axial T2-weighted (2,500/90) MR image through the inferior talocalcaneal portion of the tarsal tunnel in both ankles shows varicose veins occupying the right tarsal tunnel (arrows).
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Figure 17. Tarsal tunnel syndrome secondary to a ganglion in a 34-year-old woman. Sagittal STIR (2,421/ 20/160) MR image through the tarsal tunnel reveals a lobular high-signal-intensity lesion posterior to the FDL tendon in the expected location of the neurovascular bundle (arrows).
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Figure 18a. Schwannoma in a 25-year-old man. (a) Coronal T1-weighted (450/25) MR image shows a well-defined ovoid mass that is isointense relative to adjacent muscle (arrows). (b) On a corresponding coronal gadolinium-enhanced T1-weighted MR image, the lesion demonstrates heterogeneous, predominantly peripheral enhancement with more clearly defined margins (arrows).
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Figure 18b. Schwannoma in a 25-year-old man. (a) Coronal T1-weighted (450/25) MR image shows a well-defined ovoid mass that is isointense relative to adjacent muscle (arrows). (b) On a corresponding coronal gadolinium-enhanced T1-weighted MR image, the lesion demonstrates heterogeneous, predominantly peripheral enhancement with more clearly defined margins (arrows).
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Figure 19a. Rheumatoid nodule in the heel fat pad in a 70-year-old man with long-standing seropositive rheumatoid arthritis. Sagittal T1-weighted (450/25) (a) and STIR (2,421/20/160) (b) MR images show an ill-defined subcutaneous lesion lying just superficial to the plantar fascia (arrows). The lesion has low signal intensity in a and heterogeneous high signal intensity in b. A well-corticated calcaneal spur is also seen.
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Figure 19b. Rheumatoid nodule in the heel fat pad in a 70-year-old man with long-standing seropositive rheumatoid arthritis. Sagittal T1-weighted (450/25) (a) and STIR (2,421/20/160) (b) MR images show an ill-defined subcutaneous lesion lying just superficial to the plantar fascia (arrows). The lesion has low signal intensity in a and heterogeneous high signal intensity in b. A well-corticated calcaneal spur is also seen.
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Copyright © 2000 by the Radiological Society of North America.
