 Hello, this is Dr. Vasan CJ, final year resident from Mahatma Gandhi Medical College and Research Institute, and my co-other is Dr. Prabhakaran, Aston Professor in the same college. And my topic today is role of MRI in non-traumatic angle joint pathologies. So coming to introduction, angle joint is a signable joint of the lower limb with multiple articulations, ligamentous collections and intricate soft tissue. So, MRI plays a major role in identifying the etiology in patients with non-traumatic angle and foot pain. Due to its quick non-invasive imaging, it's a high soft tissue contrast resolution, multi-planar capabilities, free of ionizing radiation and ability to post-contrast image. And MRI has the unique capability to evaluate the RCS, ligamentous tenderness and muscular injuries about the foot and angle with a single imaging study before they become evident in other imaging modalities. And these cases are often difficult to diagnose. So the injuries to specific soft tissue structures can be accurately assessed on MRI, allowing appropriate therapeutic intervention and rehabilitation. MRI has also been helpful in the diagnosis of several soft tissue abnormalities that are unique to the foot and angle such as osteomyelitis, neuropathic joint, ganglion cyst, synovitis, tuberculosis arthritis, rheumatoid arthritis and plantar fasciitis. So the aims and objectives of the study are to describe the imaging spectrum in patients with non-traumatic angle and heel pain by MRI. And also to assess the role of MRI in detection of various Oshias, ligamentous and tenderness pathologies of angle in patients with non-traumatic etiology. So coming to the materials and methods, this study was carried out in 28 patients for a period of two years. Return and informed consent was obtained from each patient in the study group. So the inclusion criteria includes patients presenting with clinical symptoms of angle pain, swelling and restriction of movement, but with no history of trauma. Patient with acute and chronic symptoms will be included in the study. Coming to exclusion criteria, patients having history of trauma, patients having a congenital anomalies of angle, patients who have had angle surgeries, any absolute contraindications for MRI. MRI scan was performed with 1.5 Tesla, Felix Achiva, using a dedicated angle coil. MRI examination of the angle joint was performed in the axial, coronal and sagittal sections. The FOV included the entire angle, that is the hind foot up to the level of the metatarsal basis. The patient was positioned in superimposition with the medial malulus centered in the coil to evaluate the hind foot and the angle joint. The foot was allowed to rest in a relaxed position generally in 10 degree to 20 degree of plantar affection and 10 to 30 degree of external rotation. So coming to the results of the study, the distribution of the patients according to age. So in this we can see that the age group that has involved most was from 41 to 50. And next to that the 31 to 40 age group was involved. Coming to the gender distribution of the study participants, this was more frequent in males compared to females. Coming to the duration of the lesion among the study participants, being acute and chronic, most of the participants had chronic symptoms compared to acute. And coming to the distribution of actual cases. So we had the highest number of cases was of osteomyelitis, which was followed by neuropathic joint, and then ganglion cyst, tuberculosis, rheumatoid arthritis and plantar fasciitis. Three cases were present in the study. And the least one was tino sinovitis. So in our study, the most common pathology was osteomyelitis, 28% followed by neuropathic joint ganglion cyst, tuberculosis arthritis, rheumatoid arthritis, plantar fasciitis and tino sinovitis. The most common age group affected was 41 to 50 years and more common in males. So, and most of the patients had chronic symptoms than acute. Coming to discussion. So the first and the most common case was osteomyelitis. So, the pathogenesis was secondary to hemat, hematogenous spread or direct inoculation the bacterial proliferation within the bone induces an acute separative response. So there is accumulation of pus within the medullary cavity, leading to raised intra medullary pressure and vascular congestion, which can disrupt the interest blood supply. There is also formation of reactive bone and hypervascular granulation tissue. So this continuous accumulation of pus within the medullary cavity and hence going into the subperiosteal space can rupture through the periosteum and then spread onto the soft tissues through a channel which is known as the sinus tract. So coming to the case of osteomyelitis. So in this MRT1 weighted axial and still sections of foot shows extensive marrow edema with cortical destruction and irregular border of the calcaneus and adjacent sinus tract leading to the subperiosteal space and also to the soft tissue structures, so this way of osteomyelitis. The second common case was neuropathic joint also known as chart cuts joint. So inflammatory response from minor injuries that results in osteolysis in the setting of peripheral neuropathy, the patient has no sensation. The most common pathology are cost being diabetes militants. So here MR axial T1 weighted and sagittal T1 weighted sections of foot shows extensive destruction of the cuneiform bones and metatarsals, suggestive of neuropathic joint. In the sagittal and axial we can see there is so much of destruction with surrounding inflammation in the metatarsals and cuneiform bones. The next common case was ganglion cyst. So generally the ganglion cyst was thought to result from some mix or degeneration of the connective tissue associated with the joint capsules and tendon sheets. The main represents equally of synovial herniations or coalescence of small degenerative cyst arising from the tendon sheath and joint capsule or bursae. So here coronal proton density fat set images and axial T2 weighted images of foot show large subtaller ganglion cyst, as we can see here having fluid fluid intensity. Coming to rheumatoid arthritis. It is a multi-system inflammatory disease causing synovial hyperemia, which is an indication of acute inflammation. Synovial hyperplasia looks like a rice bodies and panacea formation. There is also degrees thickness of the cartilage and joints. So in this case MRI coronal and sagittal T2 weighted images of ankle shows hyperendens thickening of the synovial membrane with irregularities of the tibia, talus and calcaneus. So there is also synovial thickening and hyperplasia, which is evident in these pictures. Coming to plantar fasciitis. It is a frequent cause of heel pain. And it's a low grade inflammatory process involving the plantar aponeurosis with or without involvement of the perifacial structures. Plantar fasciitis can result from a number of causes which can be mechanical degenerative and systemic. So MRI stir and PD fadsad images sagittal show partial fusiform thickening of the plantar fascia with adjacent soft tissue edema, which is suggestive of plantar fasciitis. So coming to conclusion, MRI is an excellent non-invasive radiation free imaging modality with multi-planar capabilities and excellent soft tissue delineation. So MRI is very useful in evaluating ankle pathologies having so much of intricate osteos and ligamental structures and is particularly advantages for assessing the tendons, ligaments, nerves, fascia and also detecting occult bone injuries with the help of seeing marrow edema. So both non-traumatic and traumatic pathologies of the ankle and foot can be diagnosed easily by MRI. So MRI provides accurate information regarding the present and presents an extent of infection in diabetic foot and helpful in differentiating neuroarthropathy from osteomyelitis, which allows appropriate planning of surgical management. MRI provides objective assessment of the morphological changes associated with plantar fasciitis as well as in assisting other causes of heel pain. Thank you and these are my references.