[Chronic pain in the hindfoot: computed tomography as a complement in clinico-radiographic evaluation. A study of 38...

A series of 38 patients affected with a chronically painful hindfoot underwent CT as a complement to conventional radiography and/or clinics for suspected bone and joint disorders. In all, CT depicted 20 bone abnormalities, i.e., 7 talar osteochondrites, 1 talar osteoid osteoma, 3 subtalar coalitions, 1 calcaneal bone lipoma, 5 posttraumatic talar deformities and 3 posttraumatic calcaneal deformities. Conventional radiography missed 6 of these abnormalities, i.e., 3 talar osteochondrites and 3 subtalar coalitions. In 5 cases CT gave additional information, useful both for the diagnosis (demonstration of fat in the bone lipoma) and to clarify the painful symptoms (2 patients with subtalar osteoarthrosis and 2 with peroneal tendon impingement). Twelve of 15 clinically suspected soft tissue abnormalities were also demonstrated, namely, 2 tibiotalar ligament injuries, 1 sprain of the interosseous ligament of tarsal sinus, 2 cases of accessory soleus muscle, 4 peroneal tendon injuries, 2 posterior tibial tendon injuries and 1 long flexor tendon injury. In the extant 3 patients with suspected bone disorders, both radiography and CT found nothing to confirm the clinical suspicion. To conclude, the authors believe CT to play a major diagnostic role, thanks to its capabilities in demonstrating the abnormal changes underlying chronically painful hindfoot conditions.