Joint Disease

Primary radiographic findings include:

  • osteophyte
  • erosion
  • subchondral resorption
  • arthritis mutilans

Click here to view the learning module, "Primary Radiographic Findings of Joint Disease in the Foot and Ankle". (It will open in a new window.)

Joint disorders seen in the foot include:

  • rheumatoid arthritis
  • seronegative arthritis
  • osteoarthritis
  • gouty arthritis
  • neuropathic osteoarthropathy
  • septic arthritis

Podcast

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Here are some examples of joint disease followed by interpretations (*):

  • Case 1a
  • Case 1b
  • *Case 1a
  • *Case 1b
  • Case 2a
  • Case 2b
  • *Case 2a
  • *Case 2b
  • Case 3
  • *Case 3
  • Case 4
  • *Case 4
Charcot DP
Charcot Lateral
Charcot DP

DP view. Findings include subchondral resorption (R); mixed lucency (L) and sclerosis (S) involving affected bones; loss of apposition (A) (partial and total) between adjacent bones at several joints; fragmentation/loose osseous bodies (O).

Charcot Lateral

Lateral view. Findings include subchondral resorption (R); mixed lucency (L) and sclerosis(S) involving affected bones; loss of apposition (A) (partial and total) between adjacent bones at several joints; fragmentation/loose osseous bodies (O).

osteoarthritis dp
osteoarthritis lateral
osteoarthritis dp marked

DP view. The black arrows identify subchondral sclerosis (aka eburnation) and uneven joint narrowing. There are osteophytes along the meddial aspect of the medial cuneiform-navicular joint (white arrow). The first metarsal base articulates less than 100% with the medial cuneiform (gray arrowhead). Diagnoses: post-traumatic arthritis (osteoarthritis); subluxation of the 1st metatarsal-cuneiform joint.

osteoarthritis lateral marked

Lateral view. An osteophyte is seen along the superior aspect of the 2nd metatarsophalangeal joint (white arrow). The gray arrow identifies the abnormal form and malposition of the naviculocuneiform joint. Diagnosis: post-traumatic arthritis (osteoarthritis).

rheumatoid arthritis
rheumatoid arthritis marked

Lateral view. There is even (uniform) joint space narrowing of the talonavicular (X) and middle talocalcaneal joints. Secondary findings include inferior and posterior calcaneal spurs. Diagnoses: rheumatoid arthritis; enthesopathy.

gout
gout marked

Lateral view. Geographic decreased densities are seen at multiple intertarsal and metatarsophalangeal joints (arrows). These are erosions viewed en face. Other findings include inferior and posterior calcaneal spurs (S) and tubular vessel calcification (C). Diagnoses: gouty arthritis; enthesopathy; Moenkeberg's sclerosis.

Should a radiographic study be ordered for suspicion of joint disease?

Definitely yes.

What are the best views to order?

At a minimum order DP and lateral views. Oblique views can be valuable adjunct views but are not necessary.

Other information

Osteoarthritis suggests abnormal wear-and-tear or post-traumatic etiology, which is usually gleaned in the patient history.

References:

  1. Resnick, D: Bone and Joint Imaging, 2nd edition, WB Saunders, 1996.
  2. Christman RA: Foot and Ankle Radiology, 2nd edition, Lippincott Williams & Wilkins, 2015.