{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T02:39:33Z","timestamp":1773801573165,"version":"3.50.1"},"reference-count":58,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Musculoskelet Radiol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Magnetic resonance imaging is a vital tool in sports medicine for evaluating ankle and foot injuries in athletes, offering detailed insights into bone, cartilage, ligament, and tendon pathology. However, the findings in athletes, especially those who are asymptomatic, can present pitfalls that may lead to misdiagnosis and unnecessary treatment. Common findings such as bone marrow edema, joint effusions, and tendon sheath fluid are frequently observed in athletes without symptoms and may represent physiologic adaptations rather than pathology.<\/jats:p>\n                  <jats:p>This article emphasizes the importance of correlating magnetic resonance imaging results with clinical evaluation and physical examination to avoid overinterpretation. Radiologists should be familiar with normal variants and nonspecific findings in athletes to ensure accurate reporting. Radiology reports must clearly describe findings and focus conclusions on those most likely to be clinically significant.<\/jats:p>\n                  <jats:p>Effective communication between clinicians, radiologists, and athletes is essential to prevent unnecessary interventions and economic consequences. A comprehensive approach, combining clinical assessment with advanced imaging, ultimately ensures accurate diagnosis and optimal management of ankle and foot injuries in athletes, minimizing the risk of overtreatment and supporting safe return to play.<\/jats:p>","DOI":"10.1055\/a-2743-3151","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T23:41:42Z","timestamp":1770075702000},"page":"133-142","source":"Crossref","is-referenced-by-count":0,"title":["Pitfalls and How to Avoid Misdiagnosis in Magnetic Resonance Imaging of the Ankle and Foot in Athletes"],"prefix":"10.1055","volume":"30","author":[{"given":"Nicolae V.","family":"Bolog","sequence":"additional","affiliation":[{"name":"Department of Radiology, Team Radiologie Plus, Thurmed AG, Munsterlingen, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amelie M.","family":"Lutz","sequence":"additional","affiliation":[{"name":"Department of Radiology, Team Radiologie Plus, Thurmed AG, Munsterlingen, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7000-9033","authenticated-orcid":false,"given":"Gustav","family":"Andreisek","sequence":"additional","affiliation":[{"name":"Department of Radiology, Team Radiologie Plus, Thurmed AG, Munsterlingen, Switzerland"},{"name":"University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"issue":"13","key":"ref1","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.2106\/JBJS.I.01537","article-title":"The epidemiology of ankle sprains in the United States","volume":"92","author":"B R Waterman","year":"2010","journal-title":"J Bone Joint Surg Am"},{"issue":"24","key":"ref2","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1136\/bjsports-2016-096189","article-title":"Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains","volume":"50","author":"P A Gribble","year":"2016","journal-title":"Br J Sports Med"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1051\/sicotj\/2021024","article-title":"Acute foot and ankle injuries and time return to sport","volume":"7","author":"G Thevendran","year":"2021","journal-title":"SICOT J"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"99","DOI":"10.5334\/jbr-btr.1206","article-title":"Common mistakes and pitfalls in magnetic resonance imaging of the knee","volume":"100","author":"F Vanhoenacker","year":"2016","journal-title":"J Belg Soc Radiol"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1148\/radiology.215.3.r00jn05835","article-title":"Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings","volume":"215","author":"M Zanetti","year":"2000","journal-title":"Radiology"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1080\/02841850802161023","article-title":"Bone marrow edema: pathophysiology, differential diagnosis, and imaging","volume":"49","author":"A M Starr","year":"2008","journal-title":"Acta Radiol"},{"issue":"13","key":"ref7","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1136\/bjsports-2011-090661","article-title":"Evaluating bone marrow oedema patterns in musculoskeletal injury","volume":"46","author":"M G Kozoriz","year":"2012","journal-title":"Br J Sports Med"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1186\/s13018-018-1017-5","article-title":"Overuse injuries in sport: a comprehensive overview","volume":"13","author":"R Aicale","year":"2018","journal-title":"J Orthop Surg Res"},{"issue":"11","key":"ref9","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.3390\/medicina57111143","article-title":"Reviewing bone marrow edema in athletes: a difficult diagnostic and clinical approach","volume":"57","author":"U Tarantino","year":"2021","journal-title":"Medicina (Kaunas)"},{"issue":"08","key":"ref10","first-page":"1040","article-title":"Stress fractures in runners","volume":"5","author":"A M McBryde","year":"1982","journal-title":"Orthopedics"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0278-5919(20)30961-3","article-title":"Stress fractures of the tarsal navicular in long-distance runners","volume":"7","author":"A Ting","year":"1988","journal-title":"Clin Sports Med"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1177\/0363546513490645","article-title":"Correlation of MRI grading of bone stress injuries with clinical risk factors and return to play: a 5-year prospective study in collegiate track and field athletes","volume":"41","author":"A Nattiv","year":"2013","journal-title":"Am J Sports Med"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1177\/036354659502300418","article-title":"Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system","volume":"23","author":"M Fredericson","year":"1995","journal-title":"Am J Sports Med"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1177\/0363546514521990","article-title":"Bone marrow edema lesions in the professional runner","volume":"42","author":"P R Kornaat","year":"2014","journal-title":"Am J Sports Med"},{"issue":"10","key":"ref15","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1055\/a-2013-2226","article-title":"Asymptomatic bone marrow edema in weight-bearing bones in athletes and military trainees: a systematic literature review","volume":"44","author":"A Karimi","year":"2023","journal-title":"Int J Sports Med"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1148\/radiology.202.2.9015087","article-title":"Can running cause the appearance of marrow edema on MR images of the foot and ankle?","volume":"202","author":"K M Lazzarini","year":"1997","journal-title":"Radiology"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1007\/s43465-020-00052-3","article-title":"Bone marrow oedema in the knees of asymptomatic high-level athletes: prevalence and associated factors","volume":"54","author":"V Mandalia","year":"2020","journal-title":"Indian J Orthop"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s00256-020-03530-9","article-title":"MRI features of and factors related to ankle injuries in asymptomatic amateur marathon runners","volume":"50","author":"W Yao","year":"2021","journal-title":"Skeletal Radiol"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"W720","DOI":"10.2214\/AJR.10.5880","article-title":"Bone marrow edema patterns in the ankle and hindfoot: distinguishing MRI features","volume":"197","author":"A M Rios","year":"2011","journal-title":"AJR Am J Roentgenol"},{"issue":"07","key":"ref22","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1007\/s00247-006-0129-y","article-title":"High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes?","volume":"36","author":"N Shabshin","year":"2006","journal-title":"Pediatr Radiol"},{"issue":"S 02","key":"ref23","doi-asserted-by":"crossref","first-page":"S251","DOI":"10.1007\/s00247-008-0792-2","article-title":"Major pitfalls in musculoskeletal imaging-MRI","volume":"38","author":"J H Kan","year":"2008","journal-title":"Pediatr Radiol"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"463","DOI":"10.3113\/FAI.2007.0463","article-title":"A specific bone marrow edema around the foot and ankle following trauma and immobilization therapy: pattern description and potential clinical relevance","volume":"28","author":"I Elias","year":"2007","journal-title":"Foot Ankle Int"},{"issue":"11","key":"ref25","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1016\/j.ejrad.2015.07.017","article-title":"Posterior ankle impingement in athletes: pathogenesis, imaging features and differential diagnoses","volume":"84","author":"D Hayashi","year":"2015","journal-title":"Eur J Radiol"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1097\/JSM.0000000000001021","article-title":"Posterior ankle impingement syndrome clinical features are not associated with imaging findings in elite ballet dancers and athletes","volume":"32","author":"P Baillie","year":"2022","journal-title":"Clin J Sport Med"},{"issue":"02","key":"ref27","first-page":"193","article-title":"Internal derangement of the talofibular component of the ankle","volume":"91","author":"I Wolin","year":"1950","journal-title":"Surg Gynecol Obstet"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"154","DOI":"10.7547\/87507315-82-3-154","article-title":"The os trigonum syndrome. A literature review","volume":"82","author":"R L Blake","year":"1992","journal-title":"J Am Podiatr Med Assoc"},{"issue":"05","key":"ref29","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1177\/036354659202000508","article-title":"Os trigonum impingement in dancers","volume":"20","author":"J J Marotta","year":"1992","journal-title":"Am J Sports Med"},{"issue":"02","key":"ref30","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s002560050049","article-title":"The value of MR imaging in the diagnosis of the os trigonum syndrome","volume":"25","author":"C J Wakeley","year":"1996","journal-title":"Skeletal Radiol"},{"issue":"03","key":"ref31","doi-asserted-by":"crossref","first-page":"829","DOI":"10.2214\/ajr.169.3.9275907","article-title":"Anterolateral soft-tissue impingement in the ankle: diagnosis using MR imaging","volume":"169","author":"D A Rubin","year":"1997","journal-title":"AJR Am J Roentgenol"},{"issue":"02","key":"ref32","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1148\/radiology.215.2.r00ma01497","article-title":"Posterior ankle impingement syndrome: MR imaging findings in seven patients","volume":"215","author":"N J Bureau","year":"2000","journal-title":"Radiology"},{"issue":"05","key":"ref33","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1177\/03635465010290050501","article-title":"The posteromedial impingement lesion of the ankle. A series of six cases","volume":"29","author":"R S Paterson","year":"2001","journal-title":"Am J Sports Med"},{"issue":"06","key":"ref34","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1148\/rg.226025034","article-title":"Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management","volume":"22","author":"P Robinson","year":"2002","journal-title":"Radiographics"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1177\/03635465020300012101","article-title":"The relationship of the kicking action in soccer and anterior ankle impingement syndrome. A biomechanical analysis","volume":"30","author":"J L Tol","year":"2002","journal-title":"Am J Sports Med"},{"issue":"02","key":"ref36","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1055\/s-2008-1078703","article-title":"Posterior impingement syndromes of the ankle","volume":"12","author":"J C Lee","year":"2008","journal-title":"Semin Musculoskelet Radiol"},{"issue":"04","key":"ref37","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.carj.2017.04.001","article-title":"Imaging of ankle impingement syndromes","volume":"68","author":"A M Al-Riyami","year":"2017","journal-title":"Can Assoc Radiol J"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"2325967120979994","DOI":"10.1177\/2325967120979994","article-title":"Asymptomatic foot and ankle abnormalities in elite professional soccer players","volume":"9","author":"E Bezuglov","year":"2021","journal-title":"Orthop J Sports Med"},{"key":"ref39","first-page":"1490S","article-title":"A single axial impact load causes articular damage that is not visible with micro-computed tomography: an ex vivo study on caprine tibiotalar joints","volume":"13","author":"R P Blom","year":"2021","journal-title":"Cartilage"},{"issue":"01","key":"ref40","doi-asserted-by":"crossref","first-page":"e001879","DOI":"10.1136\/bmjsem-2023-001879","article-title":"Fifteen out of 16 elite athletes showed concomitant low-grade cartilage lesions of the ankle with unstable syndesmotic injuries: concerns from a prospective case series","volume":"10","author":"A B Walinga","year":"2024","journal-title":"BMJ Open Sport Exerc Med"},{"issue":"24","key":"ref41","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1056\/NEJM197412122912406","article-title":"The reaction of articular cartilage to injury and osteoarthritis (first of two parts)","volume":"291","author":"H J Mankin","year":"1974","journal-title":"N Engl J Med"},{"issue":"05","key":"ref42","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1177\/028418519103200511","article-title":"Traumatic trabecular lesions observed on MR imaging of the knee","volume":"32","author":"O Tervonen","year":"1991","journal-title":"Acta Radiol"},{"issue":"03","key":"ref43","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1148\/radiology.203.3.9169716","article-title":"Pseudodefect of the talar dome: an anatomic pitfall of ankle MR imaging","volume":"203","author":"T T Miller","year":"1997","journal-title":"Radiology"},{"issue":"02","key":"ref44","doi-asserted-by":"crossref","first-page":"358","DOI":"10.2214\/AJR.14.14012","article-title":"The notch of Harty (pseudodefect of the tibial plafond): frequency and characteristic findings at MRI of the ankle","volume":"205","author":"R D Boutin","year":"2015","journal-title":"AJR Am J Roentgenol"},{"issue":"05","key":"ref45","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s00256-003-0628-y","article-title":"Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography","volume":"32","author":"M R Schmid","year":"2003","journal-title":"Skeletal Radiol"},{"issue":"01","key":"ref46","doi-asserted-by":"crossref","first-page":"111","DOI":"10.2214\/ajr.162.1.8273647","article-title":"Fluid in normal and abnormal ankle joints: amount and distribution as seen on MR images","volume":"162","author":"M E Schweitzer","year":"1994","journal-title":"AJR Am J Roentgenol"},{"issue":"05","key":"ref47","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/s00276-017-1924-x","article-title":"Fluid distribution in ankle and midfoot joints: MR findings in asymptomatic volunteers","volume":"40","author":"V De Grove","year":"2018","journal-title":"Surg Radiol Anat"},{"issue":"12","key":"ref48","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1007\/s00276-019-02355-z","article-title":"Fluid distribution in ankle tendon sheaths in healthy volunteers: MRI findings","volume":"41","author":"I Willekens","year":"2019","journal-title":"Surg Radiol Anat"},{"issue":"06","key":"ref49","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1172\/JCI101182","article-title":"The origin and nature of normal human synovial fluid","volume":"19","author":"M W Ropes","year":"1940","journal-title":"J Clin Invest"},{"issue":"1104","key":"ref50","doi-asserted-by":"crossref","first-page":"20190722","DOI":"10.1259\/bjr.20190722","article-title":"Fluid around the distal tibialis posterior tendon on ankle MRI: prevalence and clinical relevance","volume":"92","author":"S Lee","year":"2019","journal-title":"Br J Radiol"},{"issue":"03","key":"ref51","doi-asserted-by":"crossref","first-page":"675","DOI":"10.2214\/ajr.167.3.8751680","article-title":"MR imaging of posterior tibial tendon dysfunction","volume":"167","author":"N J Khoury","year":"1996","journal-title":"AJR Am J Roentgenol"},{"issue":"03","key":"ref52","doi-asserted-by":"crossref","first-page":"627","DOI":"10.2214\/ajr.175.3.1750627","article-title":"MR imaging of disorders of the posterior tibialis tendon","volume":"175","author":"M E Schweitzer","year":"2000","journal-title":"AJR Am J Roentgenol"},{"issue":"01","key":"ref53","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1111\/sms.12209","article-title":"Achilles tendon rupture\u2014treatment and complications: a systematic review","volume":"25","author":"C Holm","year":"2015","journal-title":"Scand J Med Sci Sports"},{"issue":"03","key":"ref54","doi-asserted-by":"crossref","first-page":"613","DOI":"10.2214\/ajr.175.3.1750613","article-title":"MR imaging of disorders of the Achilles tendon","volume":"175","author":"M E Schweitzer","year":"2000","journal-title":"AJR Am J Roentgenol"},{"issue":"06","key":"ref55","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.aanat.2009.07.006","article-title":"Fascicles of the adult human Achilles tendon - an anatomical study","volume":"191","author":"P Szaro","year":"2009","journal-title":"Ann Anat"},{"issue":"01","key":"ref56","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s00276-020-02542-3","article-title":"Pseudo-tear appearance of the Achilles tendon on MR imaging in normal volunteers","volume":"43","author":"E Abelkis","year":"2021","journal-title":"Surg Radiol Anat"},{"issue":"01","key":"ref57","doi-asserted-by":"crossref","first-page":"6131","DOI":"10.1038\/s41598-021-85604-9","article-title":"The correlations between dimensions of the normal tendon and tendinopathy changed Achilles tendon in routine magnetic resonance imaging","volume":"11","author":"P Szaro","year":"2021","journal-title":"Sci Rep"},{"issue":"03","key":"ref58","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.1600-0838.2011.01400.x","article-title":"Asymptomatic Achilles, patellar, and quadriceps tendinopathy: a longitudinal clinical and ultrasonographic study in elite fencers","volume":"23","author":"A Giombini","year":"2013","journal-title":"Scand J Med Sci Sports"},{"issue":"02","key":"ref59","doi-asserted-by":"crossref","first-page":"323","DOI":"10.2214\/ajr.173.2.10430128","article-title":"High-resolution MR imaging of the asymptomatic Achilles tendon: new observations","volume":"173","author":"K Soila","year":"1999","journal-title":"AJR Am J Roentgenol"},{"issue":"01","key":"ref60","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s40798-024-00786-6","article-title":"Towards Achilles tendon injury prevention in athletes with structural MRI biomarkers: a machine learning approach","volume":"10","author":"N Kapinski","year":"2024","journal-title":"Sports Med Open"}],"container-title":["Seminars in Musculoskeletal Radiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2743-3151.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T23:43:27Z","timestamp":1773791007000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2743-3151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":58,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,3,17]]},"published-print":{"date-parts":[[2026,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2743-3151","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1089-7860","1098-898X"],"issn-type":[{"value":"1089-7860","type":"print"},{"value":"1098-898X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]}}}