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OBJECTIVE: To determine whether any positive change in the alignment of the bones of the feet occur with the use of custom-made flexible orthotics, cast by weight bearing, in individuals having flexible pes planus. METHODS: Anteroposterior and lateral radiographs were obtained with and without orthotics in place. The anteroposterior and lateral talocalcaneal angles and the lateral pitch of both the left and right foot were assessed. RESULTS: The t test values and P values derived from the radiographic measurements indicated statistically significant improvements in weight-bearing foot alignment. DISCUSSION: Biomechanical faults in the pedal foundation can adversely affect any of the joints and structures of the foot/ankle complex, lower extremities, pelvis, and spine. CONCLUSION: This study supports the use of a custom-made flexible orthotic for the improvement of pedal structural alignment.

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OBJECTIVE: To review the magnetic resonance imaging (MRI) appearance of bone marrow edema (BME) and to discuss the applications of this imaging modality in the diagnosis of associated disorders. A case of BME in the foot is also provided to acquaint the reader with how MRI may assist in establishing a differential diagnosis in patients with normal radiographs and clinical findings that suggest osseous injury. CLINICAL FEATURES: A 42-yr-old woman suffered from persistent pain along the dorsum of her foot that worsened with jogging. There was foot pronation and palpable pain and swelling at the third tarsometatarsal joint. An MRI was performed, but it was initially misinterpreted. A second review of the MRI examination established the presence of stress-induced BME adjacent to the articular margins of the third tarsometatarsal joint. INTERVENTION AND OUTCOME: Medical treatment consisted of a cortisone injection into the left third tarsometatarsal joint, which provided transient relief. Chiropractic treatment included flexible custom orthotics prescribed to specifically address her foot pronation. This was the only chiropractic treatment employed. CONCLUSION: In the presented case, the sensitivity of MRI to stress-induced BME identified the cause of this patient's symptoms and, more importantly, directed management. Because of its ability to demonstrate anatomic and physiologic information, MRI is the ideal imaging modality for assessing suspected injury to the osseous tissues. In patients who relay historical information that suggests chronic or acute osseous injury but demonstrate no radiographic changes to support the clinical suspicion of bony abnormality, an MRI may be indicated to exclude occult injury.

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A brief historical review of the discovery of X-ray by Wilhelm Konrad Roentgen on November 9, 1895, is presented. This synopsis discusses the evolution of X-ray imaging from the primitive Crookes x-ray tube to the state-of-the-art high-frequency generators. Technological advancements from fluoroscopy to plain films, nuclear medicine, computed tomography and magnetic resonance imaging, along with changes in X-ray film and intensifying screens, are also provided. A concise overview of chiropractic radiology and the introduction of X-ray into the chiropractic curriculum, first at Palmer College and then at other colleges is presented. Historical recognition of the development of the American Chiropractic Board of Radiology (ACBR), its founding fathers and its certification program for training chiropractic radiologists is reviewed. General comments pointing to computerized digital imaging as the filmless imaging of the future are offered.

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OBJECTIVE: To present an interesting and unusual case of double patella syndrome in a patient with multiple epiphyseal dysplasia. The pertinent clinical and radiographic findings and a brief review of the literature are discussed. CLINICAL FEATURES: An 11-yr-old male patient suffered from occasional right hip pain and limited range of motion, as well as a nontender soft tissue mass in the right knee. Radiographic examination of the hips and knees demonstrated double-layered patellae and bilateral coxa magna deformity. INTERVENTION AND OUTCOME: Although surgery was initially recommended, conservative chiropractic management was employed and resulted in complete resolution of the patient's presenting hip symptoms. CONCLUSION: This case is the first reported of double patella seen on MRI and demonstrates the value of this technology in the noninvasive preoperative assessment of double patella syndrome. The patient's clinical and radiographic features led to the correct diagnosis.

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OBJECTIVE: To discuss an interesting case depicting multiple levels of cervical spondylolysis. Differential diagnosis and a brief review of the literature are discussed. CLINICAL FEATURES: A 24-yr-old man suffered from constant neck discomfort of approximately 4 months' duration. After physical examination, X-rays were performed and revealed multiple congenital anomalies. The patient's symptoms are considered independent of the radiographic findings. INTERVENTION AND OUTCOME: This patient was successfully treated with conservative chiropractic management and experienced complete resolution of his presenting symptoms. CONCLUSION: This case nicely demonstrates the congenital nature of cervical spondylolysis. It is unusual in that no prior case report has described three levels of involvement. The spondylolysis and other changes of the neural arch should not be confused with fracture.

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OBJECTIVE: To present a case of myositis ossificans traumatica (MOT) in a hockey player. Serial X-ray studies allow the reader an opportunity to observe MOT in its earliest through fulminated stages. CLINICAL FEATURES: A 20-yr-old hockey player was subjected to an acute blow to the lateral thigh. Copious amounts of swelling soon developed. The patient was unable to skate. X-rays were initially performed 4 hr after the injury and demonstrated a hugh mass developing in the thigh at that time. INTERVENTION AND OUTCOME: The player was inappropriately treated with deep tissue massage and heat at the time of injury. It is believed that this led to the fulmination and advanced degree of MOT development. Immobilization allowed for resorption of the calcific density of the ossified structure. CONCLUSION: Proper care of acute trauma is essential in disorders of this nature. Ice, immobility and recognition of when a possible MOT lesion is developing is essential when dealing with contact sports.

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Intraosseous hemangioma is a slow-growing primary benign neoplasm of capillary, cavernous, or venous origin. The most common type is the cavernous hemangioma, composed of large thin-walled vessels and sinuses lined by endothelial cells. Although found in any bone, hemangioma is most common in the vertebrae, where it represents 2-3% of all radiographically detectable spinal tumors. Most spinal hemangiomas are solitary, asymptomatic lesions of the vertebral body, with 10-15% showing concomitant involvement of the posterior elements. Rarely, the lesion is located to the posterior arch. An unusual case of an expanding vertebral hemangioma isolated to the posterior elements of T9 is presented.

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The sclerotic pedicle is a commonly encountered roentgen sign that may be associated with numerous conditions, both benign and malignant. The following paper discusses the common as well as the unusual causes of this interesting phenomenon and demonstrates the radiographic presentations of the various etiologies.

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There are many conditions of the spine to which various authors have applied descriptive names. This paper, an extensive review of the literature, provides the first complete source for such named vertebrae. Included are 88 names covering all categories of bone disease. A brief description of the radiographic appearance and its pathogenesis is provided for each, along with a consideration of the disease processes which may produce the appearance.

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The most sinister complication of Paget's disease is malignant degeneration. The true etiology of Paget's disease remains unproven and unknown. The relative incidence of sarcoma ranges from 0.9% to 20% depending upon the population source. The anatomical distribution of lesions is similar to that of uncomplicated Paget's disease except for the high incidence in the humerus and rare occurrence in the spine. Approximately 50% of the lesions histologically represent osteosarcomas, with fibrosarcoma, fibrous histiocytoma, chondrosarcoma and giant cell tumor rarely occurring. The radiographic presentation is most commonly lytic, but sclerotic and mixed patterns occur. Cortical destruction and soft tissue mass are the cardinal radiographic signs. Malignant periosteal response is seldom found associated with Paget's sarcoma. The most common sites are femur, humerus, pelvis, skull and tibia. The prognosis is fatal at a very rapid rate. There are but a few isolated cases of long-term survival reported.

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