Hello, everyone. My name is Brandon Moritz and I'm a fourth year medical student at the University of Oklahoma College of Medicine. Today I have the pleasure of presenting an audio paper at the American Orthopedic Foot and Ankle Society Annual Meeting. Today I'll be talking about a paper called Halim's Hint, a mnemonic for the anatomy of hindfoot structures at the level of the sussentaculum tali on coronal T1-weighted magnetic resonance images. We published this in January 2022 with these other co-authors and we were led by Dr. Amgad Halim, who is OU faculty. I have no relevant disclosures to provide today. And we'll be looking at a very complex region of the hindfoot. We'll also be looking at a very well-described anatomy from magnetic resonance imaging. And also we are filling a gap in the literature where there have been no recent study, no studies in general, describing a mnemonic for this region of the foot. So our learning objectives is to define and apply this mnemonic and then also we'll use it to look at normal and pathologic anatomy. So at the level of the sussentaculum tali, it's very intricate. There's an abundant number of muscles, tendons, aponeurosis and ligaments in that area. And so we seek to create a mnemonic that illustratively describes this region of complex anatomy. The study was a retrospective review of 124 MRIs. We looked at coronal T1-weighted spin echo MR images, and this was completed by our most senior author, who's a very senior radiologist in the field. The results led to the development of a mnemonic called the Halim's Hen in the nest with four eggs, which has nine major elements. Those elements then represent certain structures. So the bony structures are represented by the body, head and neck of the hen, the tendons, crest, beak, waddle and tail of the hen. The muscles are the four eggs under the hen. And the ligaments is the long plantar ligament that represent the legs and the plantar and aponeurosis represents the nest. So let's take a look at this. So as you can see in the images, the body represents the calcaneus. The head and neck represent the sescentaculum tali. The crest is the tibialis posterior. The beak is the flexor digitorum longus. The waddle is the flexor hollis longus. The tail is represented by the fibularis longus and the fibularis brevis. And then the flexed legs represents the long plantar ligament. And the plantar aponeurosis, it represents the hen's nest. And then for the four eggs, the first three eggs represent the abductor hollis, the flexor digitorum brevis and the abductor digiti minimi. And then the fourth egg is represented by the quadratus plantae. And altogether, this makes the full mnemonic illustrative of this part of the hind foot. In the discussion, we'll take a look at four pathologies while this mnemonic is not limited to just these four. So in pes planus, in these two images, we see tibialis posterior tendinopathy and we also see atrophy of the quadratus plantae. You can see them identified by the red arrows. And for the flexor digitorum brevis hemangioma, you see the T2s have some hyperintensity representing the hemangioma. And also the T1 has a large hemangioma also matching where the flexor digitorum brevis would be. And then for Baxor's neuropathy, we see chronic denervation of the abductor digiti minimi leading to atrophy, which is within that red circle. And also you see in peroneal tendinitis, which would represent the tail of the hen. You see the red arrow identifying where that would be and the inflammatory changes that are occurring. And in conclusion, this mnemonic illustrates this very complex region of the hind foot at the level of the sesentaculum tali on coronal T1 weighted MR images. It's an effective tool not only for teaching students, residents, fellows, but also for great recall for tenured physicians and faculty as well. And it can be used long down the line to recall for an entire career. And it not only aids in identifying normal anatomy, but it also aids in identifying pathologic anatomy as well. And my acknowledgement today is to thank Dr. Halim for allowing me to contribute to this project, to present on our team's behalf, and also for the years of mentorship throughout medical school. If you'd like to read more about this paper, then please see the full manuscript at European Journal of Radiology. And then if you'd like to review our references, here they are. And I appreciate everyone's time today and thank you for tuning in.

Halim's Hint

hindfoot anatomy

mnemonic

pathologic anatomy

medical career