MRI of the plantar structures of the foot after falanga torture

Falanga is an ancient form of punishment or torture but is still commonly r eported by our refugees. The late result of caning the heel and ball of the foot is a chronic painful condition with few clinical signs. The aim of th e present study was to assess, by MRI, possible morphologic characteristics of the heel and ball of the foot, related to falanga and pain in correlati on to clinical findings. Magnetic resonance imaging of the foot was obtaine d in 12 victims exposed to falanga torture and 9 healthy volunteers. Sagitt al T1-weighted spin-echo images (TR 616-840 Ins, TE 20 ms), T2-weighted spi n-echo images (TR 1900 ms, TE 90 ms), and short tau inversion recovery (STI R) images (TR 1200 ms, TE 15 ms, TI 100 ms) were performed. The central por tion of the plantar aponeurosis was generally significantly thicker in vict ims exposed to falanga torture as compared with that of controls (P < 0.05) . In all except one of the victims, MRI demonstrated two layers of the thic kened plantar aponeurosis: a deeper portion with normal homogeneous low sig nal intensity (SI) appearance, and a superficial layer with characteristic areas of mixed SI on both T1- and T2-weighted images. There were no signs o f chronic muscular compartment syndromes, and the thickness of the plantar pad did not differ between the two groups. Magnetic resonance imaging may d emonstrate morphologic characteristics of the plantar aponeurosis which may confirm falanga torture. Further imaging with more specific sequences is w arranted to demonstrate the supposed injuries in the compartmental fat tiss ue chambers and the vascularity of the ball pad of the foot.