Ankle Anatomy and Pathology

Question 1

What three bones encompass the ankle joint?

Answer 1

Tibia, Fibula, Talus

Question 1

Are flexors or extensors on the anterior foot?

Answer 1

Extensors

Question 2

What are the three main tendons of the anterior ankle?

Answer 2

Tibialis Anterior
Extensor Hallucis Longus - attaches to big toe
Extensor Digitorum Longus - attaches to the rest of the phalanges

Question 3

Where on the foot do you assess a tibiotalar joint effusion?

A) Lateral
B) Medial
C) Anterior
D) Posterior

Answer 3

Anterior aspect

Question 4

What are the three bumps on the ankle that help form the ankle joint?

Answer 4

Medial malleolus
Lateral malleolus
Posterior malleolus

Question 5

Synovitis in the anterior ankle is associated with what abnormality?

If RA is suspected, what metatarsal would you assess?

Answer 5

Rheumatoid arthritis

5th

Question 6

Gout presents on ultrasound with monosodium urate crystal icing. What is this appearance called?

Answer 6

Double contour sign

Question 7

Medial Ankle Pneumonic: Tom, Dick, And Very Very Nervous Harry. What does it stand for?

Answer 7

1. Posterior TIBIAL tendon
2. Flexor DIGITORUM longus tendon
3. Posterior tibial ARTERY
4. Posterior tibial VEINS (2)
5. Posterior tibial NERVE
6. Flexor HALLUCUS longus tendon

Question 8

What two tendons does the “Knot of Henry” Involve?

Answer 8

FHL & FDL: The FDL crosses over top of the FHL on the medial aspect of the ankle and may cause intersection syndrome

Question 9

T or F? The deltoid ligament on the medial ankle is easy to diagnose tears with ultrasound?

Answer 9

FALSE - it is difficult

Question 10

The tarsal tunnel is a compartment formed by what two landmarks of the medial ankle?

Answer 10

Flexor retinaculum and distal tibia

Question 11

Tarsal tunnel is the nerve entrapment of what nerve?

Answer 11

Tibial nerve

Question 12

What aspect of the ankle is Tarsal Tunnel?
A) Lateral
B) Medial
C) Anterior
D) Posterior

Answer 12

B - medial

Question 13

What are the names of the tendons on the lateral ankle?

Answer 13

1. Peroneus Brevis
2. Peroneus Longus

Question 14

What are the ligaments of the lateral ankle?

Answer 14

1. Anterior and posterior talofibular
2. Anterior and posterior tibiofibular
3. Calcaneofibular- the most commonly injured

Question 15

An accessory anterior tibiofibular ligament in the lateral ankle may be present. What is the name for this ligament?

Answer 15

Bassett ligament

Question 16

Tenosynovitis in the peroneal tendons is most common at the level of what landmark?

Answer 16

Lateral malleolus

Question 17

Anechoic / hypoechoic cleft that extends to the tendon surface in the lateral ankle is characteristic of what pathology?

Answer 17

Longitudinal tear/split

Question 18

A complete tendon tear in the lateral ankle most commonly occurs where? (hint: landmark)

Answer 18

Lateral malleolus

Question 19

Injury to what structure may result in subluxation or dislocation of the peroneal tendons?

Answer 19

Injury to the superior peroneal retinaculum

Question 20

T or F? A low-lying peroneus brevis muscle belly increases the risk for ankle pathology?

Answer 20

TRUE

Question 21

What tendon in the lateral ankle may be seen as an anatomical variant?

Answer 21

Peroneus Quartus

Question 22

Where can the peroneus quartus be found in relation to the fibula?

Answer 22

Posterior to the fibula

Question 23

The peroneus quartus may be mistaken for what pathology?

Answer 23

Longitudinal split/tear of the peroneus tendons

Question 24

Where does the achilles tendon insert?

Answer 24

The calcaneus

Question 25

Where does the plantaris muscle originate and insert?

Answer 25

O: The lateral femur I: The calcaneus OR achilles

Question 26

What makes up the "triceps surae"?

Answer 26

1. Gastroc 2. Achilles 3. Plantaris

Question 27

The retrocalcaneal bursae is located between which two structures?

Answer 27

Achilles and calcaneus

Question 28

Whats a normal measurement for the retrocalcaneal bursae?

Answer 28

up to 2.5mm

Question 29

The sonographic "mulder sign" is associated with what pathology?

Answer 29

Mortons Neuroma

Question 30

What metatarsal head should be assessed for Gout? A) Medial first B) Lateral first C) Medial 2nd D) Lateral 2nd

Answer 30

A) medial first

Question 31

Retrocalcaneal bursal distention has what features? (2)

Answer 31

1. Tendon tear 2. Inflammation

Question 32

T or F? The achilles tendon has a true tendon sheath?

Answer 32

False - it has a paratenon instead

Question 33

Abnormal hypoechoic swelling or anechoic fluid immediately adjacent to the achilles tendon represents what pathology?

Answer 33

Paratenonitis

Question 34

"A degenerative process, appears as abnormal tendon hypoechogenicity but without disruption of the tendon fibers" is known as what pathology?

Answer 34

Tendinosis - may present with vascularity

Question 35

How can we determine between a partial and full-thickness tear?

Answer 35

Dynamic Evaluation - have patient dorsiflex and plantar flex

Question 36

What are indirect signs of achilles tendon partial-thickness tear?

Answer 36

1. Cortical irregularity of calcaneus 2. Fluid within retro-calcaneal bursae

Question 37

What three features are associated with Haglund Syndrome?

Answer 37

1. Distal achilles tendon abnormality 2. Bursal distention 3. Prominent posterosuperior corner of calcaneus

Question 38

Posterior acoustic shadowing from refraction at the tendon stumps is an indirect sign of what pathology?

Answer 38

Full-thickness tear of achilles tendon

Question 39

T or F? The plantaris tendon usually remains intact when there is a full-thickness tear in the achilles?

Answer 39

TRUE - plantaris is stronger

Question 40

What may mimic an intact achilles tendon when there is actually a full-thickness tear?

Answer 40

The plantaris tendon can be mistaken as it is right next to the achilles

Question 41

How many cuneiform bones are there?

Answer 41

3