Foot and ankle scan protocol

Question 1

Structure of interest in anterior ankle (3)

Answer 1

anterior joint space, anterior extensor tendons, anterior inferior tibiofibular ligament

Question 2

normal amount of fluid in anterior joint space

Answer 2

3mm

Question 3

anterior talo-fibula ligament (ATFL) appearance

Answer 3

2cm long, 3mm tight fibrillar structure anglesd toward the second toes

Question 4

Tibio-Fibula ligament has similar appearance to

Answer 4

anterior talo-fibula ligament

Question 5

extensor tendons consist of

Answer 5

extensor digitorum, extensor hallucis and tibialis anterior

Question 6

how do we tell separate extensor tendon

Answer 6

by independently mobilising each of the toes and watching the tendons glide, you can identify which is which and exclude tendon rupture

Question 7

lateral ankle structures of interest

Answer 7

peroneous longus and brevis tendons
calcaneo- fibula ligament
anterior talo fibula ligament

Question 8

Which is more common Ankle ligament injury or tendon injury

Answer 8

ligament injury

Question 9

most commonly injured ankle ligament

Answer 9

Anterior talofibular ligament

Question 10

most commonly dislocated

Answer 10

peroneal tendons

Question 11

which is closer to bone Peroneus longus and brevis tendons

Answer 11

peroneus brevis

Question 12

what is important to see with peroneus brevis

Answer 12

insertion onto the base of 5th metatarsal

Question 13

where do we put the probe to see calcaneo fibular ligament

Answer 13

probe diagonally under the malleolus, angled from the fibula to the heel

Question 14

medial ankle structures of interest

Answer 14

Tibialis Posterior tendon
Flexor Digitorum tendon
Flexor Hallucis Longus tendon
Deltoid ligament
Posterior tibial nerve

Question 15

posterior ankle structures of interest

Answer 15

Achilles tendon
Retrocalcaneal (Kager’s) fat-pad
Retrocalcaneal bursa
Plantar fascia

Question 16

Normal thickness of achilles tendon

Answer 16

5-6mm

Question 17

most frequently injured ankle tendon

Answer 17

achilles tendon

Question 18

Most common site injury on achilles tendon

Answer 18

2-6 cm proximal to calcaneal insertion (area relative avascularity)

Question 19

achilles tendon is only ankle tendon that does not have

Answer 19

synovial sheath

Question 20

should achilles tendon have fluid around it?

Answer 20

no

Question 21

normal amount of fluid in retrocalacaneal bursa

Answer 21

2-3mm

Question 22

normal thickness and echotexture of plantar fascia

Answer 22

3-4mm and uniform echotexture

Question 23

plantar fascia seen as ________ structure inserting on ____

Answer 23

fibrillar structure inserting onto the calcaneum

Question 24

plantar fascia appearance

Answer 24

flat and homogenous

Question 25

what is plantar fibromatosis

Answer 25

fusiform nodule thickenings of the plantar fascia

Question 26

where is plantar plate seen arising

Answer 26

base of prosimal phalanx on the plantar aspect

Question 27

how do you visual plantar plate fully

Answer 27

extend the toe

Question 28

US appearance of the plantar plates

Answer 28

homogeneous elongated wedge arising from the base of the proximal phalanx extending under the heard of the metatarsal

Question 29

mortons neuroma seen as

Answer 29

a non compressible, hypoechoic rounded mass at the metatarsal head interspace

Question 30

intermetatarsal bursa bursa appearance

Answer 30

hypoechoic area between the metatarsal heads but will be compressible and avascular. It will be seen to bulge out the plantar aspect.

Question 31

gout joint effusion is

Answer 31

Abnormal uric acid metabolism resulting in joint inflammation. May see tophaceous gout as a complex echogenic mass (tophus) in the soft tissue of the big toe.

Question 32

Osteoarthritis is

Answer 32

Bony irregularity at the bone ends with joint effusion. When acute the joint will be hyperaemic

Question 33

Rheumatoid arthritis is

Answer 33

Thickened synovium with a complex ‘thick’ joint effusion, pannus & associated boney iregularity.