MSK- foot and ankle protocol Flashcards
anterior ankle structures of interest (3)?
Anterior joint space
Anterior extensor tendons(anterior tibial, EHL,EDL)
Anterior inferior tibiofibular ligament
Anterior tibial margin meets?
cartilage dome of talus
normal amount of fluid in anterior ankle?
Normal = 3mm fluid
Anterior talo-fibula ligament (ATFL) scan?
- heel of the probe on the anterior aspect of the distal fibula
- rotate the toe of the probe towards the 2nd toe
Anterior talo-fibula ligament (ATFL) size?
- length
- thickness
- 2cm long
- 3mm thick
Tibio-Fibula ligament (TFL) scan?
- from the ATAF, further rotate the toe of the probe until just above the horizontal
- TFL has a similar appearance to the ATAF
How to examine the Extensor tendons?
seen by independently mobilising each of the toes and watching the tendons glide, you can identify which is which and exclude tendon rupture
what should be seen in extensor tendons scan?
in transverse across the anterior ankle crease, you will see from lateral to medial:
- theextensor digitorum
- extensor hallucis
- tibialis anteriortendons
- overlying extensor retinaculum should also be observed
Lateral ankle structues of interest? (3)
Peroneus longus and brevis tendons.
Calcaneo-fibula ligament.
Anterior Talo-Fibula ligament
whats more common a ankle ligament or tendon injury?
ligament
most commonly injured ankle ligament?
Anterior talofibular ligament
most commonly dislocated?
Peroneal tendons
Peroneus longus and brevis tendons easily seen how?
the two tendons are easily seen with the peroneusbrevis closest to thebone
how to scan Peroneus longus and brevis tendons?
- begin in transverse, posterior to the lateral malleolus
- follow them proximally to the muscle and distally with particular attention to the insertion of the peroneus brevis tendon onto the base of the 5th metatarsal
how to scan Calcaneo-fibular ligament?
with probe diagonally under the malleolus, angled from the fibula to the heel=peroneus tendons in transverse , calcaneo-fibula ligament underlying them
medial anke- structures of interest? (5)
Tibialis Posterior tendon Flexor Digitorum tendon Flexor Hallucis Longus tendon Deltoid ligament Posterior tibial nerve
How to scan Tibialis posterior, flexor digitorum and flexor hallucis longus tendons?
- Assess the tendons along their length in longitudinal and transverse
- Pay particular attention to the insertion of the Tibialis Posterior tendon with caution not to mistake the often present accessory ossicle, for an avulsed fragment
what ligament in the medial ankle is poorly assessed with ultrasound?
deltoid ligament
where is the posterior tibial nerve easily seen?
neurovascular bundle easily seen posterior to the medial malleolus
Posterior ankle structures of intrest?
Achilles tendon
Retrocalcaneal (Kager’s) fat-pad
Retrocalcaneal bursa
Plantar fascia
achilles tendon normal thickness?
5-6 mm thick
most frequently injured ankle tendon?
achilles tendon
achilles tendon most common site of injury?
2-6 cm proximal to calcaneal insertion (area relative avascularity)
what is the only ankle tendon that does not have a synovial sheath?
achilles tendon
what is the only ankle tendon that does not have a synovial sheath?
achilles tendon
Retrocalacaneal bursa normal fluid?
2-3mm
Plantar fascia thickness and echotexture?
3-4 mm thick, uniform echotexture
how to assess Plantar Fascia?
- Patient prone on bed, foot flexed with toes on the bed for support
- Place the probe over the midline of the heel on the plantar aspect
- The toe of the probe towards the heel
sono apperance of plantar fascia?
- fibrillar structure inserting onto the calcaneum
- It should be flat and homogenous
assessment of Plantar Fibromatosis?
- Follow the plantar fascia into the arch and look for fusiform, nodular thickenings
- They may be subtle and more numerous than can be palpated.
how does plantar fibromatosis present?
one or more palpable thickenings in the arch of their foot
sono apperance of plantar plates?
a homogeneous elongated wedge arising from the base of the proximal phalanx extending under the head of the metatarsal
sono apperance of mortons neroma?
compressible, hypoechoic rounded mass at the metatarsal head interspace
sono apperance of intermetatarsal bursa?
- hypoechoic area between the metatarsal heads but will be compressible and avascular
- seen to bulge out the plantar aspect
3 Joint effusions?
1, gout
2, osteoarthritis
3. rheumatois arthritis
gout?
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
Osteoarthritis?
Bony irregularity at the bone ends with joint effusion. When acute the joint will be hyperaemic
Rheumatoid arthritis?
Thickened synovium with a complex ‘thick’ joint effusion, pannus & associated boney iregularity
