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Ultrasound examination of the ankle and foot joints is considered one of the most informative formats for examining these parts of the body. The advantage of this method is added by the fact that it is a non-invasive diagnostic, which means for the patient the absence of pain and radiation exposure.
Ultrasound examination of the ankle and foot joints allows you to make a detailed picture of almost all structures. What can be scanned by ultrasound when examining the presented area includes not only muscle tissue, but also ligaments, cartilage, tendons. With the help of the survey, in many cases it is possible to detect even small pathological changes in the early stages of development.
Due to detailed testing, it is possible to detect neoplasms of various etiologies, as well as to identify the exact localization of the area with the inflammatory process, where the accumulated exudate has collected. Using a highly sensitive sensor, it is also possible to determine the location of hematomas.
In addition to the fact that ultrasound imaging provides information about the structure of the ligaments and other soft tissues of the lower leg and foot at rest, it also allows you to identify abnormalities that may disturb the patient only during physical activity. This possibility is especially valuable for doctors who sent the patient for examination to clarify the cause of the limitation of joint mobility.
The possibility of safe multiple dynamic examination, direct contact with the patient, the use of kinematic tests determine the priority of ultrasound among all methods for diagnosing injuries of the ankle joint and foot.
The essence of the method
Ultrasound examination of the ankle joint and foot is carried out with a high-frequency linear transducer with a frequency of more than 7,5 MHz. The study begins with an assessment of the ligamentous apparatus of the ankle joint, then the doctor performs an ultrasound scan of the joints and ligaments of the foot, plantar aponeurosis. When scanning tendons, their size, structure, contours, transition into muscle tissue and sliding are evaluated during dynamic observation. Ultrasound scanning during active movements in the ankle joint allows visualization of tendon movements. In addition, intra-articular bodies, cysts of the ankle joint can be detected.
Ultrasound navigation has recently been increasingly accompanied by puncture of the ankle joint. Ultrasonic control minimizes the risk of injury to nerves, blood vessels, as well as muscle and other tissues during the procedure. Ankle puncture is actually a type of surgical intervention, during which the skin, subcutaneous tissue and joint capsule are punctured. Ultrasonic control during this manipulation allows you to monitor the correct position of a special puncture needle with laser notches at all stages of the procedure, assess the volume of intra-articular fluid, and ensure control over the introduction of a drug into the joint cavity. Thanks to ultrasound guidance, the doctor performing the procedure chooses the safest point for inserting the needle into the joint cavity. Under the control of ultrasound, the specialist removes blood, pus and other pathological liquid media from the joint, and, if necessary, then injects medicine into the joint cavity.
The advantages of ultrasound
Modern medical technologies offer many ways to assess the condition of the musculoskeletal system, including the joints of the lower leg and foot. But ultrasound examination is consistently in high demand among both physicians and patients themselves, and not only because of the absence of accompanying painful sensations.
Ultrasound is highly valued for its combination of accessibility and information content, because in one trip to the diagnostician you can find out about the state of different tissues that differ in structure. Another important item on the list of positive aspects of the technique is the price. Against the background of computed tomography or magnetic resonance imaging, the ultrasound method of examination will be much cheaper.
Add to this is a relatively short time period for which the results of the survey will be ready along with the conclusion. Even the diagnostician himself can explain some of it at the request of the patient. But the final diagnosis, as well as the preparation of a treatment program, are in the prerogative of the attending physician of a particular patient.
An important advantage of the method is harmlessness. Unlike other health assessment methods, it does not use dangerous radiation rays or magnetic fields. The absence of radiation exposure for patients completely ruled out absolute contraindications for manipulation.
This means that ultrasound will freely do:
- to kid;
- a woman at any stage of pregnancy;
- people with weakened immune systems;
The patient will only have to decide where to do the examination, choosing between a private medical center and a public hospital or clinic. The location of the examination is less important than the ultrasound machine, which should preferably be of the latest generation so that the ultrasound doctor can obtain an image of the best resolution.
When using high-precision expert-class equipment, the doctor will be able to examine even the smallest anomalous phenomena, such as deviations in the anatomical features of collagen fibers, not to mention the detection of even small neoplasms.
If any neoplasm is detected, the patient may be sent for additional examination to determine whether the tumor is malignant or benign. In such cases, an ultrasound examination, even on an expert-class ultrasound machine, will be insufficient and sometimes it is impossible to do without performing a biopsy. In some cases, an MRI with contrast may be required.
When to book an appointment
In the vast majority of cases, the specialists who refer the patient for an ultrasound examination of the ankle joint are surgeons or orthopedic traumatologists, to whom people go, complaining of pain, or simply discomfort in the area of the foot and lower leg. In addition to the pain syndrome, the patient is concerned about a sharp deterioration in the quality of life due to a significant limitation of his motor activity.
Since the diagnosis does not involve a complex preparatory stage, in some cases, an ultrasound examination can be performed immediately after visiting a specialist. The doctor writes out a referral for an ultrasound scan, collecting data on the patient’s current complaints, and conducting an examination and palpation. Usually, the state of the joints of the ankle and foot is assessed at a time, but in some cases, only one part is required to be examined. Such a separation is especially relevant after a surgical intervention, completion of a course of conservative therapy or physiotherapy.
The most common pathologies of the foot and lower leg area, which become the reasons for contacting the ultrasound diagnostics office, are:
- bursitis;
- synovitis;
- tendonitis;
- osteochondrosis;
- arthrosis;
- rheumatism;
- arthritis;
Also, specialists refer patients to ultrasound examination of the foot and lower leg after traumatic damage to these areas, to clarify the presence or severity of damage to muscles, ligaments and tendons.
This is about:
- dislocation;
- subluxation;
- rupture of ligaments;
- muscle sprains;
- tendon injury.
With the help of highly sensitive sensors, it is even possible to visualize articular surfaces and diagnose pathological processes in cartilage tissue.
In order not to reach the stage when it is impossible to cope with the problem with the help of conservative treatment, you need to immediately seek the advice of a specialist if you find yourself:
- joint pain;
- crunch;
- suspicious clicks;
- restrictions on motor activity;
- swelling;
- neoplasms are suspected.
In general, the reason for seeking qualified help should be any phenomena uncharacteristic of the ankle and lower leg. Such precautions will help to start treatment at the initial stage of the development of the disease, and prevent surgical intervention.
Thanks to high-precision ultrasound imaging, in the case of an inflammatory process, it is possible to detect its source and assess the degree of involvement of other areas. Such accuracy, together with the ability to set a point for articular puncture in order to evacuate exudate, increases the effectiveness of further treatment by an order of magnitude.
Regular ultrasound examination during the treatment process allows you to adjust the therapy in time to achieve the best result.
The inflammatory process affecting the joints, even in the early phase, causes intense pain, accompanied by restriction of movement. If the inflammation is chronic, then in the future each new acute attack will be accompanied by serious disruptions in the metabolism of cartilage tissue. The logical outcome of the development of such a scenario is arthrosis, which is characterized by structural disorders of the cartilaginous tissue of the foot or ankle.
The classic manifestation of a heel spur is the inability to fully lean on the heel. At first, an unpleasant symptom can be traced only with a prolonged load on the heel region, for example, with prolonged walking. Then unpleasant sensations make themselves felt even in the morning after a night’s rest or with minimal impact on the affected limb.
When pain appears or worsens without any significant reason, it pushes the patient to go to the doctor.
If during the initial examination, the specialist suspects Morton’s neuroma, he will also send the patient for an ultrasound of the foot to confirm the diagnosis. An ultrasound scan will show a seal in the interdigital zone of the foot. Clinically, this confirms the pain syndrome during palpation of the specified area.
Diagnostics is additionally used as control monitoring during the following procedures:
- functional test to assess the range of motion of the joint;
- taking fluid and tissues from the joint area.
The second point corresponds to the classical puncture of the joint.
How is the procedure performed
Before an ultrasound examination of the lower leg and foot, the patient must remove shoes, pants and socks, and lie down on the couch. A special gel is applied to the skin of the area under study for better contact of the sensor with the tissues. Next, you should follow the requests of a specialist, since a change in body position may be required to obtain a complete clinical picture.
The doctor examines the state of the joint in several projections:
- Anterior projection – visualizes the joints of the tibial muscle, the long extensor of the thumb, the muscles of the anterior surface of the lower leg, as well as the tendons of the long extensor of the fingers.
- Medial location – allows you to view the posterior tibial muscle, deltoid ligament and tibial nerve, diseases of which are often accompanied by discomfort.
- Lateral access – provides access to the tendons of the long and short peroneal muscles and most of the surrounding tissues.
- Posterior localization – allows you to assess the structure and general condition of the Achilles tendon, calcaneus and plantar aponeurosis.
On average, the examination takes 15-20 minutes, after which the patient is given a study protocol, and is sent to the doctor for treatment if abnormalities are found during the ultrasound examination.
If at the same time as checking the joints, a detailed assessment of the vessels of the lower extremities is required, then the position of the patient is changed. First, the patient is placed on the couch, and then they help him to bend his knees correctly.
Since the manipulation does not require a preparatory stage, the patient will only need to expose the lower limbs so as not to interfere with the sensor. After that, you can lie down on the couch, listening to the doctor’s commands.
Separately, it is worth considering that the study cannot be prescribed immediately after intra-articular injections. It is recommended to wait at least four days after the injection to restore the joint to its usual state.
At the beginning of the procedure, the patient is in the supine position, the legs are slightly bent at the knee joints, but if suspicious changes are detected, the doctor may ask you to turn the lower leg inward. This is necessary in order to make it easier for the sensor to reach the area under study.
Before starting the procedure, the skin of the ankle with the foot is liberally lubricated with gel, which is necessary to improve the conductivity of ultrasonic waves. The application of the gel does not cause any harm to the skin. Even patients with allergies do not feel any discomfort when applying it.
Particularly noteworthy are people who were sent for ultrasound examination in extremely serious condition. Although complete immobility, as for computed tomography, is not a mandatory item here, people on the verge of shock are not always able to calmly endure manipulation. And open wounds, burns, other external skin lesions do belong to the list of contraindications.
Typically, the diagnostic phase takes about fifteen minutes. During this time, the diagnostician checks the condition of the tendon-muscular apparatus and articular joints of the studied area of both limbs.
The results of the examination are given to the patient in the form of a text of the conclusion, which is sometimes accompanied by scans from the screen of the ultrasound machine in the form of pictures. The printed version of the conclusion will be analyzed in detail by the attending physician of the patient. The picture attached to the conclusion in some complex cases can help the specialist in establishing the final diagnosis.
In some cases, if after the first examination the doctor has questions, or an examination of the joint area or surrounding tissues is required during treatment, then ultrasound may be prescribed again. Since ultrasonic radiation is safe for humans, if necessary, it is possible to repeat the procedure many times.
Schematic interpretation
After the examination, the conclusion is issued either immediately to the hands of the patient, or transferred directly to the office of the attending doctor. The latter option is more common in hospitals.
If you can’t wait to deal with the doctor’s conclusion on your own, waiting for your turn in the corridor, then you should use an approximate transcript.
So, when the ligaments are torn, in addition to a sharp pain in the ankle joint, the following signs will be indicated in the conclusion: a significant violation of the course of the fibers, their discontinuity, a local decrease in echogenicity, the presence of an abnormally large amount of fluid in the synovial region.
A similar picture is observed with a partial rupture of the ligament. In this case, you can see an area with impaired echogenicity, usually reduced due to swelling of the tissues and an area of internal hemorrhage (hematoma).
With tendinitis (inflammation of the tendon), there is an accumulation of effusion, but without violations of its structure. In most cases, ultrasound scanning does not find structural changes in the tendon itself. Since the accumulation of effusion occurs in the synovial sheath of the tendon, this may indicate to talk about its involvement in the inflammatory process, therefore, most often in such situations, the diagnosis of tenosynovitis is established.
The transition from the acute stage of the inflammatory process to the chronic one has some features of the picture during ultrasound examination: the structure of the tendon becomes heterogeneous, sometimes granular due to calcifications.
In rheumatoid arthritis, the ultrasound examination determines the presence of cysts and erosions of the articular surfaces, which are not always visible in the early stages of RA during X-ray examination.
Often, during an ultrasound examination of the joints, hygromas are found: they are limited in length, the edges are rounded, the contours are even, clear.
If an ultrasound is performed by an experienced diagnostician, then he will be able to get ahead of even the severity of the rupture. With a complete rupture, the following are revealed: a violation of the integrity of the fibers, an increase in the distance between them, uneven contours of the tendon. Additionally, the accumulation of hypoechoic fluid (blood) is visualized. Partial ruptures, according to ultrasound, are accompanied by the appearance of hypoechoic cracks, local narrowing of the tendon and its relative thickening proximal and distal to the rupture site are determined. If the injury happened a long time ago, then it will be possible to consider tissue defects with areas of fibrosis and calcification. After the operation, after tendon rupture, ultrasonography visualizes ligatures with increased echogenicity.
Hyperechoic areas, as well as thickening and swelling of the plantar fascia, will tell about the heel spur.
In recent years, the role of ultrasound in the diagnosis of ankle and foot pathology has become a priority. Ultrasound scanning of the area of the foot and lower leg provides reliable information about the degree and type of damage to the tendon-muscular apparatus and other soft tissues, which is impossible with X-ray examination. Ultrasound is more accessible and cheaper than MRI, and when conducting dynamic tests, it shows high efficiency in determining damage to ligaments and tendons.
Diagnostic ultrasound examination of the ankle joint and foot area can be performed with early signs of pathological processes, which is of great importance, as it allows timely conservative treatment before the onset of irreversible changes requiring surgical intervention. Early diagnosis of the pathology of the musculoskeletal system and timely treatment significantly increase the chances of a complete restoration of mobility and a return to an active lifestyle.