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Ultrasound of the ankle joint
Last reviewed: 05.07.2025
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It should be noted that with the advent of new broadband and high-frequency sensors, the information content of ultrasound examination of tendons and ligaments of the ankle joint has increased significantly and the ultrasound method (ultrasound) today has an advantage over MRI. In addition, ultrasound examination of tendons and ligaments of the ankle joint is technically not difficult, since most of the structures being examined are located superficially, are easily accessible and parallel to the scanning surface. For examination of the ankle, it is recommended to use a sensor in the range of 7.5-13 MHz with a small working surface for ease of scanning.
Anatomy of the ankle joint
The ankle joint is formed by the articular surfaces of the distal ends of the tibia and fibula and the articular surface of the trochlea of the talus. The distal ends of the tibia and fibula form the tibiofibular syndesmosis. On the anterior and posterior surfaces are the anterior and posterior tibiofibular ligaments, stretched from the anterior and posterior edges to the lateral malleolus. The joint capsule is attached along the edge of the articular cartilage and on the anterior surface of the body of the talus to the neck of the talus. The ligaments of the ankle joint pass along its lateral surfaces. The medial ligament or deltoid is divided into the following parts: the anterior tibiotalar part goes from the anterior edge of the medial malleolus downwards and forwards and is attached to the posteromedial surface of the talus. The second part is the tibionavicular, which is longer than the previous one, starts from the medial malleolus and reaches the dorsal surface of the navicular bone.
The Achilles tendon is the largest, formed by the fusion of the fibers of the gastrocnemius and soleus muscles. It does not have a synovial membrane and at the point of attachment forms a mucous sac of the calcaneal tendon. The muscles described above bend the shin at the knee joint, flex the foot, and raise the heel. On the plantar side, the superficial fascia is called the plantar aponeurosis. Most of the fibers of which originate from the calcaneal tubercle and, heading forward, disintegrate according to the number of toes.
Ultrasound examination technique
When performing an ultrasound examination of the ankle joint, a certain sequence of actions should be followed and standard positions should be sought. According to the anatomical regions, four standard approaches are used to examine all elements of the joint: anterior, medial, lateral and posterior.
Methodology for performing ultrasound examination of the ankle joint
Ultrasound diagnostics of ankle joint injuries
Ankle ligament ruptures.
Injuries to the ankle ligaments are mostly found in athletes. A typical mechanism of injury is the inversion of the foot inwards or outwards when the limb is loaded (running, jumping off the equipment, jumping). Another mechanism of injury is also possible, the cause of which is the rotation of the foot relative to the longitudinal axis of the shin. Such injuries are most often found in skiers, when, while descending the mountains, the tip of the ski touches some obstacle, and the skier continues to move forward by inertia. At this point, the foot, fixed by the boot, remains in place, and the shin continues to move forward, resulting in forced eversion of the foot (rotation of the foot in the ankle joint around the longitudinal axis of the shin outwards). Based on the above-described mechanisms of injury development, various ligamentous components of the ankle joint are damaged. For example, the lateral collateral ligaments are damaged during supination and inversion of the foot, and the deltoid and tibiofibular ligaments can be damaged during pronation and eversion.