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Ultrasound of the ankle
Last reviewed: 20.11.2021
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It should be noted that with the advent of new broadband and high-frequency sensors, the informative value of ultrasonic examination of tendons and ligaments of the ankle joint has increased significantly and the ultrasound method today has an advantage over MRI. In addition, ultrasound examination of tendons and ligaments of the ankle joint is not technically difficult, since most of the structures studied are superficially located, easily accessible and parallel to the scanning surface. For ankle examination, it is recommended to use a sensor in the range of 7.5-13 MHz with a small working surface for easy scanning.
Anatomy of the ankle
The ankle joint is formed by the articular surfaces of the distal ends of the tibial and fibular bones and the articular surface of the talus block. The distal ends of the tibial and fibular bones form an intercellular syndesmosis. On the front and back surfaces are the anterior and posterior intercellular ligaments, stretched from the anterior and posterior margins to the lateral ankle. The joint capsule is attached along the edge of the articular cartilage and on the anterior surface of the talus bone to the collar of the talus. Ligaments of the ankle pass along its lateral surfaces. The medial ligament or deltoid is subdivided into the following parts: the anterior tibial-talus part extends from the anterior edge of the medial ankle downward and forward and is attached to the posterior medial surface of the talus. The second part is tibial-navicular, which is longer than the previous one, starts from the medial malleolus and reaches the rear surface of the scaphoid bone.
Achilles tendon is the largest, formed due to the fusion of the fibers of the gastrocnemius and soleus muscles. It does not have a synovium and at the attachment site it forms a mucosal bag of the calcaneal tendon. The muscles described above bend the shin in the knee joint, flex the foot, lift the heel. On the plantar side, the superficial fascia is called the plantar aponeurosis. Most of the fibers of which originate from the calcaneus of the calcaneus and, leading anteriorly, disintegrate according to the number of fingers.
Method of ultrasound examination
When performing an ultrasound of the ankle, one should follow a certain sequence of actions and strive to obtain standard positions. According to the anatomical regions, four standard accesses are used to examine all joint elements: anterior, medial, lateral and posterior.
Method of ultrasound of the ankle
Ultrasonic diagnosis of ankle damage
Torn ligaments of the ankle joint.
Damage to the ligaments of the ankle joint is found mainly among athletes. A typical mechanism of injury is the pivoting of the foot to the inside or outside at the time of loading on the limb (running, jumping off the projectile, jumping). Another mechanism of damage is possible, which is caused by the rotation of the foot relative to the longitudinal axis of the shank. Such injuries are most often encountered in skiers when, when descending from the mountains, the ski touches for some obstacle, and the skier himself continues to move forward by inertia. At this point, the foot, fixed by the shoe, remains in place, and the shin continues to move forward, resulting in a violent foot eccentricity (rotation of the foot in the ankle around the longitudinal axis of the shin from the outside). Proceeding from the above described mechanisms of development of trauma, various ligamentous components of the ankle joint are damaged. For example, the outer lateral ligaments are damaged during supination and inversion of the foot, while the deltoid and intercellular ligaments may suffer from pronation and eversion.