Ultrasound of the ankle joint
— an informative, safe study of the articulation of the talus, fibula and tibia. It allows you to determine the condition of tendons, ligaments, the joint itself, its fibrous capsule, synovial membrane, plantar fascia, the amount of intra-articular fluid, cartilage (tibia, talus).
The study is used to clearly visualize the structures of the ankle, the stabilizing lateral ligaments, and the tendons that run from the legs to the feet. With its help, pathological processes in the joint and the characteristics of its injury are identified.
The advantage of ultrasound over x-rays is that ultrasound scanning allows you to examine tissues that are not visible during x-rays.
ultrasound of ankle joints
In what cases is an ultrasound scan prescribed?
Pain, an unpleasant nagging pain or limited joint mobility are very alarming signs that can signal various diseases. In order for the doctor to determine further treatment tactics, he needs complete information about the condition of the joints, their structure, size and integrity. For this purpose, it is recommended to undergo ultrasound diagnostics.
As a rule, examination is recommended in the following situations:
- Trauma, blow or damage to the ankle joint;
- Suspicion of degenerative diseases of cartilage tissue (arthritis, arthrosis);
- Severe pain or limitation when moving the joint;
Also, an ultrasound examination of the ankle joint is often prescribed before and after surgery in order to determine the dynamics of treatment.
Ultrasound scanning technique of the ankle
Ultrasound machines equipped with linear 7–15 MHz sensors with color and power Doppler are ideal for scanning the ankle joint. A systematic scanning protocol with a multiplanar and dynamic approach is recommended to evaluate important anatomical structures of the anterior body. A gel pad should be created on the part of the ankle being examined, and the sensor should be placed carefully so as not to create pressure on the structures being examined. Routine practice of comparing the same structures to the contralateral healthy side is recommended.
How the research is carried out
Upon entering the office, the patient needs to take off his shoes, pants and socks and lie down on the couch. A special gel is applied to the skin of the area under study to facilitate contact of the sensor with the tissue. Next, you should be careful and follow all the specialist’s requests. To obtain a complete clinical picture, a change in body position may be required. The doctor examines the condition of the joint in various projections:
- Anterior projection - visualizes the joints of the tibialis muscle, extensor pollicis longus, the muscles of the anterior surface of the leg themselves, as well as the tendons of the extensor digitorum longus.
- Medial location - makes it possible to examine the posterior tibial muscle, deltoid ligament and tibial nerve, diseases of which are often accompanied by discomfort.
- Lateral approach—provides access to the peroneus longus and peroneus brevis tendons and most surrounding tissues.
- Posterior localization - allows you to evaluate the structure and general condition of the Achilles tendon, calcaneus and plantar aponeurosis.
On average, the examination is completed in 15-20 minutes, after which the patient is given a research protocol and referred to a doctor for deciphering and prescribing therapy if abnormalities are found during the ultrasound examination.
Where to go?
In the ultrasound diagnostic department at ENEL-CLINIC you can scan large and small joints, internal organs, lymph nodes, veins and arteries. The department is equipped with modern equipment that allows obtaining clear, informative images of any area under study.
It is convenient to get to ENEL-CLINIC from Nagornaya metro station, by your own transport - along Sevastopolsky or Nakhimovsky Avenue. The address and telephone number for making an appointment are listed in the “Contacts” section.
What can be detected on an ultrasound examination of the ankle joint?
- Joint rupture. Usually, when the integrity of the ankle joint is damaged, it is difficult for the patient to move his leg - the movement is accompanied by severe pain. The ligament and adjacent tissues become thicker, and motor activity is impaired. Fatty tissue has echogenicity within normal limits, and against this background the affected areas are clearly visible.
- With a partial rupture of the ligament, you can see an area with impaired echogenicity, usually reduced - in this case we are talking about internal hemorrhage and swelling of the tissue.
- When a tendon ruptures, a hypoechoic area (an area of reduced echogenicity) is visible. You may notice the presence of an abnormally large amount of fluid. There is a significant disturbance in the course of the fibers and their intermittency. Effusion accumulates in the synovial area.
- With tendonitis, there is an accumulation of effusion, but without disruption of the structure of the tendon itself, the tendon itself has no structural changes. Most often in such situations, a diagnosis of tenosynovitis is made.
- With rheumatism, an ultrasound examination clearly shows a change in size, the contours become blurry, and the joints narrow significantly.
- Hygromas are often detected during ultrasound examination: they are limited in length, the edges are rounded, and the contours are unclear.
- After joint surgery, ligatures with impaired echogenicity are noted during diagnosis. The transition from the acute stage of the pathological process to the chronic one has some features: the structure of the tendon is heterogeneous, sometimes granular.
Remember that early contact with a specialist significantly increases the chance of full recovery without the risk of relapse. When serious diagnoses are made, the patient may be referred for repeated diagnostic procedures, for example, CT or MRI.
Ultrasound characteristics of normal anatomical structures
- Bone surface - hyperechoic and regular with posterior acoustic shadowing
- Joints - Hypoechoic space between the bony surface and the capsule
- Tendons and ligaments - fibrillar pattern on longitudinal scans and dotted patterns on transverse scans
- Bursa - usually visualized as fluid distension and has a hyperechoic wall with hypoechoic fluid inside
- Plantar fascia - hyperechoic fibrillary band
- Vessels are hypoechoic with a positive Doppler signal
- Nerves have a fascicular pattern.
When should you make 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 foot and lower leg area. 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 examination and palpation. Usually the condition of the ankle and foot joints is assessed at one time, but in some cases it is necessary to examine only one part. This division is especially relevant after surgery, completion of a course of conservative therapy or physiotherapeutic treatment.
The most common pathologies of the foot and lower leg area, which become reasons for visiting an ultrasound diagnostic room, are:
- bursitis;
- synovitis;
- tendinitis;
- osteochondrosis;
- arthrosis;
- rheumatism;
- arthritis;
Also, specialists refer patients for an ultrasound examination of the foot and lower leg after traumatic injury to these areas, to clarify the presence or severity of damage to muscles, ligaments and tendons.
This is about:
- dislocation;
- subluxation;
- ligament rupture;
- muscle strains;
- tendon damage.
Using 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 not possible to cope with the problem with the help of conservative treatment, you need to immediately seek advice from a specialist if you discover:
- joint pain;
- crunch;
- suspicious clicks;
- restrictions on physical activity;
- swelling;
- suspected neoplasms.
In general, the reason for seeking qualified help should be any phenomena uncharacteristic of the ankle and lower leg. Such precautions will help start treatment at the initial stage 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 establish a point for joint puncture in order to evacuate exudate, increases the effectiveness of further treatment by an order of magnitude.
Regular ultrasound examinations during treatment allow timely adjustment of the therapy to achieve the best result.
The inflammatory process affecting the joints, even in the early phase, causes intense pain, accompanied by limitation of movements. 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, characterized by structural disorders of the cartilage tissue of the foot or ankle.
The classic manifestation of a heel spur is the inability to fully rest on the heel. At first, the unpleasant symptom is observed only with prolonged stress on the heel area, for example, during prolonged walking. Then the 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 intensifies without any significant reason, this prompts 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 lump in the interdigital area of the foot. Clinically, this confirms the pain syndrome upon 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 tissue from the joint area.
The second point corresponds to the classic joint puncture.
The essence of the method
Ultrasound examination of the ankle and foot is performed with a high-frequency linear sensor 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 conducts an ultrasound scan of the joints and ligaments of the foot, the plantar aponeurosis. When scanning tendons, their size, structure, contours, transition into muscle tissue and sliding during dynamic observation are assessed. Ultrasound scanning during active movements of the ankle joint allows visualization of tendon movements. Additionally, intra-articular bodies and cysts of the ankle joint can be identified.
Ultrasound navigation has recently increasingly accompanied puncture of the ankle joint. Ultrasound control allows you to minimize the risk of injury to nerves, blood vessels, as well as muscle and other tissues during the procedure. Puncture of the ankle joint is actually a type of surgical intervention during which the skin, subcutaneous tissue and joint capsule are punctured. Ultrasound 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, estimate the volume of intra-articular fluid, and provide control over the introduction of the drug into the joint cavity. Thanks to ultrasound guidance, the doctor conducting the procedure selects the safest point to insert the needle into the joint cavity. Under ultrasound control, the specialist removes blood, pus and other pathological liquids from the joint, and, if necessary, then injects medicine into the joint cavity.