Ultrasound of Mid and Hindfoot Pathology
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1 Ultrasound of Mid and Hindfoot Pathology Levon N. Nazarian, M.D. Professor of Radiology Thomas Jefferson University Hospital
2 Disclosures None relevant to this presentation
3 Educational Objective Following the presentation, participant should be able to: Discuss the role of US in imaging the mid and hind foot Identify mid and hind foot pathologies seen on US
4 Posterior Compartment
5 Achilles Tendon Most commonly injured tendon No sheath: surrounded by two echogenic lines (paratenon) Normal AP thickness 5-6 mm
6 Longitudinal Achilles Tendon
7 Achilles Tendon Insertion
8 Transverse Achilles Tendon Direct contact Heaped-up scanning gel
9 Complete Achilles Rupture Weekend warriors Hematoma and fat may occupy torn area Image in plantar flexion to measure retraction
10 Complete Achilles Rupture Sagittal Transverse
11 Complete Achilles Tear: Extended Field of View
12 Complete Achilles Rupture Dorsiflexion Plantar flexion
13 Pitfall: Do not mistake plantaris tendon for intact Achilles fibers
14 Achilles Rupture With Refractive Shadowing
15 Achilles Rupture With Refractive Shadowing
16 Achilles Rupture With Refractive Shadowing
17 Achilles Rupture With Refractive Shadowing
18 Pitfall: Do Not Mistake Thickened Paratenon for Intact Achilles Fibers
19 High Grade Partial Achilles Tear
20 High Grade Partial Achilles Tear
21 High Grade Partial Achilles Tear
22 High Grade Partial Achilles Tear
23 High Grade Partial Achilles Tear
24 Intrasubstance Achilles Tear
25 Chronic Tendinitis (Tendinosis) Thickened, heterogeneous tendon Nodular hypoechoic areas Partial tears Calcification May or may not see flow
26 Insertional Achilles Tendinosis
27 Midsubstance Achilles Tendinosis
28 Achilles Tendinosis Calc
29 Retrocalcaneal Bursitis
30 53 Year Old Man with Foot Pain
31 Aspiration Performed with 18 G Needle Result: Monosodium Urate Crystals Needle tip
32 Fluid in Superficial Achilles Bursa
33 Os Trigonum
34 Posterior Ankle Impingement With Os Trigonum
35 Posterior Ankle Impingement With Os Trigonum
36
37
38 Peroneal Tendons: Axial PL PB
39 Peroneal Tendons: Axial
40 Peroneal Tendons: Axial
41 Peroneal Tendons: Axial
42 Peroneal Tendons: Longitudinal PL PB
43 Peroneal Tenosynovitis
44 Peroneal Tenosynovitis
45 Peroneal Tenosynovitis
46 Peroneal Tenosynovitis
47 Peroneus Brevis Tendinosis
48 Dx: Peroneus Brevis Split PB PL PB Tear
49 Peroneal Retinaculum: Normal
50 Peroneal Retinaculum: Abnormal
51 Normal Peroneal Tendon Motion
52 Peroneal Subluxation Injury to peroneal retinaculum Tendons exit groove anteriorly and laterally Elicited with dorsiflexion and eversion
53 Peroneal Subluxation
54 Peroneal Subluxation
55 Peroneus Brevis Tear, Subluxation
56 Intrasheath Subluxation
57 Peroneal Tendons: Intrasheath Subluxation Type A
58 Peroneal Tendons: Intrasheath Subluxation Type B
59 Distal Peroneus Brevis 5 th MT
60 Lateral Band Plantar Fasciitis
61 Lateral Band Plantar Fasciitis
62 Avulsion Fracture at Base of 5 th Metatarsal
63 Avulsion Fracture at Base of 5 th Metatarsal
64 Lateral Ankle Ligaments
65 Anterior Talofibular Ligament Most commonly injured ankle ligament Spectrum of injury from mild sprain to complete tear May see associated avulsion fracture
66 ATFL
67 Normal ATFL
68 ATFL Sprain
69 Normal Contralateral ATFL
70 Chronic ATFL Sprain Fibula Talus
71 ATFL Sprain
72 Anterolateral Ankle Impingement
73 Anterior Ankle Impingement
74 Anterior Inferior Tibiofibular Ligament
75 Calcaneofibular Ligament From: Sarrafian SK: Anatomy of the Foot and Ankle, 2 nd Ed., JB Lippincott
76 CFL Sprain
77 High Ankle Sprain
78 Plantar Fasciitis Painful condition, common in runners US diagnosis: Thickening (greater than 3-4mm) Heterogeneity Calcification Partial tears
79 Plantar Fascia: Anatomic Dissection
80 C Normal Plantar Fascia
81 Plantar Fasciitis
82 Plantar Fibromatosis 44 year-old woman Longitudinal Transverse
83 Plantar Fibromatosis 44 year-old woman Contralateral side: same abnormality
84 Ankle Joint Effusion
85 Degenerative Arthropathy Talonavicular Joint
86 Rheumatoid Arthritis Talonavicular Joint
87 Rheumatoid Arthritis
88 Gouty Arthritis
89 Gout: Periarticular Erosion
90 Adventitial Bursitis
91 Foot Ganglion
92 Foreign Bodies
93 Foreign Bodies
94 Surgical Hardware in Toe
95 Screw Impales FHL
96 Screw Impales FHL
97 Conclusions US is an effective tool for a wide range of foot and ankle abnormalities First line modality for: Tendons Plantar fasciitis Ligamentous instability/ impingement Ganglion cysts
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