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Musculoskeletal ultrasound of the ankle and hindfoot

Mederic M Hall, MD
Sathish Rajasekaran, MD
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


The structures of the ankle and hindfoot are superficial and ideally suited for sonographic evaluation. In the authors' experience, ultrasound is the imaging modality of choice when evaluating the ankle tendons, ligaments, and peripheral nerves. The dynamic nature of the sonographic examination allows for detection of instability of both tendon and ligament, which may not be apparent on static imaging. In addition, ultrasound can display the small peripheral nerves of the ankle and foot that are prone to entrapment and insult from trauma and surgery.

This topic will describe a systematic approach to complete fundamental sonographic evaluation of each ankle quadrant as well as limited structures of the plantar hindfoot. The conditions that cause ankle and foot pain are reviewed separately. (See "Ankle sprain" and "Overview of ankle fractures in adults" and "Non-Achilles ankle tendinopathy" and "Achilles tendinopathy and tendon rupture" and "Calf injuries not involving the Achilles tendon" and "Evaluation and diagnosis of common causes of foot pain in adults".)


The physical principles and technology of ultrasound are reviewed elsewhere (see "Basic principles and safety of diagnostic ultrasound in obstetrics and gynecology"). A discussion of the general advantages and limitations of musculoskeletal ultrasound is also provided separately. (See "Musculoskeletal ultrasound of the shoulder".)

In brief, ultrasound offers many advantages for imaging the ankle and foot. Its superior spatial resolution (ie, greater ability to differentiate between objects) allows for detailed evaluation of tendon, ligament and nerve disorders that may not be apparent on other imaging modalities. Complaints of instability can be rapidly assessed in real time with dynamic ultrasound examination, and the location of pain can be correlated with precise anatomic structures by palpation with the ultrasound transducer (ie, sonopalpation). Another advantage of ultrasound is the lack of artifact associated with orthopedic hardware, which enables the clinician to examine structures surrounding the hardware for impingement or signs of inflammation.

Although many structures of the foot and ankle are easily accessible for sonographic evaluation, intraarticular structures are not. This is an inherent limitation of ultrasound technology, and other imaging modalities may be required for complete evaluation of a joint.

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Literature review current through: Nov 2017. | This topic last updated: Aug 16, 2017.
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