발목 및 족부 초음파 스캔(정상 및 증례)

강동경희대학교병원

류마티스내과

송란

Normal Anatomy

of the Ankle and Foot

Ankle : Bone and Ligaments

• Talus, Distal Tibia, Fibula Hinged synovial articulation

• Three principal sets of ligaments

Foot : Bone & Articular structures

Lateral Tendons of Ankle & Foot

Medial Tendons of Ankle & Foot

Post. & Plantar of ankle & Foot

Bursae in ankle & Foot

Normal US Findings

of the Ankle and Foot

Ankle & Foot US Examination Checklist

Anterior Medial Lateral Posterior Calf Forefoot

Ant. Tibiotalarjoint recess

Tibialisposterior

Peroneus longus& brevis

Achilles tendon

SoleusDorsal joint

recesses

Tibialis anteriorFlexor

digitorumlongus

Ant. Talofibularligament(ATaFL)

Post. bursaMedial and

lateral heads of gastrocnemius

Morton neuroma

Extensor hallucis longus

Tibial nerve,artery, vein

Calcaneofibularligament

(CFL)Plantar fascia Plantaris

Dorsal pedisartery

Flexor hallucislongus

Ant. Tibiofibularligament

(ATFL)Achilles tendon

Superficialperoneal nerve

Deltoid ligament

Extensor digitorum

longus

Anterior ankle

Longitudinal view Transverse view

Tibialis

anterior

extensor hallucis longus

extensor hallucis longusextensor digitorum longus

Medial Ankle

Proximal Distal

Lateral Ankle

Lateral ankle: Peroneal tendons, Long axis

Lateral ankle: Anterior Talofibular Ligament

Anterior

Talofibular

ligmentPosterior

TFL

Calcaneofibular

ligament

Lateral ankle: Calcaneofibular Ligament

Anterior

Talofibular

ligmentPosterior

TFL

Calcaneofibular

ligament

Posterior ankle/Heel: Achilles Tendon

Posterior ankle/Heel: Plantar Fascia

Dorsal Long. Scan of 1st MTP joint

Metatarsal Phalanx

Pathologic US Findings

of the Ankle and Foot

Pathologic conditions detectable by US in ankle & Foot

Joints

Effusion

Synovitis

Bone erosions

Osteophytes

Periarticular soft tissues

Tenosynovitis

Tendinitis/tendinosis

Tendon tears

Calcification

Bursitis

Ankle synovitis

• Normal < 3 mm

• RA, Gout, Spondyloarthritis…

• Effusion

– Abnormal hypoechoic or anechoic

– Displaceable & compressible

– Not exhibit Doppler signal

– Ant. Intracapsular fat pad

tends to displace anteriorly

• Synovial hypertrophy

– Abnormal hypoechoic

– Non-displaceable

– Poorly compressible

– Doppler signal

Tibia

Talus

Navicular

Abnormalities of the tibialis post. tendon

• M/C injured tendon on the medial

side of the ankle

• RA, spondyloarthritis

• Pain and swelling • Posterior to the medial malleolus

• Pain worse • Weight bearing with inversion

• Plantar flexion against resistance level

• Fluid within the common tendon

sheath

• Exhibit Doppler signal

Medial

Malleolus

Tenosynovitis of the peroneal tendons

Lateral

Malleolus

Peroneous

tendon

Peroneous

longus

Peroneous

brevis

• Pain and swelling • Posterior to the lateral malleolus

• Pain worse • Active eversion

• Dorsiflexion against resistance

Achilles Tendinopathy/ Enthesopathy

• Achilles tendon diameter• 2 cm proximal to the calcaneus

• Transverse diameter: 14.3 mm

• Sagittal diameter: 4.3 mm

• Absence of true synovial lining• Paratenditis

• Tendinosis

• Secondary to retrocalcaneal bursitis

• Spondyloarthritis

Calcaneous

Calcaneous

Calca

-neous

AT

AT

AT

Retrocalcaneal Bursitis

• Located between calcaneous &

distal achilles tendon

• Normally contain fluid• AP distention up to 2.5 mm

• Bursitis• Tendon tear

• Achilles enthesitis

Calcaneous

*Calcaneous

Plantar Fasciitis

> 4mm, 양측차이 >1mm

6.1mm

5.2mm

Malleolar bursitis

• Repeated micro-trauma

• Gout• RA

Lateral ligamentous injuries

• Secondary to inversion sprains with

internal rotation of the foot

combined with ankle plantar flexion

• Anterior talofibular &

calcaneofibular ligaments

• Sonographic anterior drawer test

LM

talus

Tarsal tunnel syndrome

• Entrapment of the main trunk of

the tibial nerve and/or of its

divisional branches at the medial

aspect of the ankle

• Numbness or pain in the foot and

ankle and paresthesias in the sole

of the foot

• US

Space-occupying lesions• Mass, ganglia, flexor

tenosynovitis, fracture residue

US-guided Tinel’s test

Pathology in MTP joint of Foot

Dactylitis

• Spondyloarthritis• Psoriatic arthritis, Ankylosing spondylitis, Reactive arthritis

• US• Tenosynovitis of flexor tendon

• Diffuse soft tissue edema

• Synovitis in DIP or PIP joints

Clin Exp Rheumatol 207; 25: 349-353

Morton’s neuroma

• Benign neuroma of an inter-metatarsal plantar nerve

• Painful

• m/c site: 2nd and 3rd inter-metatarsal spaces

(between 2nd−3rd & 3rd−4th metatarsal heads)

Mulder

sign

Thank you for your attention