Ultrasound of the Calf, Ankle, and Foot

2019 ◽  
pp. 376-381
Author(s):  
Yoav Morag
Keyword(s):  
Plantar Fasciitis ◽  
Region Of Interest ◽  
Imaging Study ◽  
Posterior Tibial Tendon ◽  
Peroneal Tendon ◽  
Tendon Ruptures ◽  
Morton Neuroma ◽  
Joint Effusions ◽  
Injured Tendon ◽  
Ankle And Foot

Chapter 125 discusses US examination of the calf, ankle, and foot, which is frequently performed to evaluate for muscle, tendon, and ligamentous injuries; joint effusions and synovitis; bursitis; plantar fasciitis; and Morton neuroma. US measurements of Achilles tendon ruptures in different ankle positions may help in guiding treatment selection. Dynamic US evaluation is the imaging study of choice to evaluate for peroneal tendon dislocation and intrasheath subluxation. The posterior tibial tendon (PTT) is the most commonly injured tendon at the medial aspect of the ankle which can be readily evaluated with US. US scanning may be comprehensive or focused to the region of interest.

scholarly journals Subtle cavus foot

2018 ◽  
Vol 12 (2) ◽  
pp. 112-116
Author(s):  
Adilson Sanches de Oliveira Junior ◽  
Alexandre Leme Godoy dos Santos ◽  
Caio Augusto de Souza Nery ◽  
José Felipe Marion Alloza ◽  
Marcelo Pires Prado
Keyword(s):  
Achilles Tendon ◽  
Plantar Fasciitis ◽  
Ankle Instability ◽  
Case Series ◽  
Clear Correlation ◽  
Lateral Side ◽  
Peroneal Tendon ◽  
Medial Side ◽  
Cavus Foot ◽  
Ankle And Foot

Objective: To identify the prevalence of ankle and foot disorders in patients with subtle cavus foot (SCF). Methods: This was a retrospective case series. Patients with lower limb disorders who upon clinical examination were also diagnosed with SCF were evaluated. Patients diagnosed with disorders that could lead to this deformity, such as trauma sequelae and neurological disorders, and those with the presence of cavovarus foot with severe deformity were excluded. Correlations between ankle and foot disorders and the presence of SCF were evaluated. Results: A total of 119 patients (67 males/52 females) were evaluated, totalling 238 feet. One hundred forty-one feet had subtle cavus, and 97 feet had physiological alignment. Of the 141 SCF, 76 feet were right feet, and 65 were left feet. Twenty-two patients had bilateral SCF. One undred forty complaints were identified, which led to 18 diagnoses: ankle instability (37 cases/26.2%), peroneal tendon tendinopathy (31 cases/22.0%), plantar fasciitis (18 cases/12.8%), Achilles tendon tendinopathy (10 cases/7.1%), osteochondral talar lesion (7 cases/5.0%), mechanical metatarsalgia (6 cases/4.3%), hallux sesamoid disorders (5 cases/3.5%), Morton’s neuroma (5 cases/3.5%), hallux valgus (5 cases/3.5%), pain in the lateral side of the foot (4 cases/2.8%), anterior impact (3 cases/2.1%), pain in the medial side of the tibia (2 cases/1.4%), plantar plate injury (2 cases/1.4%) and other disorders with a prevalence <1%. Conclusion: We found a clear correlation between SCF and acute and chronic ankle instability, peroneal and Achilles tendon tendinopathy and plantar fasciitis.  Level of Evidence IV; Therapeutic Studies; Case Series.

The Peroneal Groove Deepening Procedure: A Biomechanical Study of Pressure Reduction

2005 ◽  
Vol 26 (6) ◽  
pp. 442-448 ◽  
Author(s):  
Craig I. Title ◽  
Hung-Geun Jung ◽  
Brent G. Parks ◽  
Lew C. Schon
Keyword(s):  
Biomechanical Study ◽  
Posterior Tibial Tendon ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Calcaneofibular Ligament ◽  
Significant Difference ◽  
Mean Pressure ◽  
Fresh Frozen ◽  
The Mean ◽  
Pressure Changes

Background: The goal of this study was to identify pressure changes throughout the peroneal groove after a groove deepening procedure. We hypothesized that pressures would decrease. Methods: Twelve fresh-frozen foot and ankle specimens were used. A thin pressure strip containing four sensor pads was secured within the peroneal groove with pads 1 through 4 positioned at the calcaneofibular ligament (CFL) and at the distal, middle, and proximal groove, respectively. The midstance phase of gait was simulated with loads applied to the plantar foot and posterior tibial tendon and to the peroneus longus and brevis tendons. Pressures were recorded with the ankle in neutral, plantarflexion, dorsiflexion, inversion, and eversion. Groove deepening was done by osteotomizing the posterior fibular wall. Pressure readings were then recorded. Average pressures for each of the four sensor pads after the procedure were compared to those obtained before the procedure. Results: The mean pressure overlying the CFL increased at all five ankle positions; however, these changes were not significant. Significant decreases in pressure were noted within the distal and middle groove at all ankle positions after the peroneal groove deepening procedure. Pressure within the proximal groove increased at all but one position, with a significant difference noted in neutral and plantarflexion. Conclusion: Pressures within the middle and distal peroneal groove significantly decreased after a groove deepening procedure. Combining this technique with peroneal tendon debridement may be advantageous for treatment of partial peroneal tendon tears or recalcitrant peroneal tendinitis.

scholarly journals 1419. A Rare Case of Clostridium beijerinckii Traumatic Osteomyelitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S517-S517
Author(s):  
Katherine L Doktor ◽  
Kelsey Heffernan ◽  
Danielle Drames ◽  
Dana D Byrne
Keyword(s):  
Foreign Bodies ◽  
Motor Vehicle ◽  
Tendon Sheath ◽  
Tolerance Test ◽  
Clostridium Beijerinckii ◽  
Posterior Tibial Tendon ◽  
Peroneal Tendon ◽  
Gram Positive ◽  
Leg Injuries ◽  
Vehicle Collision

Abstract Background We present a case of Clostridium beijerinckii osteomyelitis in the presence of retained foreign bodies not seen on MRI. Methods A 45-year-old female with type 2 diabetes sustained multiple open right leg injuries, grossly contaminated with gravel, after a motor vehicle collision. She underwent external fixation (ex-fix) and 5 irrigations and debridements (I&D) initially. Polymicrobial intraoperative cultures (Cx) were treated with vancomycin and ertapenem for 6 weeks. One month post-antibiotic completion, pain, and swelling developed in ankle; contrast MRI revealed avascular necrosis and osteomyelitis (OM) of talus. Cx from repeat I&D grew same organisms; meropenem was recommended for 6 weeks. During meropenem week 6, pain was minimal and wound was closed. During attempt to implant hardware, pus was seen around peroneal tendon. Cx grew Clostridium species and Bacteroides from tibia, calcaneus, talus, and peroneal tendon sheath; meropenem was continued. Pain worsened 3 weeks later; I&D revealed pus in lateral ankle. To better access the medial ankle, a longitudinal incision was made along posterior tibial tendon, perpendicular to prior surgical incision. Immediate purulence, grass blades, and rocks were seen. Brucella agar had a rare gray colony at 48 hours and was subbed to blood and Brucella agar; it grew on Brucella agar with aero tolerance test. Gram stain showed Gram-positive rods with subterminal spores. Rapid ANA panel identified isolate as Clostridium beijerinckii (Cb) with > 99.9% probability and bioscore 1/24. Results Cb is a strict anaerobic gram-positive rod with oval subterminal spores. Found in soil and water, its main use is industrial solvent production. Infection by Cb is rare; only 2 cases of OM, 1 traumatic endophthalmitis, and 1 mitral valve endocarditis have been reported. While uncommon, Clostridial osteomyelitis is associated with contaminated open traumatic injuries. It can be difficult to eradicate, despite aggressive surgical intervention and appropriate antibiotics. Conclusion This is the third case of Cb OM described. Anaerobic cultures should be collected during I&D of open traumatic wounds. If infection persists, careful intraoperative evaluation of wound for residual foreign bodies, even if not seen radiologically, should be performed. Disclosures All authors: No reported disclosures.

scholarly journals Platelet Rich Plasma Therapy and Understanding the Risk Factors of Heel Pain Syndrome

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0034
Author(s):  
Astuti Pitarini ◽  
Wilson Tham ◽  
See Kwok Hong ◽  
Abinaya Prabhakaran ◽  
Chee Yu Han
Keyword(s):  
Blood Pressure ◽  
Plantar Fasciitis ◽  
Lifestyle Modification ◽  
Platelet Rich Plasma ◽  
Adult Population ◽  
Pain Syndrome ◽  
Heel Pain ◽  
Posterior Tibial Tendon ◽  
Plasma Therapy ◽  
Increased Risk

Category: Basic Sciences/Biologics, Hindfoot, Sports Introduction/Purpose: Heel pain syndrome is a complex condition causing morbidity and decreases the quality of life in our adult population. It is known that individuals with a body mass index (BMI) of more than >30 kg/m2 have increased risk of plantar fasciitis. However, heel pain consists of larger entities not merely to plantar fasciitis alone. Limited study mentioned the association between hypertension and musculoskeletal pain. Platelet rich plasma (PRP) therapy is an emerging treatment option for its regenerative properties in the treatment of degenerative enthesopathic conditions as in plantar fasciitis and lateral elbow epicondylitis. We hypothesize that obesity (BMI>30 kg/m2) and hypertension do influence the poorer outcome after PRP injection in individuals with heel pain. Methods: We analysed 154 heel pain cases from orthopaedic outpatient clinic that were treated with PRP injection. BMI and BP were taken as preadmission measurements with at least three readings for blood pressure. PRP was harvested from the antecubital vein, and spun in a centrifuge machine. Follow-up was conducted with AOFAS Ankle Hindfoot system before injection, 6 weeks and up to 2 years after injection. Results: Mean age was 49.96 (range 20-81 years old) with 52.60% female and 47.4% male. Plantar fasciitis was the majority source of heel pain (71.43%) followed by achilles tendinopathy (26.62%), posterior tibial tendon disorder (1.3%), and peroneal tendinopathy (0.65%). One hundred and twenty-eight (83.1%) patients achieved resolution of heel pain and related symptoms after injection. Statistical analysis was performed using one sample student t-test. No statistical significant result was found in both overweight (p =0.29) and obesity grade 1 (p = 0.40). Statistical significant result found in the prehypertension group (p<0.04). Conclusion: Based on this preliminary data, we recommend weight loss with trials of lifestyle modification in individuals with obesity, and better control of our patients’ blood pressure in order to achieve comparable outcome with normal BMI population.

Clinical Significance of Magnetic Resonance Imaging in Preoperative Planning for Reconstruction of Posterior Tibial Tendon Ruptures

Foot & Ankle ◽  
1992 ◽  
Vol 13 (4) ◽  
pp. 208-214 ◽  
Author(s):  
Stephen Conti ◽  
James Michelson ◽  
Melvin Jahss
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Success ◽  
Magnetic Resonance Images ◽  
Posterior Tibial Tendon ◽  
Resonance Imaging ◽  
Posterior Tibial ◽  
Surgical Evaluation ◽  
Tendon Ruptures ◽  
Magnetic Resonance Imaging Mri

A retrospective study of attenuated/ruptured posterior tibial tendons was conducted of all patients who underwent tendon reconstruction over a 4-year period. The study comprised 20 feet in 19 patients having an average age of 53.3 years, with an average follow-up of 2 years. Preoperative magnetic resonance images were taken and graded for assignment to one of three magnetic resonance imaging (MRI)-based groups. The surgical grade was determined intraoperatively based on a previously described classification scheme. No medical or rheumatologic conditions predisposing to failure could be identified. Failure was defined as postoperative progression of pain and deformity which required subsequent triple arthrodesis. There were six failures at an average of 14.7 months. Surgical evaluation was not correlated to outcome following reconstruction. MRI grading, however, was predictive of outcome. The superior sensitivity of MRI for detecting intramural degeneration in the posterior tibial tendon that was not obvious at surgery may explain why MRI is better than intraoperative tendon inspection for predicting the outcome of reconstructive surgery. Therefore, it may be helpful to obtain preoperative MRI when this particular reconstruction of the posterior tibial tendon is contemplated, since this provides the best measure of tendon integrity and appears to be the best predictor of clinical success after such surgery.

Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report

2013 ◽  
Vol 3 (1) ◽  
pp. 1-7
Author(s):  
William R Mook ◽  
James A Nunley
Keyword(s):  
Pain Score ◽  
Preliminary Report ◽  
Short Form ◽  
Peroneal Tendon ◽  
Radiographic Findings ◽  
Allograft Reconstruction ◽  
Functional Scores ◽  
Tendon Ruptures ◽  
Tendon Tears ◽  
Peroneus Brevis

ABSTRACT Background Peroneal tendon injuries represent a significant but underappreciated source of lateral ankle pain. Partial thickness tears of the peroneus brevis amenable to direct repair techniques are common. Irreparable tears are uncommon and require more complex surgical decision-making. Intercalary segment allograft reconstruction has been previously described as a treatment option; however, there are no reports of the outcomes of this technique in the literature. We present our results utilizing this technique. Materials and methods A retrospective chart review was conducted to identify all patients who underwent intercalary allograft reconstruction of the peroneus brevis. Mechanism of injury, concomitant operative procedures, pertinent radiographic findings, pre- and postoperative physical examination, intercalary graft length, medical history, visual analog scores (VAS) for pain, short form-12 (SF-12) physical health survey, lower extremity functional scores (LEFS), and complications were reviewed. Results Eight patients with eight peroneus brevis tendon ruptures requiring reconstruction were indentified. Mean follow-up was 15 months (range, 10-31). The average length of the intercalary segment reconstructed was 12 cm ± 3.9 (range, 8-20). The average postoperative VAS decreased to 1.0 ± 1.6 from 4.0 ± 2.2 (p = 0.01). No patient had a higher postoperative pain score than preoperative pain score. Average postoperative eversion strength improved from 3.5 ± 1.2 to 4.81 ± 0.37 (p = 0.03). The average SF-12 survey improved from 41.1 ± 12.3 to 50.2 ± 9.31 (p = 0.06). The average LEFS improved from 53.3 ± 17.0 to 95.25 ± 10.0 (p = 0.02). Four patients experienced sensory numbness in the sural nerve distribution, and two of these were transient. There were no postoperative wound healing complications, infections, tendon reruptures or reoperations. No allograft associated complications were encountered. All patients returned to their preoperative activity levels. Conclusion Allograft reconstruction of the peroneus brevis can improve strength, decrease pain, and yield satisfactory patientreported outcomes. Importantly, this can be successfully performed without incurring the deleterious effects associated with tendon transfer procedures. Our results suggest that allograft reconstruction may be a safe and reasonable alternative in the treatment of irreparable peroneal tendon ruptures. Level of evidence Therapeutic level IV. Mook WR, Nunley JA. Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report. The Duke Orthop J 2013;3(1):1-7. I

Ankle and Foot Injections: Ultrasound

2016 ◽  
Author(s):  
Marko Bodor ◽  
Sean Colio ◽  
Andrew Toy
Keyword(s):  
Plantar Fasciitis ◽  
Tibial Nerve ◽  
Metatarsophalangeal Joint ◽  
Short Axis ◽  
Foot And Ankle ◽  
Great Toe ◽  
Tibiotalar Joint ◽  
Fixation Screw ◽  
Metallic Hardware ◽  
Ankle And Foot

Ultrasonography can be highly useful in diagnosing and treating common musculoskeletal conditions affecting the foot and ankle, ranging from plantar fasciitis to osteoarthritis of the metatarsophalangeal joint of the great toe, as well as uncommon ones such as impingement of a tendon or nerve by fixation screw. One of the greatest advantages of ultrasonography is its high resolution for muscle, tendon, nerve, and bony surfaces and the opportunity to simultaneously identify, image, and evaluate tender structures. It can be used in a clinic setting and in the presence of metallic hardware. The short-axis injection approach is best for superficial, vertically oriented joints such as the cuneiform-metatarsal joints, whereas the long-axis approach is best for relatively deeper structures such as the tibiotalar joint and when it is important that the needle be visualized at all times, such as when performing a tibial nerve block.

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