Around the ankle joint there are numerous structures that can be visualized during the ultrasound examination.
Usually the examination is focused on one or two of compartments (anterior,
posterior,
lateral ,
medial) based on clinical question/symptoms.
Fig. 3: 4 compartments of the ankle. Structures visible in Ultrasound imaging.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Knowledge of exact location of linear structures like tendons,
vessels and nerves on the transverse plain is crucial in effective ultrasound examination of the ankle.
Fig. 1: Tendons of the ankle joint. Axial MRI scan.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
LATERAL COMPARTMENT
Fig. 2: Lateral ankle ligaments.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Anterior talofibular ligament
Fig. 4: Anterior talofibular ligament. Position of the probe. Internal deviation of the foot helps in obtaining better ultrasound image.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Fig. 18: Anterior talofibular ligament. The most frequently injured ligament of the ankle.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Anterior tibiofibular ligament
Fig. 5: Anterior tibiofibular ligament.
Position of the probe.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Fig. 19: Anterior tibiofibular ligament.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Calcaneofibular ligament
Fig. 6: Calcaneofibular ligament. The probe position. Tendon is best seen in dorsiflexion of the foot.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Fig. 24: Calcaneofibular ligament. Please note, that peroneal tendons are superficial to the ligament.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Peroneal tendons
Short-axis view
Fig. 7: Peroneal tendons . Short-axis view on the level of the lateral malleolus.
Note the place of the distal insertion of the peroneus brevis tendon on proximal head of the 5th metacarpal. This area should be evaluater in lateral ankle pain.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Fig. 22: Peroneus longus and peroneus brevis tendons on the level of lateral maleolus. short axis scan.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Long-axis view
Fig. 8: Peroneal tendons. Probe position. Long-axis view on the level of lateral malleolus.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Fig. 20: Peroneus longus and peroneus brevis tendons. Long-axis scan.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
ANTERIOR COMPARTMENT
Abterior ankle tendons:
Fig. 9: Anterior Ankle Tendons. Probe position.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Fig. 16: Anterior ankle tendons - transverse view
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Tibialis anterior longitudinal view + the distal insertion on 1st cuneiform bone.
Fig. 10: Probe positioning in evaluation of distal part of Tibialis anterior tendon and its insertion on medial cuneiform bone.
References: Cyprian Olchowy Daniel Soliński Wroclaw Medical University. Poland. (2016)
Fig. 15: Distal tibialis tendon and its insertion.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Anterior tibio-talar recess
Fig. 11: Anterior tibio-talar recess - the probe position.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Fig. 17: Anterior tibio-talar recess.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
POSTERIOR COMPARTMENT
Flexor hallucis longus tendon
Fig. 13: Flexor hallucis longus probe positioning. Please note, that foot and tirst toe are in dorsiflexion what enables good tendon elongation.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Fig. 21: Flexor hallucis longus tendon.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Achilles tendon/ retrocalcaneal bursa / Kager's Triangle
Fig. 12: Achilles tendon. Longitudinal view.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)
Fig. 23: Achilles tendon. Long-axis scan.
References: Daniel Soliński, Cyprian Olchowy Wroclaw Medical University. Poland. (2016)