Abstract:Objectives
In sonography of clinically relevant small structures of the ankle and foot, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intrasubject side‐to‐side variability must be minimal. The aim of this study was to assess the reliability of side‐to‐side sonographic evaluation of small structures of the ankle and foot.
Methods
Thirty healthy volunteers were prospectively studied. Small structures of the ankle and foot were evaluated bilaterally by 2 musculoskelet… Show more
“…Musculoskeletal ultrasound is a valuable diagnostic tool as it allows for high resolution visualization of soft tissue structures with decreased cost, portability, dynamic examination, and comparison to the contralateral side. [36][37][38][39] In a series of 98 foot and ankle patients, sonography changed the diagnosis or treatment in 64% and influenced both diagnosis and treatment in 43%. 39 Of the 7% who underwent surgery, intraoperative and sonographic diagnoses were identical.…”
Isolated disruption of the medial collateral ligament of the great toe is rare and often misdiagnosed as turf toe. It may progress to acquired traumatic hallux valgus, often requiring operative intervention and a longer return to play. This case of a grade II medial collateral ligament injury highlights the importance of a thorough physical examination and consideration of the mechanism of injury. It demonstrates the utility of diagnostic musculoskeletal ultrasound in establishing a specific diagnosis upon initial patient presentation with great toe pain. It is an example of the use of ultrasound in guiding treatment and monitoring interval healing. In this case, differentiation of the injury from the classic “turf toe” led to proper stabilization with a toe spacer and activity modification, thus preventing progression of traumatic hallux valgus and leading to successful nonoperative treatment with full return to sport.Level of EvidenceLevel V
“…Musculoskeletal ultrasound is a valuable diagnostic tool as it allows for high resolution visualization of soft tissue structures with decreased cost, portability, dynamic examination, and comparison to the contralateral side. [36][37][38][39] In a series of 98 foot and ankle patients, sonography changed the diagnosis or treatment in 64% and influenced both diagnosis and treatment in 43%. 39 Of the 7% who underwent surgery, intraoperative and sonographic diagnoses were identical.…”
Isolated disruption of the medial collateral ligament of the great toe is rare and often misdiagnosed as turf toe. It may progress to acquired traumatic hallux valgus, often requiring operative intervention and a longer return to play. This case of a grade II medial collateral ligament injury highlights the importance of a thorough physical examination and consideration of the mechanism of injury. It demonstrates the utility of diagnostic musculoskeletal ultrasound in establishing a specific diagnosis upon initial patient presentation with great toe pain. It is an example of the use of ultrasound in guiding treatment and monitoring interval healing. In this case, differentiation of the injury from the classic “turf toe” led to proper stabilization with a toe spacer and activity modification, thus preventing progression of traumatic hallux valgus and leading to successful nonoperative treatment with full return to sport.Level of EvidenceLevel V
“…Some of the studies recommended intraoperative ultrasound to follow the trajectory of the nerve and distance between the needle and the SN. 6,21,22 With the help of ultrasound, Kammar et al 6 reported that the SN trajectory showed significant variations in adults. They found that the nerve passes 5.8 mm away from the tendon at 8 cm proximal to its insertion, while it passes only 0.8 mm away as it passes at the level of 11th cm.…”
Background: One of the most common treatment options for a short Achilles tendon (AT) in cerebral palsy is percutaneous AT lengthening using 3 hemisections. Because of proximity of neurovascular structures around the tendon, iatrogenic injury to them have been a concern about this technique. The sural nerve (SN) is under risk of injury at the site of the lateral incomplete cut, especially if it is done proximally. The medial neurovascular bundle is under injury risk at medial cuts. The aim of the article was to study the anatomical relations of the SN and medial neurovascular bundle to the AT, and define dangerous levels for injury with the help of magnetic resonance imaging (MRI). Methods: Patients operated for percutaneous Achilles lengthening were called for MRI investigation of the SN and medial neruvascular bundle integrity and their anatomical relation with the AT. The distance of 5 mm was taken as the threshold for increased risk of injury. Measurements were done on MRI at each cm from the insertion of the tendon on both medial and lateral sides, and at the level of the middle cut. Results: Thirty ankles operated and followed at least 1 year were included to the study. On the medial side, the tibial nerve, and the posterior tibial artery lied more than 5 mm away from the tendon at all levels in all patient. On the lateral side, the first 4 cm were relatively safe for the middle lateral cut, while increased risk of SN damage was detected in more proximal levels. Overall, 6 of 30 ankles had radiographically detectable SN injury. Conclusions: The first 4 cm of the AT on the lateral side was detected to be safe for the middle lateral directed cut, while whole tendon length were found to be safe for the first and the third cuts of the percutaneous Achilles lengthening surgery using 3 hemisections in children with cerebral palsy. Level of Evidence: Level III.
“…The US diagnosis of deltoid ligament tears may be challenging, given its anatomical complexity and variability. A recent study emphasized the importance of evaluating the healthy contralateral side as a reference [93].…”
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