Ultrasound of the Musculoskeletal SystemAuthors: Bianchi, Stefano, Martinoli, Carlo
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With the patient seated or supine, the examination of the anterior aspect of the ankle is best conducted with the knee flexed 45° so that the plantar surface of the foot lies flat on the examination table. The main anatomic structures in the anterior ankle that are amenable to US examination are the tibialis anterior and extensor tendons, the anterior tibial artery and deep peroneal nerve, and the anterior synovial recess of the ankle joint. The tibialis anterior tendon appears to be approximately twice as large as the other extensor tendons. It can be evaluated on both long-axis and short-axis scanning planes from its myotendinous junction down to its bony insertion (Fig. 13). The extensor hallucis longus tendon is examined in a similar fashion (Fig. 13a).
Fig. 13 a,b. Normal tibialis anterior and extensor hallucis longus tendons. a Transverse 12−5 MHz US image reveals the cross-sectional appearance of the tibialis anterior (open arrows) and the extensor hallucis longus (white arrow) tendons. Both are overlain by thin anisotropic bands (arrowheads) relative to the retinacula. Deep to the tendons, note the anterior surface of the talar dome covered by a thin rim of hypoechoic articular cartilage (rhombi). b Longitudinal 12−5 MHz US scan over the ankle joint shows the tibialis anterior tendon (arrows) in its long axis. The internal architecture of this tendon is clearly depicted, reflecting an echogenic fibrillar pattern. Rhombi, talar articular cartilage. The photographs at the upper left of the figures indicate probe positioning.