title: [Technique and value of arthrosonography in rheumatologic diagnosis--3: Ultrasound diagnosis of the ankle joint, foot and toes].
abstract: The clinical investigation of ankles, feet, and toes is frequently equivocal in rheumatology. Sonography can distinguish between underlying pathologies. We suggest following standard scans: 1) anterior longitudinal scan to diagnose effusions in the ankle and talonavicular joints, to display erosive and osteoarthrotic pathologies, and to diagnose tenosynovitis of the extensor tendons; 2) anterior transverse scan to document the findings in an additional dimension; 3) lateral transverse scan and 4) lateral longitudinal scan to diagnose tenosynovitis of the peroneus tendons; 5) medial transverse scan and 6) medial longitudinal scan to diagnose tenosynovitis of the flexor tendons; 7) posterior longitudinal scan and 8) posterior transverse scan to evaluate the Achilles tendon, the retrocalcaneal bursa, and the posterior recess of the ankle joint. Additionally we suggest optional scans: 9) plantar longitudinal scan for the plantar fascia and the plantar calcaneal surface; 10) distal anterior longitudinal scan to evaluate the midtalar joints; 11) distal anterior longitudinal scan to evaluate the toes; and 12) plantar, distal transverse scan to evaluate the flexor tendons of the toes. Additionally, the correlating longitudinal and transverse scans can be used to confirm the findings. The frequency of the transducer should be about 7.5 MHz for ankles and the peroneus, flexor, and extensor tendons. Ten to over 20 MHz are possible for more superficially located structures. Using modern equipment with higher resolution a hypoechoic border may be normal up to 3 mm in the ankle joints, the MTP joints, and around the peroneus tendons, and up to 4 mm around the tibialis posterior tendons.
authors.affiliation: Rheumaklinik Berlin-Buch Karower Strasse 11, 13125 Berlin, Germany. schmidt.wa@t-online.de
authors.forename: W A
authors.initials: WA
authors.lastname: Schmidt
authors.forename: R W
authors.initials: RW
authors.lastname: Hauer
authors.forename: D
authors.initials: D
authors.lastname: Banzer
authors.forename: M
authors.initials: M
authors.lastname: Bohl-Bühler
authors.forename: J
authors.initials: J
authors.lastname: Braun
authors.forename: H
authors.initials: H
authors.lastname: Mellerowicz
authors.forename: H
authors.initials: H
authors.lastname: Sattler
authors.forename: M
authors.initials: M
authors.lastname: Backhaus
mesh_terms: D000843:Ankle Joint / Q000000981:diagnostic imaging*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D036981:Fasciitis, Plantar / Q000000981:diagnostic imaging; D005534:Foot Diseases / Q000000981:diagnostic imaging*; D033023:Foot Joints / Q000000981:diagnostic imaging*; D006801:Humans; D011111:Polymyalgia Rheumatica / Q000000981:diagnostic imaging*; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity; D013717:Tenosynovitis / Q000000981:diagnostic imaging; D014033:Toe Joint / Q000000981:diagnostic imaging*; D014159:Transducers; D014463:Ultrasonography