1
|
Bordalo M, Felippe de Paula Correa M, Yamashiro E. High-resolution Ultrasound of the Foot and Ankle. Clin Podiatr Med Surg 2024; 41:853-864. [PMID: 39237188 DOI: 10.1016/j.cpm.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
High-resolution ultrasound (US) can be used to assess soft tissue abnormalities in the foot and ankle. Compared to MRI, it has lower cost, is widely available, allows portability and dynamic assessment. US is an excellent method to evaluate foot and ankle tendon injuries, ligament tears, plantar fascia, peripheral nerves, and the different causes of metatarsalgia.
Collapse
Affiliation(s)
- Marcelo Bordalo
- Radiology Department, Aspetar Orthopedic and Sports Medicine Hospital, Al Waab Street, Zone 54, PO Box 29222, Doha, Qatar.
| | | | - Eduardo Yamashiro
- Radiology Department, Aspetar Orthopedic and Sports Medicine Hospital, Al Waab Street, Zone 54, PO Box 29222, Doha, Qatar
| |
Collapse
|
2
|
Bordalo M, Felippe de Paula Correa M, Yamashiro E. High-resolution Ultrasound of the Foot and Ankle. Foot Ankle Clin 2023; 28:697-708. [PMID: 37536826 DOI: 10.1016/j.fcl.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
High-resolution ultrasound (US) can be used to assess soft tissue abnormalities in the foot and ankle. Compared to MRI, it has lower cost, is widely available, allows portability and dynamic assessment. US is an excellent method to evaluate foot and ankle tendon injuries, ligament tears, plantar fascia, peripheral nerves, and the different causes of metatarsalgia.
Collapse
Affiliation(s)
- Marcelo Bordalo
- Radiology Department, Aspetar Orthopedic and Sports Medicine Hospital, Al Waab Street, Zone 54, PO Box 29222, Doha, Qatar.
| | | | - Eduardo Yamashiro
- Radiology Department, Aspetar Orthopedic and Sports Medicine Hospital, Al Waab Street, Zone 54, PO Box 29222, Doha, Qatar
| |
Collapse
|
3
|
Abstract
The lesser metatarsophalangeal joint plantar plate and calcaneonavicular (spring) ligament are highly specialized soft tissue structures within the foot, consisting partly of fibrocartilage and capable of withstanding high compressive and tensile loads. Preoperative advanced imaging, in the form of point-of-care ultrasound and MRI, has become indispensable for surgeons hoping to confirm, quantify, and better localize injuries to these structures before surgery. This article describes the technical considerations of ultrasound and MRI and provides examples of the normal and abnormal appearances of these structures. The pros and cons of each imaging modality are also discussed.
Collapse
Affiliation(s)
- Adam E Fleischer
- Weil Foot & Ankle Institute, 3000 N, Halsted Suite 700, Chicago, IL 60657, USA; Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA.
| | - Rachel H Albright
- Stamford Health Medical Group, 800 Boston Post Road, Suite 302, Darien, CT 06820, USA
| |
Collapse
|
4
|
Diagnostic Accuracy of Magnetic Resonance Imaging (MRI) Versus Dynamic Ultrasound for Plantar Plate Injuries: A Systematic Review and Meta-Analysis. Eur J Radiol 2022; 152:110315. [DOI: 10.1016/j.ejrad.2022.110315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/14/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022]
|
5
|
Viyasar T, Manning C, Cooke R, Zubairy AI, Khan SH. Imaging in metatarsalgia. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 34601938 DOI: 10.12968/hmed.2021.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Metatarsalgia is a common clinical conundrum that requires careful assessment. There are a variety of causes and understanding these can help manage the pain. These causes have different imaging characteristics and require specific imaging. By understanding core imaging principles and how they apply to causes of metatarsalgia, pathology can be more efficiently investigated. This article covers primary, secondary and iatrogenic causes of metatarsalgia with the most appropriate imaging modalities for each and the salient imaging findings. This article reviews the common forefoot pathologies and how they may be optimally radiologically investigated, with an emphasis on the key imaging findings.
Collapse
Affiliation(s)
- Thevarajah Viyasar
- Department of Radiology, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Christopher Manning
- Department of Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Robert Cooke
- Department of Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Aamir I Zubairy
- Department of Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Shah Hm Khan
- Department of Radiology, East Lancashire Hospitals NHS Trust, Blackburn, UK
| |
Collapse
|
6
|
Ultrasound findings of plantar plate tears of the lesser metatarsophalangeal joints. Skeletal Radiol 2021; 50:1513-1525. [PMID: 33423073 DOI: 10.1007/s00256-020-03708-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023]
Abstract
Lesser metatarsophalangeal (MTP) joint plantar plate tears are a common and increasingly recognised cause of metatarsalgia, MTP joint instability and forefoot deformity. Increased interest in early accurate diagnosis of plantar plate tears follows recent surgical innovations allowing direct plantar plate repair. The purpose of this review is to describe the ultrasound features of normal lesser MTP joint plantar plates and to characterise and illustrate the direct and indirect ultrasound findings of plantar plate tears. Lesser MTP joint plantar plate tears are most commonly located at the 2nd MTP joint, involving the lateral distal plantar plate insertion with variable propagation medially and proximally. The most common ultrasound appearance of a plantar plate tear is a discrete partial or full thickness hypoechoic defect in the plate substance. Flattening and attenuation or non-visualisation of the plantar plate represent more extensive tears. Dynamic imaging with toe dorsiflexion improves visualisation of tears and augments MTP joint subluxation. A common indirect finding is pericapsular fibrosis along the MTP joint capsule adjacent to a plantar plate tear, which requires differentiation from Morton's neuroma, and key distinguishing features at ultrasound are described. Other indirect findings include the cartilage interface sign, flexor tendon subluxation onto the metatarsal head or medial to the midline, flexor tenosynovitis, proximal phalangeal enthesophytes or avulsion and MTP joint synovitis. Ultrasound offers several advantages over MR imaging but requires a meticulous ultrasound examination, and optimisation of scanning technique is described.
Collapse
|
7
|
Central Metatarsalgia and Walking on Pebbles: Beyond Morton Neuroma. AJR Am J Roentgenol 2018; 210:821-833. [DOI: 10.2214/ajr.17.18460] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
8
|
Second and Third Metatarsophalangeal Plantar Plate Tears: Diagnostic Performance of Direct and Indirect MRI Features Using Surgical Findings as the Reference Standard. AJR Am J Roentgenol 2017; 209:W100-W108. [DOI: 10.2214/ajr.16.17276] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
9
|
Donegan RJ, Stauffer A, Heaslet M, Poliskie M. Comparing Magnetic Resonance Imaging and High-Resolution Dynamic Ultrasonography for Diagnosis of Plantar Plate Pathology: A Case Series. J Foot Ankle Surg 2017; 56:371-374. [PMID: 28231969 DOI: 10.1053/j.jfas.2016.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Indexed: 02/03/2023]
Abstract
Plantar plate pathology has gained noticeable attention in recent years as an etiology of lesser metatarsophalangeal joint pain. The heightened clinical awareness has led to the need for more effective diagnostic imaging accuracy. Numerous reports have established the accuracy of both magnetic resonance imaging and ultrasonography for the diagnosis of plantar plate pathology. However, no conclusions have been made regarding which is the superior imaging modality. The present study reports a case series directly comparing high-resolution dynamic ultrasonography and magnetic resonance imaging. A multicenter retrospective comparison of magnetic resonance imaging versus high-resolution dynamic ultrasonography to evaluate plantar plate pathology with surgical confirmation was conducted. The sensitivity, specificity, and positive and negative predictive values for magnetic resonance imaging were 60%, 100%, 100%, and 33%, respectively. The overall diagnostic accuracy compared with the intraoperative findings was 66%. The sensitivity, specificity, and positive and negative predictive values for high-resolution dynamic ultrasound imaging were 100%, 100%, 100%, and 100%, respectively. The overall diagnostic accuracy compared with the intraoperative findings was 100%. The p value using Fisher's exact test for magnetic resonance imaging and high-resolution dynamic ultrasonography was p = .45, a difference that was not statistically significant. High-resolution dynamic ultrasonography had greater accuracy than magnetic resonance imaging in diagnosing lesser metatarsophalangeal joint plantar plate pathology, although the difference was not statistically significant. The present case series suggests that high-resolution dynamic ultrasonography can be considered an equally accurate imaging modality for plantar plate pathology at a potential cost savings compared with magnetic resonance imaging. Therefore, high-resolution dynamic ultrasonography warrants further investigation in a prospective study.
Collapse
Affiliation(s)
- Ryan J Donegan
- Fellow, Specialty Surgical Center of Irvine Sports Medicine Fellowship, Irvine, CA.
| | - Anthony Stauffer
- Staff Radiologist, West Coast Radiology Santa Ana, Santa Ana, CA
| | | | | |
Collapse
|
10
|
Duan X, Li L, Wei DQ, Liu M, Yu X, Xu Z, Long Y, Xiang Z. Role of magnetic resonance imaging versus ultrasound for detection of plantar plate tear. J Orthop Surg Res 2017; 12:14. [PMID: 28109309 PMCID: PMC5251279 DOI: 10.1186/s13018-016-0507-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/22/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Plantar plate tears could be the reason of forefoot pain, affecting foot function. Magnetic resonance imaging (MRI) and ultrasound (US) were commonly used for the diagnosis of plantar plate tears. The decision of whether to use MRI or US carried some controversy. Our study aimed to find out the diagnostic accuracy of MRI versus US for plantar plate tears. METHODS The database of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and relative orthopedic meetings until May 2016 were searched. Studies involved in the diagnostic detection of MRI or ultrasound for plantar plate tears with surgical criteria as the reference test were included. Data was analyzed by meta-analysis. We compared sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary receiver operating characteristic (sROC) plot of both MRI and US. RESULTS Seven studies involving 246 plantar plate tears were included. The MRI showed more diagnostic accuracy than US for the detection of plantar plate tears. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of MRI were 95%, 54%, 2.08, and 0.08, respectively, while the same values for US were 93%, 33%, 1.20, and 0.35, respectively. And the sROC showed more superior diagnostic accuracy than the US. CONCLUSION The current result suggests that MRI has better accuracy than US for detection of plantar plate tears.
Collapse
Affiliation(s)
- Xin Duan
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China
| | - Lang Li
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China
| | - Dai-Qing Wei
- Department of Bone and Joint Surgery, Affiliated Hospital of Westsouth Medical University, #25 Taiping Steeet, Luzhou, Sichuan Province, China
| | - Ming Liu
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China
| | - Xi Yu
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China
| | - Zhao Xu
- Anesthesia Department, West China Hospital, Sichuan University, # 37 Guoxuexiang Street, Chengdu, Sichuan province, China
| | - Ye Long
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China
| | - Zhou Xiang
- Orthopedics Department, West China Hospital, Sichuan University, #37 Guoxuexiang Street, Chengdu, 610017, Sichuan Province, China.
| |
Collapse
|
11
|
Henderson REA, Walker BF, Young KJ. The accuracy of diagnostic ultrasound imaging for musculoskeletal soft tissue pathology of the extremities: a comprehensive review of the literature. Chiropr Man Therap 2015; 23:31. [PMID: 26543553 PMCID: PMC4634582 DOI: 10.1186/s12998-015-0076-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 10/16/2015] [Indexed: 12/17/2022] Open
Abstract
Musculoskeletal diagnostic ultrasound imaging (MSK-DUSI) has been growing outside the traditional radiology speciality. Increased use of this technology has been reported in several healthcare settings, however an apparent gap in the knowledge of the accuracy of this diagnostic technology indicated a review was warranted. We undertook a structured review of the literature to assess the accuracy of MSK-DUSI for the diagnosis of musculoskeletal soft tissue pathology of the extremities. An electronic search of the National Library of Medicine’s PubMed database (1972 to mid-2014) was conducted. All relevant systematic reviews of diagnostic studies, all diagnostic studies published after the date of the latest systematic reviews and relevant diagnostic studies outside the scope the systematic reviews that directly compared the accuracy of MSK-DUSI (the index test) to an appropriate reference standard for the target condition were included. A fundamental appraisal of the methodological quality of studies was completed. The individual sensitivity, specificity and likelihood ratio data were extracted and entered into diagnostic accuracy tables. A total of 207 individual studies were included. The results show that MSK-DUSI has acceptable diagnostic accuracy for a wide spectrum of musculoskeletal conditions of the extremities. However, there is a lack of high quality prospective experimental studies in this area and as such clinicians should interpret the results with some caution due to the potential for overestimation of diagnostic accuracy.
Collapse
Affiliation(s)
- Rogan E A Henderson
- Private Practice of Chiropractic, Spearwood, WA Australia ; 253 Winterfold Road, Coolbellup, 6163 WA Australia
| | - Bruce F Walker
- Associate Professor, Discipline of Chiropractic, School of Health Professions, Murdoch University, Murdoch, WA Australia
| | - Kenneth J Young
- Senior Lecturer, Discipline of Chiropractic, School of Health Professions, Murdoch University, Murdoch, WA Australia
| |
Collapse
|
12
|
Abstract
Disorders affecting the forefoot are common in the clinical practice. Accurate history and physical examination are the mainstays of diagnosis but imaging modalities are frequently obtained to confirm the clinical suspicion and plan appropriate treatment. In this article we will present the ultrasound (US) technique of examination of the forefoot followed by a brief description of the normal US anatomy and of US appearance of the most frequent forefoot disorders; rheumatoid arthritis, osteoarthritis, overuse arthropathy, Morton neuromas, bursitis, mucoid cysts, foreign bodies, bone disorders.
Collapse
Affiliation(s)
- Stefano Bianchi
- CIM SA, Cabinet d'Imagerie Médical, route de Malagnou 40A, 1208 Geneva, Switzerland
| |
Collapse
|