Musculoskeletal Ultrasound in Common Foot and Ankle Pathologies

Review Article

Austin J Orthopade & Rheumatol. 2015;2(2): 1017.

Musculoskeletal Ultrasound in Common Foot and Ankle Pathologies

Badon M1, Brown C2, Talusan PG3, Reach JS2 and Kohler MJ4*

1Department of Orthopedic Surgery, University of Massachusetts Memorial Medical Center, USA

2Department of Orthopedic Surgery, Yale University School of Medicine, USA

3Department of Orthopedic Surgery, University of Michigan, USA

4Department of Medicine, Division of Rheumatology,Allergy, Immunology, Harvard Medical School, USA

*Corresponding author: Minna J Kohler, Department of Medicine: Division of Rheumatology, Allergy,Immunology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St. Yawkey 2C, Boston MA 02114, USA

Received: April 06, 2015; Accepted: July 09, 2015; Published: July 11, 2015


Background: Musculoskeletal ultrasound has been performed since the early 1970s, but a perceived high level of “operator dependence” limited its expansion into orthopaedic surgery. Recent advancements in hardware and image processing have given rise to lightweight portable machines capable of detailed examination of superficial bony and soft-tissue structures. This portability, coupled with other ultrasound advantages such as allowing dynamic, real-time, and functional evaluations without radiation exposure has stimulated interest in the use of ultrasound by orthopaedic surgeons.

Methods: This review examines the use of musculoskeletal ultrasound in the foot and ankle by the orthopaedic surgeon in the areas of tendon pathology, heel pain, inflammatory conditions, nerve pathology, fractures, sprains, and ultrasound-guided interventions.

Results: Musculoskeletal ultrasound has numerous advantages over standard imaging techniques in the diagnosis and treatment of musculoskeletal pathology. Musculoskeletal ultrasound fails, however, to adequately image deep pathologies in obese patients and joints hidden by bones.

Conclusion: Musculoskeletal ultrasound has many applications and it is necessary to continue the research of this imaging technology in other orthopaedic fields.

Keywords: Musculoskeletal ultrasound; Tendinopathy; Sprain; Plantar Fasciitis; Foot


Musculoskeletal ultrasound (MUS) is an imaging technology that uses high-frequency sound waves to reconstruct an image. The transducer and image processor analyze sound waves reflected off of tissue interfaces. This produces a bright echo that determines relative location of structures as well as tissue size, shape, and consistency [1].

In the past decade, major advancements in the production and analysis of sonographic signals have resulted in improved resolution, less artifact, three and four-dimensional imaging, and extended fieldof- view reconstructions. Color and power Doppler ultrasound (US) are useful when examining synovium, vascular structures, effusions, and tumors [2].

A disadvantage of MUS is that it is operator dependent [3]. Like any other skill in orthopaedic surgery, with appropriate training and an orthopaedic surgeon’s deep understanding of musculoskeletal anatomy, physiology, and function, the learning curve may be lessened in this subspecialty group [4].

The ability to perform dynamic ultrasound imaging in the clinic, at the bedside, and in the operative theater (Figure 1) allows novel opportunities for the orthopaedic surgeon to enhance patient care in a cost-effective way [4]. MUS use has expanded rapidly among other musculoskeletal providers such as sports medicine, rheumatology, and physical medicine and rehabilitation. It is hoped that this review stimulates interest and research by orthopaedic surgeons in the use of this complementary imaging modality in the other orthopaedic subspecialties.