PURPOSE: We studied the diagnostic value of ultrasonography to confirm the presence of the syndesmosis injuries in the ankle. MATERIALS AND METHODS: Pre-operative ultrasonography were taken in 42 cases of ankle fractures to determine injury of syndesmosis between February 2000 and August 2003. Tear of syndesmosis was confirmed when they met the following criteria; widening of distal tibiofibular clear space greater than 7 mm on pre-operative AP X-rays, leakage of contrast dye during intra-operative arthrography, and operative findings revealing syndesmosis rupture. We compared these diagnoses with those made by pre-operative ultrasonography. RESULTS: Syndesmosis injuries were confirmed in 23 cases among the total 42 cases. Ultrasonography revealed syndesmosis tear in 25 cases, with 20 cases corresponding with confirmed tear and 5 cases without tear in confirm. Syndesmoses were found to be intact in 17 cases of ultrasonograph, but 3 cases were actually confirmed tear. In ankle ultrasonography, the sensitivity was 90.9%, the specificity was 75.0%. CONCLUSION: Preoperative ultrasonography is a non-invasive and useful study to determine the syndesmosis injury in ankle fractures.
Ankle Fractures ; Ankle Joint* ; Ankle* ; Arthrography ; Diagnosis ; Rupture ; Sensitivity and Specificity ; Ultrasonography*

Ankle disorders are a relatively common pathological condition, and ankle injuries account for approximately 14% of sports-related orthopedic emergency visits. Various imaging modalities can be used to make a diagnosis in cases of ankle pain; however, ultrasound (US) has several benefits for the evaluation of ankle pain, especially in the tendons, ligaments, and nerves of the ankle. The purpose of this article is to review the common causes of ankle pathology, with particular reference to US features. In addition, the importance of a dynamic evaluation and a stress test with US is emphasized.
Ankle Injuries ; Ankle Joint* ; Ankle* ; Diagnosis ; Emergencies ; Exercise Test ; Ligaments ; Orthopedics ; Pathology ; Tendons ; Ultrasonography*

PURPOSE: The purpose of this study was to present a technique for measuring physiologic distal tibiofibular syndesmosis widening using 3-dimensional ultrasonography (3D-US) with an evaluation of its reliability, and to determine whether there were differences in the measurements between different dynamic stress tests. METHODS: We retrospectively evaluated 3D-US of 20 subjects with normal ankle syndesmosis. 3D-US was performed in neutral (N), dorsiflexion with external rotation (DFER), and weight-bearing standing (WB) positions at the anterior inferior tibiofibular ligament level in both ankles for comparison. Using 3D-US volume data, axial images were reconstructed at the level of the lateral prominence of the anterior tibial tubercle to ensure consistent measurements of the tibiofibular clear space (TFCS) by two radiologists. RESULTS: There was a wide range of TFCS values among the subjects (N, 1.2 to 4.2 mm; DFER, 2.3 to 4.8 mm; WB, 1.7 to 4.6 mm). When both ankles of each subject were evaluated, the side-to-side differences were less than 1 mm in all positions, with high intraclass correlation coefficient (ICC) values between both ankles (ICC, 0.85 to 0.93). The inter-rater agreement for all TFCS measurements between the two radiologists was excellent (ICC, 0.81 to 0.96). In comparisons between the two dynamic stress tests, the TFCS was significantly wider in the DFER position than in the WB position (DFER vs. WB, 3.3 mm vs. 2.9 mm; P<0.001). CONCLUSION: Using 3D-US, we were able to consistently evaluate the TFCS with good reliability. In a comparison of the two dynamic tests, there was more significant widening of the TFCS in the DFER position than in the WB position.
Ankle Joint ; Ankle ; Diagnosis ; Exercise Test ; Lateral Ligament, Ankle ; Retrospective Studies ; Ultrasonography ; Weight-Bearing

The superficial peroneal nerve is vulnerable to damage from ankle sprain injuries and fractures as well as surgery to this region. And it is also one of the most commonly involved nerves in complex regional pain syndrome type II in the foot and ankle region. We report two cases of ultrasound-guided pulsed radiofrequency treatment of superficial peroneal nerve for reduction of allodynia in CRPS patients.
Ankle ; Ankle Injuries ; Causalgia ; Foot ; Humans ; Hyperalgesia* ; Neuralgia ; Peripheral Nerves ; Peroneal Nerve* ; Pulsed Radiofrequency Treatment* ; Ultrasonography

Sports injuries of the foot and ankle are commonly encountered in clinical practice. Ultrasound is very useful for the diagnosis of such injuries, because it is more economical, readily accessible, and can perform a dynamic study compared to magnetic resonance imaging. This review focused on the sonographic features of common foot and ankle sports injuries.
Ankle ; Athletic Injuries ; Diagnosis ; Foot ; Magnetic Resonance Imaging ; Sports ; Ultrasonography

OBJECTIVES: This study compared foot arch height, plantar fascia thickness, a range of motion assessments of the ankle joint, strength of the ankle joint, plantar pressure, and balance between obese and normal weight young adults. METHODS: Fifty-two participants were required for the present study design to achieve 80% power, 0.8 effect size (η2), and an alpha level of 0.05. The participants were categorized to normal weight or obese groups based on BMI (≤ 24 kg/m2 and ≥ 25 kg/m2, respectively). The foot and ankle disability index and Sport survey were completed by the participants before the measurements. Foot arch height was measured using the navicular drop test, and plantar fascia thickness was measured using ultrasound. Plantar pressure and balance tests were also conducted, followed by ankle joint range of motion and strength tests. RESULTS: Foot arch height and plantar fascia thickness was significantly higher in the obese group compared with the normal weight group (p < 0.01). There were significant differences in eversion of ankle strength, plantar pressure in the big toe and heel and anterior-posterior balance between normal and obese weight groups (p < 0.05). CONCLUSION: Obese young adults had more abnormalities in the medial longitudinal arch, plantar fascia, and plantar pressure as well as weakened ankle eversion strength and balance problems compared with the normal weight group.
Ankle ; Ankle Joint ; Body Mass Index ; Fascia ; Foot ; Hallux ; Heel ; Humans ; Obesity ; Range of Motion, Articular ; Sports ; Ultrasonography ; Young Adult

PURPOSE: To compare the efficacy and availability of foot pump and active ankle exercise for preventing deep vein thrombosis after total knee arthroplasty with hemodynamic evaluation using a color doppler duplex ultrasonography. MATERIALS AND METHODS: Thirty-six patients who underwent total knee arthroplasty between Oct. 2005 and Apr. 2006 were enrolled in this study. Retrospective analysis of 36 patients(Group 1 - foot pump after TKA, 18; Group 2-passive ankle exercise, 18) was conducted and all patients underwent color doppler duplex ultrasonography preoperatively and postoperative 7 to 14 days at femoral, popliteal and calf vein and the hemodynamic status was assessed. RESULTS: The mean baseline velocity was decreased postoperatively in both group, at all veins, but the mean peak velocity was increased only in Group. In Group 1, mean flow ratio was increased, but in Group 2, mean flow ratio was decreased except femoral vein. There were significant differences between Group 1 and Group 2(p<0.05). CONCLUSION: This study demonstrated that foot pump may be more effective than active ankle exercise in preventing postoperative deep vein thrombosis due to more increased venous flow rate and foot pump may be more compliable than active ankle exercise due to less painful, more convenient, so foot pump can be one of the available method for preventing DVT after total knee arthroplasty.
Ankle ; Arthroplasty* ; Femoral Vein ; Foot* ; Hemodynamics ; Humans ; Knee* ; Retrospective Studies ; Ultrasonography, Doppler, Color ; Ultrasonography, Doppler, Duplex ; Veins ; Venous Thrombosis*

Four patients with soft tissue defects around the ankle joint were covered with peroneal artery perforator-based propeller flaps. Using color Doppler sonography, the flap was designed by considering the location of the perforator and soft tissue defects. The procedure was then performed by rotating the flap by 180o. Additional skin graft was required in a patient due to partial necrosis, and delayed wound repair was performed in another patient with poor blood circulation at the distal part of the flap. The remaining patients did not have any complications and results were considered excellent. Good outcomes were eventually obtained for all patients.
Ankle Joint* ; Arteries* ; Blood Circulation ; Humans ; Necrosis ; Skin ; Transplants ; Ultrasonography, Doppler, Color ; Wounds and Injuries

The purpose of this study was to investigate the ultrasonographic features of flexor hallucis longus (FHL) tenosynovitis in sports players. High-resoluted ultrasound was used to measure the thickness and echogenicity of the flexor hallucis longus at the posteromedial ankle, especially the fibro-osseous tunnel, for 60 sports players (120 feet). They were compared with their asymptomatic feet. There were two group; group 1 was symptomatic feet, 2 was asymptomatic. The 36 males (72 feet) and 24 females (48 feet) had an average age of 21.3 years (range, 18.23 years). Thickness, echogenicity of the tendon on each group were evaluated by the ultrasonography and the results were statistically analyzed. The mean thickness of the FHL on group 1 was 3.4+/-1.2 mm, 2.1+/-1.3 mm on group 2. There was significant difference between two groups (p=0.002). The thickness of FHL based on gender and location was not significant different (p>0.05). For group 1, increased thickness of the FHL and reduced echogenicity, peritendious fluid collection were observed in ultrasonographic findings.Increased thickness (>3 mm) and hypoechoic lesion, peritendinous fluid collection of the tendon were sonographic findings at the posteromedial ankle in the FHL tenosynovitis. The authors suggested that Ultrasonography is a valuable and alternative tool for the evaluation of FHL tenosynovitis.
Ankle ; Athletes ; Female ; Foot ; Foot Diseases ; Humans ; Male ; Sports* ; Tendons ; Tenosynovitis* ; Ultrasonography

PURPOSE: We wanted to determine the incidence and characteristics of failing graft after implantation of autologous reversed vein grafts. METHOD: From Sep. 2003 to Dec. 2005, 84 leg bypasses using autologous reversed vein grafts were performed for chronic leg ischemia in 75 patients. After the operations, duplex ultrasonography (DUS) and measurement of the ankle brachial index (ABI) were performed every 3 months for the purpose of examining the graft patency. The criteria for a failing graft was a peak systolic velocity (PSV) of the stenotic lesion >300 cm/s, or a PSV distal to the occlusive lesion <40 cm/s, but with sustained patency of the vein graft. We investigated the timing of detection, the site of the causative lesion, and the clinical symptoms of the failing grafts. For the treatment of failing grafts, surgeries (vein patch, graft extension, or inflow artery reconstruction) were performed in 4 legs. The Kaplan Meier method was used for calculating the rate of graft patency. RESULT: Nine failing grafts were detected by DUS in 8 patients. The sites of causative lesions were the inflow artery (2), the proximal anastomosis (6), and the distal anastomosis (1). Seven of the 9 patients with failing grafts were asymptomatic, 1 patient had claudication and another patient suffered from resting pain of the involved leg. The assisted graft primary patency rates at 1 and 2 years after operations were 86% and 53%, respectively. CONCLUSION: Nine cases of failing grafts were detected during surveillance with duplex ultrasonography after implantation of autologous reversed vein grafts.
Ankle Brachial Index ; Arteries ; Diagnosis* ; Humans ; Incidence ; Ischemia ; Leg ; Lower Extremity* ; Transplants* ; Ultrasonography ; Veins