Practical ultrasound (US) of the forefoot
This article presents 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.
A basic history and local physical examination must be obtained in all patients to focalise the US examination; this approach significantly shortens the examination time.
Localised tenderness while increasing the pressure through the transducer helps in focusing the US examination and permits more in depth assessment of the affected structures.
For routine US examination, the author used a two-position standard examination.
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Position 1 involved examining the patient supine with the knee flexed at 90 degrees and the plant of the foot resting on the bed.
This position allows adequate stabilisation of the foot and ankle flexion resulting in extensor tendons stretching.
The author assessed the dorsal aspect of the forefoot starting the examination at the level of the metatarsals and moving them distally over the metatarsophalangeal (MTP) and interphalangeal joints.
The author identified different extensor tendons starting the examination at the anterior aspect of the ankle and then following them till the distal insertion trough transverse images.
Position 2 involved the patient being examined with the knee extended and the leg resting on the examination bed.
Transverse and sagittal images were obtained over the distal half of the plantar aspect of the foot.
The skin, subcutaneous tissues and plantar fascia were examined followed by the flexor tendons and forefoot joints.
The author also provided a brief description of the normal US anatomy and of US appearance of the most frequent forefoot disorders namely, rheumatoid arthritis, osteoarthritis, overuse arthropathy, Morton’s neuroma, bursitis, mucoid cysts, foreign bodies and bone disorders.
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References:
- Bianchi, S. (2014) Practical US of the forefoot. Journal of Ultrasound: June 2014, Vol. 17, No. 2, pp. 151-164. DOI:10.1007/s40477-014-0078-5
 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.
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