CME OnDemand: Novel Imaging and MIS Techniques in Foot and Ankle Care (2026)-High-resolution Ultrasound of the Foot and Ankle

High-resolution Ultrasound of the Foot and Ankle

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High-resolution ultrasound (US) has become an increasingly important tool for diagnosing and guiding procedures in foot and ankle care. It is particularly useful for soft-tissue assessment and offers several advantages over MRI: lower cost, broad availability, portability, real-time and dynamic examination, easy comparison with the contralateral side, high spatial resolution for superficial structures, and the ability to correlate findings directly with the patient’s point of pain. Because most foot and ankle structures are superficial, high-frequency linear probes (typically 10–15 MHz) are recommended.<br /><br />The article reviews core ultrasound principles (echogenicity patterns of bone, fluid, fat, muscle, tendons, and ligaments) and summarizes main clinical indications: musculotendinous injuries, ligament sprains, peripheral nerve disorders, metatarsalgia, synovitis/joint effusion/loose bodies, plantar fascia pathology, and image-guided interventions (injections and aspirations).<br /><br />For tendons, US can distinguish tendinitis (hypoechogenicity with Doppler hyperemia), tendinosis (thickening with hypoechogenicity, variable Doppler flow), calcific tendinopathy (readily visible calcifications), tenosynovitis (thickened synovial sheath), paratenonitis (e.g., around the Achilles), and partial-to-complete tears including split tears and avulsions. Elastography is highlighted as an emerging adjunct, often showing increased stiffness in abnormal Achilles tendons, though its meaning in asymptomatic tendons remains uncertain.<br /><br />For ligaments, US can support clinical diagnosis by showing thickening, hypoechogenicity, loss of fibrillar pattern, discontinuity in complete tears, and possible bony avulsion fragments.<br /><br />US is also emphasized for peripheral nerve imaging (often superior to MRI for small nerves), identifying compression neuropathies, neuromas, and potential external causes. In metatarsalgia, US can detect bursitis, Morton neuroma, synovitis, plantar plate tears (with sensitivity comparable to MRI), stress fractures (periosteal changes), and radiolucent foreign bodies. Limitations include operator dependence and reduced ability to assess bone/cartilage-associated injuries.

Keywords

high-resolution ultrasound

foot and ankle imaging

musculoskeletal ultrasound

soft-tissue assessment

tendinopathy and tendon tears

ligament sprain evaluation

peripheral nerve ultrasound

Morton neuroma

plantar plate tear

ultrasound-guided injections and aspirations