Ultrasound Imaging of Plantar Pathology

DR NIRAJ DUBEY
KHOO TECK PUAT
HOSPITAL
SINGAPORE
•Large variety of lesions with different ways of classification
•Benign/malignant, tumours/infections/inflammations etc,
etc
•Relevant- decreasing scale of occurrence from commonest
to rarest
•Vast majority are benign, tumours whether benign/
malignant very rare
•Commonest patient types are middle aged to elderly ,
usually females who do a lot
•of manual labour
•Young athletic individuals
•Fibromas
•Ganglions, synovial cysts, (epidermoid cysts)
•Plantar fasciitis, cellulitis
•Intermetatarsal bursa, adventitial bursa
•Morton’s neuroma
•Callus, abscess eg diabetic foot
•Foreign body granuloma
•Joint diseases with swelling eg arthritis
•Tenosynovitis
•Lipomas
•Subcutaneous nodules eg gout, rheumatoid
•Stress reactions/callus formation
•Vascular lesions eg haemangiomas, AVMs,
lymphangiomas
•Granuloma annulare
•Tumours such as PVNS, leiomyomas
•Ultrasound features and echogenecity relate to internal
contents
•Most lesions are iso to hypoechoic to adjacent tissues and
are solid
•Cystic lesions have a range of appearances-from anechoic
in a simple ganglion cyst to varying internal echogenecity
depending upon cyst complications such as infection,
hemorrhage-accoustic enhancement
•Infections such as tenosynovitis, cellulitis, abscess as well
as arthritic inflammations will have different levels of
vascularity and are well demonstrated by colour and
power doppler
•Vascular lesions such as AVMs will show flow
•Special procedures will show certain lesion eg Mulder’s
test for Morton’s neuroma and intermetatarsal
bursa/bursitis
•High frequency probe- 7- 15 MHz
•Scan in two planes
•Plantar fascia- scan along the length of fascia
•Tendons and their sheaths are to be scanned in the
longitunal and transverse planes
•Transverse scan for Intermetatarsal bursitis and
Morton’s neuroma
•Look at a foreign body granuloma from all directions
•Ganglions and cysts – adjacent vascular structures
should be defined for the surgeon, also try to
demonstrate the neck of a cyst and it’s relation to
underlying joint/ bone /synovial sheath
•Use doppler liberally and compare opposite side if
needed, always correlate with plain x ray
Ultrasoundpaedia.com
Plantar fasciiitis
Plantar fascia tear
Ultrasoundpaedia.com
Plantar fibromas
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Plantar fibroma
Morton’s neuroma and Intermetatarsal bursitis,
differentials
Mulder’s manoeuvre
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bursitis
Submetatarsal
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Adventitial or frictional
bursa
Ultrasound cases.info Copyright © Dr. T.S.A. Geertsm
Ziekenhuis Gelderse Vallei, Ede, The Netherlands.
Foreign body
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Ganglion cysts
Ganglion cysts
Ultrasound cases.info Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The
Netherlands.
Gouty tophus
Ultrasoundpaedia.com
Inflammatory changes, rheumatoid nodules heel
Ultrasound cases.info Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The
Netherlands.
Plantar lipoma
Ultrasound cases.info Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The
Netherlands.
Rheumatoid nodule
Rheumatoid nodule
Nodular fasciitis
FHL tenosynovitis,
arthritis of joint
Flexor digitorum
tenosynovitis
Ultrasound cases.info Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The
Netherlands.
Epidermoid cyst foot
Pseudotumoural soft tissue lesions of the foot and ankle: a pictorial review
Erik Van Hul,1 Filip Vanhoenacker, 1,2 Pieter Van Dyck,1 Arthur De Schepper,1 and Paul M. Parizel1 Insights
IInsightsnsights Imaging. 2011 August; 2(4): 439–452.
Imaging
2011 Aug
Plantar plate
Ultrasoundpaedia.com
?Nodular lesion left
2 nd MT
GCTTS plantar aspect, third toe, longitudinal and transverse
view
Ultrasound cases.info Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The
Netherlands.
Arterio venous
malformation