Comprehensive Sonographic Protocol for Assessment of Ankle Inversion Injuries

Abstract

Ankle inversion injuries are very common and well suited to ultrasound evaluation of soft tissue and bony injury. The breadth of information which may be obtained by the ultrasound assessment is broad and has led us to question the need for a dedicated protocol. A review of ultrasound , plain x-ray and MRI findings in patients suffering ankle inversion stress was performed to establish the scope of potential injury. The standard commonly performed ultrasound examination is inadequate and expansion to a more comprehensive protocol results in higher yield from the ultrasound examination. “Ultrasound is an excellent modality for soft tissue and bony assessment in patients who have suffered ankle inversion stress injury. This paper outlines a comprehensive protocol for thorough investigation of these injuries. It goes beyond the standard investigation of lateral ligaments to include: •Anterior ankle joint •Subtalar joint •Anterior talofibular ligament •Calcaneofibular ligament •Anterior inferior tibio-fibular syndesmosis •Dorsal talo-navicular ligament •Peroneal tendons •Superior peroneal retinaculum •Base of 5th metatarsal •Calcaneo-cuboid ligament (Bifurcate) •Extensor digitorum brevis muscle and origin enthesis •Fibula extensor retinaculum avulsion injury •Tibio-talar deltoid ligament (POMI Lesion) •Flexor retinaculum / deltoid ligament conjoint attachment to medial malleolus. A variety of commonly encountered patterns of injury will be discussed involving injury to these easily examined structures.”